Delirium is a cloud state of consciousness with extreme trouble focusing attention, difficulty maintaining a coherent stream of thought, trouble answering questions, and disturbances in the sleep/wake cycle with the example of being drowsy during the day yet awake and agitated at night. Other signs include vivid dreams and nightmares being common, difficulty to engage in conversation as speech may become rambling and incoherent, disorientation of time, place, and name, memory impairment of recent events, and perceptual disturbances. The DSM criteria is a disturbance in attention and awareness, a change in cognition nor better accounted for by a dementia such as disturbance in orientation, language, memory, perception, or visuospatial ability, rapid onset (usually within hours or days) and fluctuation during the course of a day. Symptoms are caused by a medical condition, substance intoxication or withdrawal, or a toxin.
Delirium is a rapid onset and can fluctuate during the course of a day with lucid intervals where a person becomes alert and coherent and daily fluctuations help distinguish delirium from other syndromes, especially Alzheimer’s disease. It can occur at any age but is common in children and older adults. It is often misdiagnosed and untreated leading to a high mortality high and a predictor of death within the next six months. There is increased risk of further cognitive decline. The treatment of delirium can achieve a complete recovery if the underlying cause is treated by also using atypical antipsychotic medications. Treatment usually takes 1 to 4 weeks to clear but takes longer in older people than younger people. Hospital settings reduce risk factors for delirium such as sleep deprivation, immobility, dehydration, and visual and hearing impairment. Family should learn about delirium symptoms and its reversible nature to avoid interpreting the onset of delirium as a new state of a progressive dementia.
Recent current research has explored new approaches in order to prevent delirium in adults. One new approach that was tested was using limited sedation in surgery within hospital settings. Signs of reduced delirium appeared but only in healthy older adults. It was noted that catching and identifying delirium after surgery can be quite difficult due to the side-effects of anesthesia. Other recent trials have included the use of a lighter sedation drug called dexmedetomidine, clinical trials on testing lighter sedation, and other clinical trials minimizing levels of anesthesia. Two other strategies to prevent delirium are the use of programs such as HELP and the ABCDEF bundle which are aimed to ensure the safety of people with delirium or who are at risk for developing delirium.
Researchers test new approaches to prevent delirium in older adults. (2020). NIH: National Institute on Aging .