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0 Delirium, an acute decline in attention and cognition,
is a common, life threatening, and potentially
preventable clinical syndrome among persons who
are 65 years of age or older.
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EPIDEMIOLOGY
0 In direct contrast to dementia, which is a chronic
confusional state, delirium is an acute confusional
state. Rates of delirium are highest among
hospitalized older patients, and the rates vary
depending on the patients characteristics, setting of
care, and sensitivity of the detection method. The
prevalence of delirium at hospital admission ranges
from 14 to 24 percent, and the incidence of deliriumarising during hospitalization ranges from 6 to 56
percent among general hospital populations
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DIAGNOSIS
It is a clinical diagnosis
Core feature is its impact on cognitive
function Assess all elderly people on admission
mmse may not be appropriate or
possibleUse the 4 question confusion
screening assessment.
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4 Question Screening
Assessment0Acute onset or fluctuating
course
0Inattention
0Easily distracted
0Disorganised thinking0Altered level of consciousness
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CLINICAL
CHARACTERISTICS
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Hyperactive Delirium
0Heightened arousal
0Verbally and physicallythreatening and aggressive
0Restlessness0Wandering
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Hypoactive Delirium
0 Clinical clues much less obvious
0 Apathy
0
Sleepy0 Polite
0 Not interested in eating or drinking
0 Occasional incoherent speech
0
Does not always understand what is said to him
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ETIOLOGIC AND RISK
FACTORS0 The cause of delirium is typically multifactorial.
0 In fact, the development of delirium involves the
complex interrelationship between a vulnerablepatient (one with predisposing factors) and exposure
to precipitating factors or noxious insults
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PATHOGENESIS
0 The pathophysiology of delirium remains poorly
understood.
0
Electroencephalographic studies have demonstrateddiffuse slowing of cortical background activity, which
does not correlate with underlying causes.
0 The leading hypotheses for the pathogenesis of
delirium focus on the roles of neurotransmission,
inflammation, and chronic stress.
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DEMENTIA VS DELIRIUM
0Dementia has an insidious onset, chronicmemory and executive function disturbance,
tends not to fluctuate. In delirium cognitivechanges develop acutely and fluctuate.
0Dementia has intact alertness and attentionbut impoverished speech and thinking. In
delirium speech can be confused ordisorganized. Alertness and attention wax andwane.
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PREVENTION AND
MANAGEMENT
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SUMMARY
0 Delirium is a common presentation of acute illness in
older people
0
The presence of delirium is associated with adverseoutcome
0 Characterised by recent onset fluctuating inattention
and drowsiness linked to triggering factors
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