Delirium – a common condition associated with negative outcome in the elderly

Delirium (“acute confusional state”), characterized by an acute decline in attention and cognition, is a common clinical syndrome in elderly patients. The prevalence of delirium increases with age, and is highest among hospitalized older patients. A systematic literature search of MEDLINE, EMBASE, and the Cochrane Library limited to the period 2000-2012 was conducted. The antecedent of delirium is often multifactorial, the development involving a complex interrelationship between a vulnerable patient with predisposing factors and exposure to precipitating events. Important predisposing factors include high age, cognitive impairment, comorbidity, sensory impairment, and low Body Mass Index (BMI). Infections, cardiovascular events, trauma/fracture, surgery, stroke, metabolic abnormalities, and dehydration, are all recognized as precipitating factors. Delirium is associated with negative outcomes like cognitive decline, increased morbidity and mortality, and should be prevented. Prevention and treatment of delirium is multifactorial and multidisiplinary, focusing on the treatment of factors precipitating and maintaining the delirium. No pharmacological treatment has so far demonstrated significant efficacy. The knowledge of risk factors and the underlying pathophysiological mechanisms involved remains scarce, and further research is warranted to explore the mechanisms and thereby develop targeted prevention and treatment strategies.