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Delirium and acute confusional states: Prevention, treatment, and prognosis

Author
Joseph Francis, Jr, MD, MPH
Section Editors
Michael J Aminoff, MD, DSc
Kenneth E Schmader, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Delirium is an acute confusional state characterized by an alteration of consciousness with reduced ability to focus, sustain, or shift attention. This results in a cognitive or perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia. Delirium develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day. Delirium is typically caused by a medical condition, substance intoxication, or medication side effect.

Delirium is considered by some to be a specific type of confusional state that is characterized by increased vigilance along with psychomotor and autonomic overactivity and manifested as agitation, tremulousness, and hallucinations. In this discussion, however, the term delirium will be used synonymously with acute confusional state and will include states characterized by somnolence and decreased arousal, so-called hypoactive delirium. (See "Diagnosis of delirium and confusional states", section on 'Definition and terminology'.)

The management of delirium is based primarily upon expert consensus and observational studies, and only a small number of controlled clinical trials, which are difficult to perform in patients with cognitive impairment. The preponderance of evidence is most compelling for primary prevention of delirium using non-pharmacologic, multicomponent approaches targeted broadly at high risk patients [1,2].  Prevention and therapy of delirium are based on the following principles:

Avoiding factors known to cause or aggravate delirium, such as multiple medications, dehydration, immobilization, sensory impairment, and sleep disturbance

Identifying and treating the underlying acute illness

                    

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Literature review current through: Nov 2016. | This topic last updated: Wed Aug 13 00:00:00 GMT 2014.
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