Delirium Research Paper

Introduction: Delirium is a clinical syndrome characterized by an acute impairment of cognitive and perceptual function, and also an alteration in consciousness and attention. The onset of delirium is sudden, often within a few hours or days, and confusion tends to fluctuate during the course of the day. Moreover to confirm a diagnosis of delirium, there should be evidence that this disturbance is caused by the direct physiopathological consequence of a general medical condition.[1] They are different types of delirium: the hyperactive form, characterized by agitation and aggressiveness, the hypoactive delirium, with reduced psychomotor activity and lethargy symptoms, and the mixed form with alternating episodes of hyperactive and hypoactive

Some see it as an unavoidable condition during a hospital stay for elderly, others as a temporary and reversible condition without any serious long-term effect. However, statistics are very effective in showing that delirium has a strong impact in both patients functioning and health care costs. A 841 non-intensive care patients study showed a 62% increase in premature death in the year following a delirium compared to patient without delirium.[4] In terms of costs attributable to delirium, including inpatient costs but also outpatient, nursing home, home health, rehabilitation and other costs, a study ranged it from 16 303 to 64 421$ per patient per year.[5] Treatment mainly relies on prevention and reduction of the precipitating factors, by both supportive therapies and pharmacological management. It is best to identify patients at risk so that preventive measures can be taken, and nursing staffs play a decisive role. Concomitant antipsychotic medication should only be used in older persons with delirium who are in significant distress due to agitation or psychotic

Indeed drug trials concerning delirium have difficulties evaluating the drug efficacy because of the fluctuating course of the delirium and the simultaneous treatment of underlying risk factors. Haloperidol has been considered as the drug of choice, by allowing both oral and parenteral administration, and having a lower incidence of adverse effects than others typical antipsychotics[6] if used at the lowest dose and for the shortest length possible. However the use of antipsychotic drugs typical and atypical remains controversial as it increases the risk of stroke and death in elderly patients with dementia and can potentially prolong the QT interval.[8] Atypical antipsychotics may be considered as alternative agents as they have lower rates of extrapyramidal side effects. In older people with delirium who also have Parkinson’s disease or Lewis body dementia, they are preferred over typical