Delirium in neurological practice
Keywords:delirium, dementia, acute stroke, cholinergic activity
Delirium is an acute, usually reversible, fluctuating impairment of the level of consciousness, attention, and cognitive activity resulted from impaired brain metabolism due to a wide range of various neurological and non-neurological diseases, the effects of drugs and other substances. The main manifestations of delirium are acute changes in consciousness, disturbance of attention, perception, often with the development of hallucinations, emotion, sleep-wake cycle, psychomotor and autonomic activity. Delirium is divided into hypoactive and hyperactive subtypes depending on the severity of psychomotor and emotional disturbances. Patients with acute stroke are also often susceptible to episodes of delirium at the risk factors such as age, pre-existing cognitive impairment, pneumonia, urinary tract infections, and right hemispheric stroke. The pathophysiology of delirium has been less known, but there is evidence of the role of cholinergic deficiency. Delirium is a transient condition, but it needs treatment to prevent the development of complications since it is usually associated with poor functional outcomes, longer hospitalization and higher mortality. The strategy for the treatment of patients with delirium should be directed to early identification of its symptoms, elimination of modifiable risk factors and metabolic causes. In patients with severe symptoms of agitation and hallucinations, short-term prescription of antipsychotics for their relief is possible.
Lindesay J., Rockwood K., Macdonald A. Delirium. Oxford: Oxford University Press, 2002.
Pandharipande P., Jackson J., Ely E.W. Delirium: acute cognitive dysfunction in the critically ill. Current Opinion in Critical Care. 2005. 11 (4). 360-368. DOI: 10.1097/01.ccx.0000170503.76528.4b.
Marcantonio E.R. Delirium in Hospitalized Older Adults. N. Engl. J. Med. 2017. 377 (15). 1456-1466. DOI: 10.1056/NEJMcp1605501.
Burns A., Gallagley A., Byrne J. Delirium. J. Neurol. Neurosurg. Psychiatry. 2004. 75. 362-367. doi: 10.1136/jnnp.2003.023366.
Плам Ф., Познер Д. Диагностика ступора и комы. Москва, 1986. 544 с.
World Health Organisation (1992). The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva: WHO, 1992.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. Virginia: American Psychiatric Association Publishing, 2013.
Lipowski Z.J. Delirium in the elderly patient. The New England Journal of Medicine. 1989. 320. 9. 578-582.
Lipowski Z.J. Delirium: acute confusional states. New York: Oxford University Press, 1990.
Stagno D., Gibson C., Breitbart W. The delirium subtypes: a review of prevalence, phenomenology, pathophysiology, and treatment response. Palliative & Supportive Care. 2004. 2 (2). 171-179. DOI: https://doi.org/10.1017/S1478951504040234.
De Rooij S.E., Schuurmans M.J., van der Mast R.C., Levi M. Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review. International Journal of Geriatric Psychiatry. 2005. 20. 7. 609-615. doi.org/10.1002/gps.1343.
Hosker C., Ward D. Hypoactive delirium. BMJ. 2017. 357. doi.org/10.1136/bmj.j2047.
Peritogiannis V., Bolosi M., Lixouriotis C., Rizos D.V. Recent insights on prevalence and correlations of hypoactive delirium. Behav. Neurol. 2015. 2015. 416792. doi: 10.1155/2015/416792. PMID: 26347584.
Trzepacz P.T. Update on the neuropathogenesis of delirium. Dement. Geriatr. Cogn. Disord. 1999. 10. 330-334. DOI: 10.1159/000017164.
Jackson J.C., Gordon S.M., Hart R.P., Hopkins R.O., Ely E.W. The association between delirium and cognitive decline: a review of the empirical literature. Neuropsychol. Rev. 2004. 14. 87-98. DOI: 10.1023/b:nerv.0000028080.39602.17.
Inouye S.K., Marcantonio E.R., Kosar C.M. et al. The short-term and long-term relationship between delirium and cognitive trajectory in older surgical patients. Alzheimers Dement. 2016. 12. 766-775. DOI: 10.1016/j.jalz.2016.03.005.
Hshieh T.T., Fong T.G., Marcantonio E.R., Inouye S.K. Cholinergic Deficiency Hypothesis in Delirium: A synthesis of current evidence. Journal of Gerontology: Medical Sciences. 2008. 63A (7). 764-772. DOI: 10.1093/gerona/63.7.764.
Klimiec E., Dziedzic T., Kowalska K., Slowik A., Klimkowicz-Mrowiec A. Knowns and Unknowns About Delirium in Stroke: A Review. Cogn. Behav. Neurol. 2016. 29 (4). 174-189. doi: 10.1097/WNN.0000000000000110. PMID: 27984255.
Infante M.T., Pardini M., Balestrino M., Finocchi C., Malfatto L., Bellelli G., Mancardi G.L., Gandolfo C., Serrati C. Delirium in the acute phase after stroke: comparison between methods of detection. Neurol. Sci. 2017 Jun. 38 (6). 1101-1104.
Mansutti I., Saiani L., Palese A. Detecting delirium in patients with acute stroke: a systematic review of test accuracy. BMC Neurology. 2019. 19. 310. https://doi.org/10.1186/s12883-019-1547-4.
Mansutti I., Saiani L., Palese A. Delirium in patients with ischaemic and haemorrhagic stroke: findings from a scoping review. Eur. J. Cardiovasc. Nurs. 2019. 18 (6). 435-448. DOI: 10.1177/1474515119846226.
Patel M.B., Bednarik J., Lee P., Shehabi Y., Salluh J.I. et al. Delirium monitoring in Neurocritically ill patients: a systematic review. Crit. Care Med. 2018. 46 (11). 1832-1841. doi: 10.1097/CCM.0000000000003349.
Haight T.N., Marsh E.B. Identifying Delirium Early after Stroke: A New Prediction Tool for the Intensive Care Unit. J. Stroke Cerebrovasc. Dis. 2020. 29 (11). 105219. doi: 10.1016/j.jstrokecerebrovasdis.2020.105219. Epub 2020 Aug 12. PMID: 33066899.
Serafim R.B., Bozza F.A., Soares M. et al. Pharmacologic prevention and treatment of delirium in intensive care patients: a systematic review. J. Critic. Care. 2015. 30. 799-807. doi: 10.1016/j.jcrc.2015.04.005.
American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J. Am. Geriatr. Soc. 2015. 63. 142-150.
Burry L., Mehta S., Perreault M.M., Luxenberg J.S., Siddiqi N. et al. Antipsychotics for treatment of delirium in hospitalised non-ICU patients. Cochrane Database Syst. Rev. 2018. 18 (6). CD005594. doi: 10.1002/14651858.CD005594.pub3.
Devlin J.W., Skrobik Y., Gélina C., Needham D.M., Slooter A.J.C. et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine. 2018. 46 (9). DOI: 10.1097/CCM.0000000000003299.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.