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.

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 delirium arising during hospitalization ranges from 6 to 56 percent among general hospital populations

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 possible

Use the 4 question confusion

screening assessment.

4 Question Screening Assessment

0Acute onset or fluctuating

course 0Inattention

0Easily distracted

0Disorganised thinking 0Altered level of consciousness

CLINICAL CHARACTERISTICS

Hyperactive Delirium
0Heightened arousal 0Verbally and physically

threatening and aggressive 0Restlessness 0Wandering

Hypoactive Delirium
0 Clinical clues much less obvious 0 Apathy 0 Sleepy 0 Polite 0 Not interested in eating or drinking 0 Occasional incoherent speech 0 Does not always understand what is said to him

ETIOLOGIC AND RISK FACTORS

0 The cause of delirium is typically multifactorial.

0 In fact, the development of delirium involves the

complex interrelationship between a vulnerable patient (one with predisposing factors) and exposure to precipitating factors or noxious insults

PATHOGENESIS
0 The pathophysiology of delirium remains poorly

understood. 0 Electroencephalographic studies have demonstrated diffuse 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
0 Dementia has an insidious onset, chronic

memory and executive function disturbance, tends not to fluctuate. In delirium cognitive changes develop acutely and fluctuate. 0 Dementia has intact alertness and attention but impoverished speech and thinking. In delirium speech can be confused or disorganized. Alertness and attention wax and wane.

PREVENTION AND MANAGEMENT

SUMMARY
0 Delirium is a common presentation of acute illness in

older people 0 The presence of delirium is associated with adverse outcome 0 Characterised by recent onset fluctuating inattention and drowsiness linked to triggering factors