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  • Review Article
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Delirium in elderly adults: diagnosis, prevention and treatment

Abstract

Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and global cognitive dysfunction. The etiologies of delirium are diverse and multifactorial and often reflect the pathophysiological consequences of an acute medical illness, medical complication or drug intoxication. Delirium can have a widely variable presentation, and is often missed and underdiagnosed as a result. At present, the diagnosis of delirium is clinically based and depends on the presence or absence of certain features. Management strategies for delirium are focused on prevention and symptom management. This article reviews current clinical practice in delirium in elderly individuals, including the diagnosis, treatment, outcomes and economic impact of this syndrome. Areas of future research are also discussed.

Key Points

  • Delirium is a frequent cause and a serious complication of hospitalization and has important implications from both a functional and an economic standpoint

  • Delirium is potentially preventable and treatable, but major barriers, including underrecognition of the syndrome and poor understanding of the underlying pathophysiology, have hampered the development of successful therapies

  • Neuroimaging has identified structural changes, including cortical atrophy, ventricular dilatation and white matter lesions, to be predictors of delirium

  • Current evidence suggests that disruption of neurotransmission, inflammation or acute stress responses might contribute markedly to the development of delirium

  • Delirium is not always transient and reversible, and it can result in long-term cognitive changes

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Figure 1: Relationships between various etiological factors in delirium.
Figure 2: Outcomes of delirium.

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Jo Ellen Wilson, Matthew F. Mart, … E. Wesley Ely

References

  1. Chadwick, J. & Mann, M. N. The Medical Works of Hippocrates (Blackwell, Oxford, 1950).

    Google Scholar 

  2. Morandi, A. et al. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med. 34, 1907–1915 (2008).

    Article  CAS  PubMed  Google Scholar 

  3. Inouye, S. K. Predisposing and precipitating factors for delirium in hospitalized older patients. Dement. Geriatr. Cogn. Disord. 10, 393–400 (1999).

    Article  CAS  PubMed  Google Scholar 

  4. Inouye, S. K. Delirium in hospitalized older patients: recognition and risk factors. J. Geriatr. Psychiatry Neurol. 11, 118–125 (1998).

    Article  CAS  PubMed  Google Scholar 

  5. US Department of Health and Human Services. CMS statistics (publication no. 03445, Centers for Medicare and Medicaid Services, Washington, DC, 2004).

  6. Inouye, S. K. Delirium in hospitalized older patients. Clin. Geriatr. Med. 14, 745–764 (1998).

    Article  CAS  PubMed  Google Scholar 

  7. Siddiqi, N., House, A. O. & Holmes, J. D. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 35, 350–364 (2006).

    Article  PubMed  Google Scholar 

  8. Bruce, A. J., Ritchie, C. W., Blizard, R., Lai, R. & Raven, P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int. Psychogeriatr. 19, 197–214 (2007).

    Article  PubMed  Google Scholar 

  9. Girard, T. D. & Ely, E. W. Delirium in the critically ill patient. Handb. Clin. Neurol. 90, 39–56 (2008).

    Article  PubMed  Google Scholar 

  10. Inouye, S. K. Delirium in older persons. N. Engl. J. Med. 354, 1157–1165 (2006).

    Article  CAS  PubMed  Google Scholar 

  11. Pisani, M. A., McNicoll, L. & Inouye, S. K. Cognitive impairment in the intensive care unit. Clin. Chest Med. 24, 727–737 (2003).

    Article  PubMed  Google Scholar 

  12. Fong, T. G. et al. Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT. J. Gerontol. A Biol. Sci. Med. Sci. 61, 1294–1299 (2006).

    Article  PubMed  Google Scholar 

  13. Yokota, H., Ogawa, S., Kurokawa, A. & Yamamoto, Y. Regional cerebral blood flow in delirium patients. Psychiatry Clin. Neurosci. 57, 337–339 (2003).

    Article  PubMed  Google Scholar 

  14. Hshieh, T. T., Fong, T. G., Marcantonio, E. R. & Inouye, S. K. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J. Gerontol. A Biol. Sci. Med. Sci. 63, 764–772 (2008).

    Article  PubMed  Google Scholar 

  15. Eikelenboom, P. & Hoogendijk, W. J. Do delirium and Alzheimer's dementia share specific pathogenetic mechanisms? Dement. Geriatr. Cogn. Disord. 10, 319–324 (1999).

    Article  CAS  PubMed  Google Scholar 

  16. Han, L. et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch. Intern. Med. 161, 1099–1105 (2001).

    Article  CAS  PubMed  Google Scholar 

  17. Blitt, C. D. & Petty, W. C. Reversal of lorazepam delirium by physostigmine. Anesth. Analg. 54, 607–608 (1975).

    CAS  PubMed  Google Scholar 

  18. Mendelson, G. Pheniramine aminosalicylate overdosage. Reversal of delirium and choreiform movements with tacrine treatment. Arch. Neurol. 34, 313 (1977).

    Article  CAS  PubMed  Google Scholar 

  19. Schuster, P., Gabriel, E., Kufferle, B., Strobl, G. & Karobath, M. Reversal by physostigmine of clozapine-induced delirium. Clin. Toxicol. 10, 437–441 (1977).

    Article  CAS  PubMed  Google Scholar 

  20. Flacker, J. M. et al. The association of serum anticholinergic activity with delirium in elderly medical patients. Am. J. Geriatr. Psychiatry 6, 31–41 (1998).

    Article  CAS  PubMed  Google Scholar 

  21. Mach, J. R. et al. Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study. J. Am. Geriatr. Soc. 43, 491–495 (1995).

    Article  PubMed  Google Scholar 

  22. Mussi, C., Ferrari, R., Ascari, S. & Salvioli, G. Importance of serum anticholinergic activity in the assessment of elderly patients with delirium. J. Geriatr. Psychiatry Neurol. 12, 82–86 (1999).

    Article  CAS  PubMed  Google Scholar 

  23. Flacker, J. M. & Lipsitz, L. A. Serum anticholinergic activity changes with acute illness in elderly medical patients. J. Gerontol. A Biol. Sci. Med. Sci. 54, M12–M16 (1999).

    Article  CAS  PubMed  Google Scholar 

  24. Thomas, C. et al. Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium. BMC Neurosci. 9, 86 (2008).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Trzepacz, P. T. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin. Clin. Neuropsychiatry 5, 132–148 (2000).

    CAS  PubMed  Google Scholar 

  26. Young, B. K., Camicioli, R. & Ganzini, L. Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment. Drugs Aging 10, 367–383 (1997).

    Article  CAS  PubMed  Google Scholar 

  27. Gaudreau, J. D. & Gagnon, P. Psychotogenic drugs and delirium pathogenesis: the central role of the thalamus. Med. Hypotheses 64, 471–475 (2005).

    Article  CAS  PubMed  Google Scholar 

  28. Rudolph, J. L. et al. Chemokines are associated with delirium after cardiac surgery. J. Gerontol. A Biol. Sci. Med. Sci. 63, 184–189 (2008).

    Article  PubMed  Google Scholar 

  29. Maclullich, A. M., Ferguson, K. J., Miller, T., de Rooij, S. E. & Cunningham, C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J. Psychosom. Res. 65, 229–238 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Dilger, R. N. & Johnson, R. W. Aging, microglial cell priming, and the discordant central inflammatory response to signals from the peripheral immune system. J. Leukoc. Biol. 84, 932–939 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Dunn, A. J. Effects of cytokines and infections on brain neurochemistry. Clin. Neurosci. Res. 6, 52–68 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Eikelenboom, P., Hoogendijk, W. J., Jonker, C. & van Tilburg, W. Immunological mechanisms and the spectrum of psychiatric syndromes in Alzheimer's disease. J. Psychiatr. Res. 36, 269–280 (2002).

    Article  CAS  PubMed  Google Scholar 

  33. de Rooij, S. E., van Munster, B. C., Korevaar, J. C. & Levi, M. Cytokines and acute phase response in delirium. J. Psychosom. Res. 62, 521–525 (2007).

    Article  PubMed  Google Scholar 

  34. Cunningham, C. et al. Systemic inflammation induces acute behavioral and cognitive changes and accelerates neurodegenerative disease. Biol. Psychiatry 65, 304–312 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. van Munster, B. C. et al. Time-course of cytokines during delirium in elderly patients with hip fractures. J. Am. Geriatr. Soc. 56, 1704–1709 (2008).

    Article  PubMed  Google Scholar 

  36. Trzepacz, P. T. & van der Mast, R. The Neuropathophysiology of Delirium (Oxford University Press, Oxford, 2002).

    Google Scholar 

  37. Kudoh, A., Takase, H., Katagai, H. & Takazawa, T. Postoperative interleukin-6 and cortisol concentrations in elderly patients with postoperative confusion. Neuroimmunomodulation 12, 60–66 (2005).

    Article  CAS  PubMed  Google Scholar 

  38. McIntosh, T. K. et al. Beta-endorphin, cortisol and postoperative delirium: a preliminary report. Psychoneuroendocrinology 10, 303–313 (1985).

    Article  CAS  PubMed  Google Scholar 

  39. Robertsson, B. et al. Hyperactivity in the hypothalamic-pituitary-adrenal axis in demented patients with delirium. Int. Clin. Psychopharmacol. 16, 39–47 (2001).

    Article  CAS  PubMed  Google Scholar 

  40. O'Keeffe, S. T. & Devlin, J. G. Delirium and the dexamethasone suppression test in the elderly. Neuropsychobiology 30, 153–156 (1994).

    Article  CAS  PubMed  Google Scholar 

  41. McKeith, I. G. Clinical use of the DST in a psychogeriatric population. Br. J. Psychiatry 145, 389–393 (1984).

    Article  CAS  PubMed  Google Scholar 

  42. Soiza, R. L. et al. Neuroimaging studies of delirium: a systematic review. J. Psychosom. Res. 65, 239–248 (2008).

    Article  PubMed  Google Scholar 

  43. Burns, A., Gallagley, A. & Byrne, J. Delirium. J. Neurol. Neurosurg. Psychiatry 75, 362–367 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Kishi, Y., Iwasaki, Y., Takezawa, K., Kurosawa, H. & Endo, S. Delirium in critical care unit patients admitted through an emergency room. Gen. Hosp. Psychiatry 17, 371–379 (1995).

    Article  CAS  PubMed  Google Scholar 

  45. Jalan, R. et al. Oral amino acid load mimicking hemoglobin results in reduced regional cerebral perfusion and deterioration in memory tests in patients with cirrhosis of the liver. Metab. Brain Dis. 18, 37–49 (2003).

    Article  CAS  PubMed  Google Scholar 

  46. Strauss, G. I. et al. Regional cerebral blood flow during mechanical hyperventilation in patients with fulminant hepatic failure. Hepatology 30, 1368–1373 (1999).

    Article  CAS  PubMed  Google Scholar 

  47. Yazgan, Y. et al. Value of regional cerebral blood flow in the evaluation of chronic liver disease and subclinical hepatic encephalopathy. J. Gastroenterol. Hepatol. 18, 1162–1167 (2003).

    Article  PubMed  Google Scholar 

  48. Alsop, D. C. et al. The role of neuroimaging in elucidating delirium pathophysiology. J. Gerontol. A Biol. Sci. Med. Sci. 61, 1287–1293 (2006).

    Article  PubMed  Google Scholar 

  49. Lipowski, Z. J. Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am. J. Psychiatry 140, 1426–1436 (1983).

    Article  CAS  PubMed  Google Scholar 

  50. McCusker, J., Cole, M., Abrahamowicz, M., Primeau, F. & Belzile, E. Delirium predicts 12-month mortality. Arch. Intern. Med. 162, 457–463 (2002).

    Article  PubMed  Google Scholar 

  51. Hufschmidt, A. & Shabarin, V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta Neurol. Scand. 118, 245–250 (2008).

    Article  CAS  PubMed  Google Scholar 

  52. Inouye, S. K. et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann. Intern. Med. 113, 941–948 (1990).

    Article  CAS  PubMed  Google Scholar 

  53. Wei, L. A., Fearing, M. A., Sternberg, E. J. & Inouye, S. K. The Confusion Assessment Method: a systematic review of current usage. J. Am. Geriatr. Soc. 56, 823–830 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  54. Breitbart, W. et al. The Memorial Delirium Assessment Scale. J. Pain Symptom Manage. 13, 128–137 (1997).

    Article  CAS  PubMed  Google Scholar 

  55. The Hospital Elder Life Program (HELP) http://www.hospitalelderlifeprogram.org.

  56. Inouye, S. K. et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N. Engl. J. Med. 340, 669–676 (1999).

    Article  CAS  PubMed  Google Scholar 

  57. Marcantonio, E. R., Flacker, J. M., Wright, R. J. & Resnick, N. M. Reducing delirium after hip fracture: a randomized trial. J. Am. Geriatr. Soc. 49, 516–522 (2001).

    Article  CAS  PubMed  Google Scholar 

  58. Caplan, G. A., Coconis, J., Board, N., Sayers, A. & Woods, J. Does home treatment affect delirium? A randomised controlled trial of rehabilitation of elderly and care at home or usual treatment (The REACH-OUT trial). Age Ageing 35, 53–60 (2006).

    Article  PubMed  Google Scholar 

  59. Kaneko, T. et al. Prophylactic consecutive administration of haloperidol can reduce the occurrence of postoperative delirium in gastrointestinal surgery. Yonago Acta. Med. 42, 179–184 (1999).

    CAS  Google Scholar 

  60. Kalisvaart, K. J. et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J. Am. Geriatr. Soc. 53, 1658–1666 (2005).

    Article  PubMed  Google Scholar 

  61. Liptzin, B., Laki, A., Garb, J. L., Fingeroth, R. & Krushell, R. Donepezil in the prevention and treatment of post-surgical delirium. Am. J. Geriatr. Psychiatry 13, 1100–1106 (2005).

    Article  PubMed  Google Scholar 

  62. Sampson, E. L. et al. A randomized, double-blind, placebo-controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement. Int. J. Geriatr. Psychiatry 22, 343–349 (2007).

    Article  PubMed  Google Scholar 

  63. Noyan, M. A., Elbi, H. & Aksu, H. Donepezil for anticholinergic drug intoxication: a case report. Prog. Neuropsychopharmacol. Biol. Psychiatry 27, 885–887 (2003).

    Article  PubMed  Google Scholar 

  64. Slatkin, N. & Rhiner, M. Treatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report. J. Pain Symptom Manage. 27, 268–273 (2004).

    Article  PubMed  Google Scholar 

  65. Wengel, S. P., Roccaforte, W. H. & Burke, W. J. Donepezil improves symptoms of delirium in dementia: implications for future research. J. Geriatr. Psychiatry Neurol. 11, 159–161 (1998).

    Article  CAS  PubMed  Google Scholar 

  66. Gleason, O. C. Donepezil for postoperative delirium. Psychosomatics 44, 437–438 (2003).

    Article  PubMed  Google Scholar 

  67. Bourne, R. S., Tahir, T. A., Borthwick, M. & Sampson, E. L. Drug treatment of delirium: past, present and future. J. Psychosom. Res. 65, 273–282 (2008).

    Article  PubMed  Google Scholar 

  68. Leung, J. M. et al. Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients. Neurology 67, 1251–1253 (2006).

    Article  CAS  PubMed  Google Scholar 

  69. Levanen, J., Makela, M. L. & Scheinin, H. Dexmedetomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anesthesiology 82, 1117–1125 (1995).

    Article  CAS  PubMed  Google Scholar 

  70. Budd, S. & Brown, W. Effect of a reorientation technique on postcardiotomy delirium. Nurs. Res. 23, 341–348 (1974).

    Article  CAS  PubMed  Google Scholar 

  71. Cole, M. et al. Systematic intervention for elderly inpatients with delirium: a randomized trial. Can. Med. Assoc. J. 151, 965–970 (1994).

    CAS  Google Scholar 

  72. Lazarus, H. & Hagens, J. Prevention of psychosis following open-heart surgery. Am. J. Psychiatry 124, 1190–1195 (1968).

    Article  CAS  PubMed  Google Scholar 

  73. Meagher, D., O'Hanlon, D., O'Mahony, E. & Casey, P. The use of environmental strategies and psychotropic medication in the management of delirium. Br. J. Psychiatry 168, 512–515 (1996).

    Article  CAS  PubMed  Google Scholar 

  74. Williams, M., Campbell, E., Raynor, W., Mlynarczyk, S. & Ward, S. Reducing acute confusional states in elderly patients with hip fractures. Res. Nurs. Health 8, 329–337 (1985).

    Article  CAS  PubMed  Google Scholar 

  75. American Psychiatric Association. Treatment of Patients with Delirium Practice Guideline http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm.

  76. McDowell, J. A., Mion, L. C., Lydon, T. J. & Inouye, S. K. A nonpharmacologic sleep protocol for hospitalized older patients. J. Am. Geriatr. Soc. 46, 700–705 (1998).

    Article  CAS  PubMed  Google Scholar 

  77. Inouye, S. K., Bogardus, S. T., Jr, Williams, C. S., Leo-Summers, L. & Agostini, J. V. The role of adherence on the effectiveness of nonpharmacologic interventions: evidence from the delirium prevention trial. Arch. Intern. Med. 163, 958–964 (2003).

    Article  PubMed  Google Scholar 

  78. Lonergan, E., Britton, A. M., Luxenberg, J. & Wyller, T. Antipsychotics for delirium. Cochrane Database of Systematic Reviews, 2007, Issue 2. Art. No.: CD005594. DOI:10.1002/14651858.CD005594.pub2 (2007).

    Google Scholar 

  79. Seitz, D. P., Gill, S. S. & van Zyl, L. T. Antipsychotics in the treatment of delirium: a systematic review. J. Clin. Psychiatry 68, 11–21 (2007).

    Article  CAS  PubMed  Google Scholar 

  80. Platt, M. M. et al. Efficacy of neuroleptics for hypoactive delirium. J. Neuropsychiatry Clin. Neurosci. 6, 66–67 (1994).

    Article  CAS  PubMed  Google Scholar 

  81. Breitbart, W. et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am. J. Psychiatry 153, 231–237 (1996).

    Article  CAS  PubMed  Google Scholar 

  82. Hu, H., Deng, W., Yang, H. & Liu, Y. Olanzapine and haloperidol for senile delirium: a randomized controlled observation. Chin. J. Clin. Rehab. 10, 188–190 (2006).

    Google Scholar 

  83. Han, C. S. & Kim, Y. K. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics 45, 297–301 (2004).

    Article  CAS  PubMed  Google Scholar 

  84. Kim, J. Y. et al. Antipsychotics and dopamine transporter gene polymorphisms in delirium patients. Psychiatry Clin. Neurosci. 59, 183–188 (2005).

    Article  CAS  PubMed  Google Scholar 

  85. US FDA MedWatch: Haloperidol (marketed as Haldol, Haldol decanoate, and Haldol lactate) http://www.fda.gov/medwatch/safety/2007/safety07.htm#Haloperidol.

  86. Inouye, S. & Marcantonio, E. Delirium. In The Dementias (eds Growdon J and Rossor M) 285–312 (Butterworth-Heinemann Elsevier, Philadelphia, 2007).

    Google Scholar 

  87. Marcantonio, E., Ta, T., Duthie, E. & Resnick, N. M. Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair. J. Am. Geriatr. Soc. 50, 850–857 (2002).

    Article  PubMed  Google Scholar 

  88. Levkoff, S. E. et al. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch. Intern. Med. 152, 334–340 (1992).

    Article  CAS  PubMed  Google Scholar 

  89. Murray, A. M. et al. Acute delirium and functional decline in the hospitalized elderly patient. J. Gerontol. 48, M181–M186 (1993).

    Article  CAS  PubMed  Google Scholar 

  90. Cole, M., McCusker, J., Dendukuri, N. & Han, L. The prognostic significance of subsyndromal delirium in elderly medical inpatients. J. Am. Geriatr. Soc. 51, 754–760 (2003).

    Article  PubMed  Google Scholar 

  91. Levkoff, S. E. & Marcantonio, E. R. Delirium: a major diagnostic and therapeutic challenge for clinicians caring for the elderly. Compr. Ther. 20, 550–557 (1994).

    CAS  PubMed  Google Scholar 

  92. Marcantonio, E. R., Flacker, J. M., Michaels, M. & Resnick, N. M. Delirium is independently associated with poor functional recovery after hip fracture. J. Am. Geriatr. Soc. 48, 618–624 (2000).

    Article  CAS  PubMed  Google Scholar 

  93. McCusker, J., Cole, M., Dendukuri, N., Han, L. & Belzile, E. The course of delirium in older medical inpatients: a prospective study. J. Gen. Intern. Med. 18, 696–704 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  94. Rockwood, K. The occurrence and duration of symptoms in elderly patients with delirium. J. Gerontol. 48, M162–M166 (1993).

    Article  CAS  PubMed  Google Scholar 

  95. Clarfield, A. M. The reversible dementias: do they reverse? Ann. Intern. Med. 109, 476–486 (1988).

    Article  CAS  PubMed  Google Scholar 

  96. Fann, J. R., Alfano, C. M., Roth-Roemer, S., Katon, W. J. & Syrjala, K. L. Impact of delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation. J. Clin. Oncol. 25, 1223–1231 (2007).

    Article  PubMed  Google Scholar 

  97. Katz, I. R. et al. Validating the diagnosis of delirium and evaluating its association with deterioration over a one-year period. Am. J. Geriatr. Psychiatry 9, 148–159 (2001).

    Article  CAS  PubMed  Google Scholar 

  98. McCusker, J., Cole, M., Dendukuri, N., Belzile, E. & Primeau, F. Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ 165, 575–583 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  99. Rahkonen, T., Luukkainen-Markkula, R., Paanila, S., Sivenius, J. & Sulkava, R. Delirium episode as a sign of undetected dementia among community dwelling elderly subjects: a 2 year follow up study. J. Neurol. Neurosurg. Psychiatry 69, 519–521 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Fong, T. G. et al. Delirium accelerates cognitive decline in Alzheimer's disease. Neurology, in press.

  101. Baker, F. M., Wiley, C., Kokmen, E., Chandra, V. & Schoenberg, B. S. Delirium episodes during the course of clinically diagnosed Alzheimer's disease. J. Natl Med. Assoc. 91, 625–630 (1999).

    CAS  PubMed  PubMed Central  Google Scholar 

  102. Fick, D. & Foreman, M. Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J. Gerontol. Nurs. 26, 30–40 (2000).

    Article  CAS  PubMed  Google Scholar 

  103. Rockwood, K. et al. The risk of dementia and death after delirium. Age Ageing 28, 551–556 (1999).

    Article  CAS  PubMed  Google Scholar 

  104. Williamson, J. W. Formulating priorities for quality assurance activity. Description of a method and its application. JAMA 239, 631–637 (1978).

    Article  CAS  PubMed  Google Scholar 

  105. National Quality Measures Clearinghouse of the Agency for Healthcare Research and Quality http://www.qualitymeasures.ahrq.gov/ (accessed 13 February 2009).

  106. Sloss, E. M. et al. Selecting target conditions for quality of care improvement in vulnerable older adults. J. Am. Geriatr. Soc. 48, 363–369 (2000).

    Article  CAS  PubMed  Google Scholar 

  107. Inouye, S. K., Schlesinger, M. J. & Lydon, T. J. Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care. Am. J. Med. 106, 565–573 (1999).

    Article  CAS  PubMed  Google Scholar 

  108. Leslie, D. L., Marcantonio, E. R., Zhang, Y., Leo-Summers, L. & Inouye, S. K. One-year health care costs associated with delirium in the elderly population. Arch. Intern. Med. 168, 27–32 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  109. Haentjens, P., Lamraski, G. & Boonen, S. Costs and consequences of hip fracture occurrence in old age: an economic perspective. Disabil. Rehabil. 27, 1129–1141 (2005).

    Article  CAS  PubMed  Google Scholar 

  110. Stevens, J. A., Corso, P. S., Finkelstein, E. A. & Miller, T. R. The costs of fatal and non-fatal falls among older adults. Inj. Prev. 12, 290–295 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Hogan, P., Dall, T. & Nikolov, P. Economic costs of diabetes in the US in 2002. Diabetes Care 26, 917–932 (2003).

    Article  PubMed  Google Scholar 

  112. Thom, T. et al. Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 113, e85–e151 (2006).

    PubMed  Google Scholar 

  113. Ely, E. W. et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM–ICU). JAMA 286, 2703–2710 (2001).

    Article  CAS  PubMed  Google Scholar 

  114. Ely, E. W. et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM–ICU). Crit. Care Med. 29, 1370–1379 (2001).

    Article  CAS  PubMed  Google Scholar 

  115. Trzepacz, P. T. et al. Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J. Neuropsychiatry Clin. Neurosci. 13, 229–242 (2001).

    Article  CAS  PubMed  Google Scholar 

  116. Albert, M. S. et al. The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients. J. Geriatr. Psychiatry Neurol. 5, 14–21 (1992).

    CAS  PubMed  Google Scholar 

  117. Neelon, V. J., Champagne, M. T., Carlson, J. R. & Funk, S. G. The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nurs. Res. 45, 324–330 (1996).

    Article  CAS  PubMed  Google Scholar 

  118. Bergeron, N., Dubois, M. J., Dumont, M., Dial, S. & Skrobik, Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 27, 859–864 (2001).

    Article  CAS  PubMed  Google Scholar 

  119. Hart, R. P., Best, A. M., Sessler, C. N. & Levenson, J. L. Abbreviated cognitive test for delirium. J. Psychosom. Res. 43, 417–423 (1997).

    Article  CAS  PubMed  Google Scholar 

  120. Hart, R. P. et al. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics 37, 533–546 (1996).

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors are supported by NIA PHS Grants K24AG000949 (SK Inouye) and K23AG031320 (TG Fong), and Grant IIRG-08-88737 (SK Inouye) from the Alzheimer's Association. Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Correspondence to Tamara G. Fong.

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Fong, T., Tulebaev, S. & Inouye, S. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 5, 210–220 (2009). https://doi.org/10.1038/nrneurol.2009.24

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