Delirium: A Review

Canadian Journal of Neurological Sciences

Volumn 38, Issue 5, 2011, Pages 673-680

  Gofton, Teneille Emma ^a  

^a MEMORIAL SLOAN KETTERING CANCER CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DELIRIUM; DIFFERENTIAL DIAGNOSIS; DISEASE COURSE; HUMAN; PATHOPHYSIOLOGY; REVIEW;

DELIRIUM; DIAGNOSIS, DIFFERENTIAL; DISEASE PROGRESSION; HUMANS;

EID: 84856365309     PISSN: 03171671     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0317167100012269     Document Type: Review

References (86)

1. Inouye, SK, Rushing, JT, Foreman, MD, Palmer, RM, Pompei, P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med. 1998; 13(4):232–234.
2. 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. 2001; 165(5):575–83.
3. Samuels, SC, Evers, MM. Delirium. Pragmatic guidance for managing a common, confounding, and sometimes lethal condition. Geriatrics. 2002; 57(6):33–8.
4. Bruera, E, Bush, SH, Willey, J, et al. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer. 2009; 115(9):2004–12.
5. Morita, T, Hirai, K, Sakaguchi, Y, Tsuneto, S, Shima, Y. Familyperceived distress from delirium-related symptoms of terminally ill cancer patients. Psychosomatics. 2004; 45(2):107–13.
6. Breitbart, W, Gibson, C, Tremblay, A. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics. 2002; 43(3):183–94.
7. http://www.psych.org [homepage on the Internet]. Diagnostic and Statistical Manual-5, proposed revisions. Virginia, USA: American Psychiatric Association Press; c2011 [cited 2011 March 24]. Available from: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=32
8. Bourgeois, JA, Seritan, SA. Diagnosis and management of delirium. Continuum. 2006; 12(18).
9. Khan, J, Harrison, HT. Central and peripheral neurologic manifestations of critical medical illness. Continuum. 2008; 14(19).
10. Fang, CK, Chen, HW, Liu, SI, Lin, CJ, Tsai, LY, Lai, YL. Prevalence, detection and treatment of delirium in terminal cancer inpatients: a prospective survey. Jpn J Clin Oncol. 2008; 38(1):56–63.
11. Guidotti, M, Chiveri, L, Mauri, M. Acute encephalopathies. Neurol Sci. 2006; 27 Suppl 1: S55–6.
12. Inouye, SK, Charpentier, PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996; 275(11):852–7.
13. Levkoff, S, Cleary, P, Liptzin, B, Evans, DA. Epidemiology of delirium: an overview of research issues and findings. Int Psychogeriatr. 1991; 3(2):149–67.
14. Francis, JF, Young, GB. Diagnosis of delirium and confusional states. Massachussetts, USA: UpToDate, Inc; c2011 [cited 2010 December 9]. Available from: http://www.uptodate.com.
15. Gaudreau, JD, Gagnon, P, Harel, F, Roy, MA, Tremblay, A. Psychoactive medications and risk of delirium in hospitalized cancer patients. J Clin Oncol. 2005; 23(27):6712–18.
16. Gaudreau, JD, Gagnon, P, Roy, MA, Harel, F, Tremblay, A. Association between psychoactive medications and delirium in hospitalized patients: a critical review. Psychosomatics. 2005; 46(4):302–16.
17. Sprung, CL, Cerra, FB, Freund, HR, et al. Amino acid alterations and encephalopathy in the sepsis syndrome. Crit Care Med. 1991; 19(6):753–7.
18. Mizock, BA, Sabelli, HC, Dubin, A, Javaid, JI, Poulos, A, Rackow, EC. Septic encephalopathy. Evidence for altered phenylalanine metabolism and comparison with hepatic encephalopathy. Arch Intern Med. 1990; 150(2):443–9.
19. Bruera, E, Miller, L, McCallion, J, Macmillan, K, Krefting, L, Hanson, J. Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage. 1992; 7(4):192–5.
20. Lawlor, PG, Gagnon, B, Mancini, IL, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000; 160(6):786–94.
21. Pereira, J, Hanson, J, Bruera, E. The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer. 1997; 79(4):835–42.
22. Jackson, JC, Gordon, SM, Hart, RP, Hopkins, RO, Ely, EW. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol Rev. 2004; 14(2):87–98.
23. Practice guideline for the treatment of patients with delirium. American Psychiatric Association. Am J Psychiatr. 1999; 156(5 Suppl):1–20.
24. www.psych.org [homepage on the Internet]. Cook I. Guideline Watch: Practice guidelines for the treatment of patients with delirium. Virginia, USA: American Psychiatric Association Press; c2011 [cited 2011 March 24]. Available from: http://www.psychiatryonline.com/pracGuide/PracticePDFs/Delirium.watch.pdf.
25. van den Boogaard, M, Pickkers, P, van der Hoeven, H, Roodbol, G, vanAchterberg, T, Schoonhoven, L. Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care. 2009; 13(4):R131.
26. Hart, RP, Levenson, JL, Sessler, CN, Best, AM, Schwartz, SM, Rutherford, LE. Validation of a cognitive test for delirium in medical ICU patients. Psychosomatics. 1996; 37(6):533–46.
27. Inouye, SK, van Dyck, CH, Alessi, CA, Balkin, S, Siegal, AP, Horwitz, RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990; 113(12):941–8.
28. Robertsson, B, Karlsson, I, Styrud, E, Gottfries, CG. Confusional State Evaluation (CSE): an instrument for measuring severity of delirium in the elderly. Br J Psychiatry. 1997; 170: 565–70.
29. Schuurmans, MJ, Shortridge-Baggett, LM, Duursma, SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003; 17(1):31–50.
30. Trzepacz, PT, Baker, RW, Greenhouse, J. A symptom rating scale for delirium. Psychiatry Res. 1988; 23(1):89–97.
31. Trzepacz, PT, Dew, MA. Further analyses of the Delirium Rating Scale. Gen Hosp Psychiatry. 1995; 17(2):75–9.
32. Albert, MS, Levkoff, SE, Reilly, C, et al. The delirium symptom interview: an interview for the detection of delirium symptoms in hospitalized patients. J Geriatr Psychiatry Neurol. 1992; 5(1):14–21.
33. Bergeron, N, Dubois, MJ, Dumont, M, Dial, S, Skrobik, Y. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intens Care Med. 2001; 27(5):859–64.
34. Breitbart, W, Rosenfeld, B, Roth, A, Smith, MJ, Cohen, K, Passik, S. The Memorial Delirium Assessment Scale. J Pain Symptom Manage. 1997; 13(3):128–37.
35. Neelon, VJ, Champagne, MT, Carlson, JR, Funk, SG. The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nurs Res. 1996; 45(6):324–30.
36. Kaplan, PW. The EEG in metabolic encephalopathy and coma. J Clin Neurophysiol. 2004; 21(5):307–18.
37. Sagawa, R, Akechi, T, Okuyama, T, Uchida, M, Furukawa, TA. Etiologies of delirium and their relationship to reversibility and motor subtype in cancer patients. Jpn J Clin Oncol. 2009; 39(3):175–82.
38. Moyer, DD. Terminal delirium in geriatric patients with cancer at end of life. Am J Hosp Palliat Care. 2011; 28(1):44–51.
39. Gaudreau, JD, Gagnon, P. Psychotogenic drugs and delirium pathogenesis: the central role of the thalamus. Med Hypotheses. 2005; 64(3):471–5.
40. Trzepacz, PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry. 2000; 5(2):132–48.
41. Tune, LE, Damlouji, NF, Holland, A, Gardner, TJ, Folstein, MF, Coyle, JT. Association of postoperative delirium with raised serum levels of anticholinergic drugs. Lancet. 1981; 2(8248):651–3.
42. Flacker, JM, Cummings, V, Mach, JR Jr., Bettin, K, Kiely, DK, Wei, J. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry. 1998; 6(1):31–41.
43. Caplan, LR. Cardiac encephalopathy and congestive heart failure: a hypothesis about the relationship. Neurology. 2006; 66(1):99–101.
44. Pugsley, W, Klinger, L, Paschalis, C, Treasure, T, Harrison, M, Newman, S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke. 1994; 25(7):1393–9.
45. Kunze, K. Metabolic encephalopathies. J Neurol. 2002; 249(9):1150–9.
46. Wilson, JX, Young, GB. Progress in clinical neurosciences: sepsisassociated encephalopathy: evolving concepts. Can J Neurol Sci. 2003; 30(2):98–105.
47. Dasgupta, M, Hillier, LM. Factors associated with prolonged delirium: a systematic review. Int Psychogeriatr. 2010; 22(3):373–94.
48. Michaud, L, Burnand, B, Stiefel, F. Taking care of the terminally ill cancer patient: delirium as a symptom of terminal disease. Ann Oncol. 2004; 15 Suppl 4: iv199–203.
49. Breitbart, W, Alici, Y. Agitation and delirium at the end of life: “We couldn't manage him”. JAMA. 2008; 300(24):2898–910, E1.
50. van Munster, BC, de Rooij, SE, Korevaar, JC. The role of genetics in delirium in the elderly patient. Dement Geriatr Cogn Disord. 2009; 28(3):187–95.
51. Hshieh, TT, Fong, TG, Marcantonio, ER, Inouye, SK. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci. 2008; 63(7):764–72.
52. Cerejeira, J, Firmino, H, Vaz-Serra, A, Mukaetova-Ladinska, EB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol. 2010; 119(6):737–54.
53. van Munster, BC, Korevaar, JC, Zwinderman, AH, Levi, M, Wiersinga, WJ, De Rooij, SE. Time-course of cytokines during delirium in elderly patients with hip fractures. J Am Geriatr Soc. 2008; 56(9):1704–9.
54. Dantzer, R, O’Connor, JC, Freund, GG, Johnson, RW, Kelley, KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008; 9(1):46–56.
55. Shih, HT, Huang, WS, Liu, CH, et al. Confusion or delirium in patients with posterior cerebral arterial infarction. Acta Neurol Taiwan. 2007; 16(3):136–42.
56. Siddiqi, N, Holt, HR, Britton, AM, Holmes, J. Interventions for preventing delirium in hospitalised patients. Cochrane DB Syst Rev. 2007(2).
57. Inouye, SK, Bogardus, ST Jr, Charpentier, PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999; 340(9):669–76.
58. Sechi, G, Serra, A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007; 6(5):442–55.
59. Lonergan, E, Luxenberg, J. Antipsychotics for delirium. Cochrane DB Syst Rev. 2007(2).
60. Tesar, GE, Murray, GB, Cassem, NH. Use of high-dose intravenous haloperidol in the treatment of agitated cardiac patients. J Clin Psychopharmacol. 1985; 5(6):344–7.
61. Meyer-Massetti, C, Cheng, CM, Sharpe, BA, Meier, CR, Guglielmo, BJ. The FDA extended warning for intravenous haloperidol and torsades de pointes: how should institutions respond? J Hosp Med. 2010; 5(4):E8–16.
62. Narang, P, El-Refai, M, Parlapalli, R, et al. Antipsychotic drugs: sudden cardiac death among elderly patients. Psychiatry. (Edgmont) 2010; 7(10):25–9.
63. Schwartz, TL, Masand, PS. The role of atypical antipsychotics in the treatment of delirium. Psychosomatics. 2002; 43(3):171–4.
64. Alici-Evcimen, Y, Breitbart, W. An update on the use of antipsychotics in the treatment of delirium. Palliat Support Care. 2008; 6(2):177–82.
65. Passik, SD, Cooper, M. Complicated delirium in a cancer patient successfully treated with olanzapine. J Pain Symptom Manage. 1999; 17(3):219–23.
66. Schwartz, TL, Masand, PS. Treatment of delirium with quetiapine. Prim Care Companion J Clin Psychiatry. 2000; 2(1):10–12.
67. Sipahimalani, A, Masand, PS. Use of risperidone in delirium: case reports. Ann Clin Psychiatry. 1997; 9(2):105–7.
68. Lonergan, E, Luxembourg, LJ, Areosa Sastre, A. Benzodiazepines for delirium. Cochrane DB Syst Rev. 2009(4).
69. Overshott, RKS, Burns, A. Cholinesterase inhibitors for delirium. Cochrane DB Syst Rev. 2008(1).
70. Paris, A, Tonner, PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005; 18(4):412–18.
71. Venn, RM, Bradshaw, CJ, Spencer, R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999; 54(12):1136–42.
72. Pandharipande, PP, Pun, BT, Herr, DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298(22):2644–53.
73. Riker, RR, Shehabi, Y, Bokesch, PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009; 301(5):489–99.
74. Sichrovsky, TC, Mittal, S, Steinberg, JS. Dexmedetomidine sedation leading to refractory cardiogenic shock. Anesth Analg. 2008; 106(6):1784–6.
75. Tan, JA, Ho, KM. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis. Intens Care Med. 2010; 36(6):926–39.
76. Jackson, KC, Lipman, LA. Drug therapy for delirium in terminally ill adult patients. Cochrane DB Syst Rev. 2004(2).
77. Schwartzstein, RM, Lahive, K, Pope, A, Weinberger, SE, Weiss, JW. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987; 136(1):58–61.
78. Cole, MG, Primeau, FJ, Bailey, RF, et al. Systematic intervention for elderly inpatients with delirium: a randomized trial. CMAJ. 1994; 151(7):965–70.
79. Pitkala, KH, Laurila, JV, Strandberg, TE, Tilvis, RS. Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci. 2006; 61(2):176–81.
80. Milisen, K, Lemiengre, J, Braes, T, Foreman, MD. Multicomponent intervention strategies for managing delirium in hospitalized older people: systematic review. J Adv Nurs. 2005; 52(1):79–90.
81. Kobayashi, K, Takeuchi, O, Suzuki, M, Yamaguchi, N. Aretrospective study on delirium type. Jpn J Psychiatry Neurol. 1992; 46(4):911–17.
82. Marcantonio, ER, Flacker, JM, Michaels, M, Resnick, NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000; 48(6):618–24.
83. Dubois, MJ, Bergeron, N, Dumont, M, Dial, S, Skrobik, Y. Delirium in an intensive care unit: a study of risk factors. Intens Care Med. 2001; 27(8):1297–304.
84. Girard, TD, Jackson, JC, Pandharipande, PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010; 38(7):1513–20.
85. Andrew, MK, Freter, SH, Rockwood, K. Prevalence and outcomes of delirium in community and non-acute care settings in people without dementia: a report from the Canadian Study of Health and Aging. BMC Med. 2006; 4: 15.
86. Leonard, M, Raju, B, Conroy, M, et al. Reversibility of delirium in terminally ill patients and predictors of mortality. Palliat Med. 2008; 22(7):848–54.