Delirium in elderly people

Sharon K Inouye, Rudi G J Westendorp, Jane S Saczynski, Sharon K Inouye, Rudi G J Westendorp, Jane S Saczynski

Abstract

Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology--it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding, reimbursement from insurers, and research funding, and widespread education for clinicians and the public about the importance of delirium.

Conflict of interest statement

Conflicts of interest

The authors have no conflicts of interest to disclose.

Copyright © 2014 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Multifactorial model of delirium in…
Figure 1. Multifactorial model of delirium in older persons
The onset of delirium involves a complex interaction between the patient’s baseline vulnerability (predisposing factors) present on admission, and precipitating factors or noxious insults occurring during hospitalization. See text for details.

References

    1. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008 Jan 14;168(1):27–32.
    1. World Health Organization Regional Office for Europe. European hospital morbidity database. World Health Organization; Copenhagen: 2012.
    1. Organization for Economic Co-operation and Development. OECD Health Data 2012. Organization for Economic Co-operation and Development; Paris: 2012.
    1. Inouye SK, Bogardus ST, Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999 Mar 4;340(9):669–76.
    1. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001 May;49(5):516–22.
    1. O'Mahony R, Murthy L, Akunne A, Young J. Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Ann Intern Med. 2011 Jun 7;154(11):746–51.
    1. Wachter RM. Understanding patient safety. 2. New York, NY: McGraw-Hill Medical; 2012.
    1. Agency for Healthcare Research and Quality (AHRQ) National Quality Clearinghouse Measure: Delirium: proportion of patients meeting diagnostic criteria on the Confusion Assessment Method (CAM) 2003 [cited 2013 3 Jan]; Available from: .
    1. Shekelle PG, MacLean CH, Morton SC, Wenger NS. Acove quality indicators. Ann Intern Med. 2001 Oct 16;135(8 Pt 2):653–67.
    1. Jones RN, Fong TG, Metzger E, Tulebaev S, Yang FM, Alsop DC, et al. Aging, brain disease, and reserve: implications for delirium. Am J Geriatr Psychiatry. 2010 Feb;18(2):117–27.
    1. Wilson RS, Hebert LE, Scherr PA, Dong X, Leurgens SE, Evans DA. Cognitive decline after hospitalization in a community population of older persons. Neurology. 2012 Mar 27;78(13):950–6.
    1. Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK, et al. Cognitive trajectories after postoperative delirium. N Engl J Med. 2012 Jul 5;367(1):30–9.
    1. Inouye SK. Delirium in older persons. N Engl J Med. 2006 Mar 16;354(11):1157–65.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007 Oct 20;370(9596):1453–7.
    1. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Jr, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14;291(14):1753–62.
    1. Lin SM, Liu CY, Wang CH, Lin HC, Huang CD, Huang PY, et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med. 2004 Nov;32(11):2254–9.
    1. van den Boogaard M, Schoonhoven L, van der Hoeven JG, van Achterberg T, Pickkers P. Incidence and short-term consequences of delirium in critically ill patients: A prospective observational cohort study. Int J Nurs Stud. 2012 Jul;49(7):775–83.
    1. Veiga D, Luis C, Parente D, Fernandes V, Botelho M, Santos P, et al. Postoperative delirium in intensive care patients: risk factors and outcome. Rev Bras Anestesiol. 2012 Jul;62(4):469–83.
    1. Pitkala KH, Laurila JV, Strandberg TE, Tilvis RS. Prognostic significance of delirium in frail older people. Dement Geriatr Cogn Disord. 2005;19(2–3):158–63.
    1. Buurman BM, Hoogerduijn JG, de Haan RJ, Abu-Hanna A, Lagaay AM, Verhaar HJ, et al. Geriatric conditions in acutely hospitalized older patients: prevalence and one-year survival and functional decline. PLoS One. 2011;6(11):e26951.
    1. Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK. Premature death associated with delirium at 1-year follow-up. Arch Intern Med. 2005 Jul 25;165(14):1657–62.
    1. Han JH, Shintani A, Eden S, Morandi A, Solberg LM, Schnelle J, et al. Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med. 2010 Sep;56(3):244–52. e1.
    1. Bickel H, Gradinger R, Kochs E, Forstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26(1):26–31.
    1. Krogseth M, Wyller TB, Engedal K, Juliebo V. Delirium is an important predictor of incident dementia among elderly hip fracture patients. Dement Geriatr Cogn Disord. 2011;31(1):63–70.
    1. Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010 Apr;58(4):643–9.
    1. Oldenbeuving AW, de Kort PL, Jansen BP, Algra A, Kappelle LJ, Roks G. Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology. 2011 Mar 15;76(11):993–9.
    1. Marcantonio ER, Kiely DK, Simon SE, John Orav E, Jones RN, Murphy KM, et al. Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2005 Jun;53(6):963–9.
    1. Fong TG, Jones RN, Shi P, Marcantonio ER, Yap L, Rudolph JL, et al. Delirium accelerates cognitive decline in Alzheimer disease. Neurology. 2009 May 5;72(18):1570–5.
    1. Fong TG, Jones RN, Marcantonio ER, Tommet D, Gross AL, Habtemariam D, et al. Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Ann Intern Med. 2012 Jun 19;156(12):848–56.
    1. Gross AL, Jones RN, Habtemariam DA, Fong TG, Tommet D, Quach L, et al. Delirium and Long-term Cognitive Trajectory Among Persons With Dementia. Archives of internal medicine. 2012;172(17):1–8.
    1. 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 Dec 15;113(12):941–8.
    1. American Psychiatric Association. Task force on DSM-IV, diagnostic and statistical manual of mental disorders: DSM-IV. 4. Washington, DC: The Association; 1994.
    1. American Psychiatric Association. Task force on DSM-IV, diagnostic and statistical manual of mental disorders: DSM-IV (text revision) 4. Washington, DC: The Association; 2000.
    1. World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organization; 1993.
    1. Adamis D, Sharma N, Whelan PJ, Macdonald AJ. Delirium scales: A review of current evidence. Aging Ment Health. 2010 Jul;14(5):543–55.
    1. Wong CL, Holroyd-Leduc J, Simel DL, Straus SE. Does this patient have delirium?: value of bedside instruments. JAMA. 2010 Aug 18;304(7):779–86.
    1. Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The Confusion Assessment Method: a systematic review of current usage. J Am Geriatr Soc. 2008 May;56(5):823–30.
    1. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) Crit Care Med. 2001 Jul;29(7):1370–9.
    1. Han JH, Zimmerman EE, Cutler N, Schnelle J, Morandi A, Dittus RS, et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med. 2009 Mar;16(3):193–200.
    1. Center for Medicare & Medicaid Services (CMS) Minimum Data Set, Version 3.0. Centers for Medicare & Medicaid Services; 2010.
    1. Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The Delirium Observation Screening Scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003 Spring;17(1):31–50.
    1. Gaudreau JD, Gagnon P, Harel F, Tremblay A, Roy MA. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage. 2005 Apr;29(4):368–75.
    1. Neelon VJ, Champagne MT, Carlson JR, Funk SG. The NEECHAM Confusion Scale: construction, validation, and clinical testing. Nurs Res. 1996 Nov-Dec;45(6):324–30.
    1. Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988 Jan;23(1):89–97.
    1. Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001 Spring;13(2):229–42.
    1. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The Memorial Delirium Assessment Scale. J Pain Symptom Manage. 1997 Mar;13(3):128–37.
    1. Cole MG, Dendukuri N, McCusker J, Han L. An empirical study of different diagnostic criteria for delirium among elderly medical inpatients. J Neuropsychiatry Clin Neurosci. 2003 Spring;15(2):200–7.
    1. Milisen K, Foreman MD, Abraham IL, De Geest S, Godderis J, Vandermeulen E, et al. A nurseled interdisciplinary intervention program for delirium in elderly hip-fracture patients. J Am Geriatr Soc. 2001 May;49(5):523–32.
    1. Inouye SK, Leo-Summers L, Zhang Y, Bogardus ST, Jr, Leslie DL, Agostini JV. A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method. J Am Geriatr Soc. 2005 Feb;53(2):312–8.
    1. Steis MR, Evans L, Hirschman KB, Hanlon A, Fick DM, Flanagan N, et al. Screening for delirium using family caregivers: convergent validity of the family confusion assessment method and interviewer-rated confusion assessment method. J Am Geriatr Soc. 2012 Nov;60(11):2121–6.
    1. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996 Mar 20;275(11):852–7.
    1. Marcantonio ER. Postoperative delirium: a 76-year-old woman with delirium following surgery. JAMA. 2012 Jul 4;308(1):73–81.
    1. Watt D, Koziol K, Budding D. Delirium and confusional states. In: Noggle C, Dean R, editors. Disorders in Neuropsychiatry. New York: Springer Publishing Company; 2012.
    1. Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008 Sep;65(3):229–38.
    1. Alagiakrishnan K, Wiens CA. An approach to drug induced delirium in the elderly. Postgrad Med J. 2004 Jul;80(945):388–93.
    1. Joels M. Impact of glucocorticoids on brain function: relevance for mood disorders. Psychoneuroendocrinology. 2011 Apr;36(3):406–14.
    1. Marcantonio ER, Rudolph JL, Culley D, Crosby G, Alsop D, Inouye SK. Serum biomarkers for delirium. J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1281–6.
    1. Schoen J, Meyerrose J, Paarmann H, Heringlake M, Hueppe M, Berger KU. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care. 2011;15(5):R218.
    1. Caplan GA, Kvelde T, Lai C, Yap SL, Lin C, Hill MA. Cerebrospinal fluid in long-lasting delirium compared with Alzheimer's dementia. J Gerontol A Biol Sci Med Sci. 2010 Oct;65(10):1130–6.
    1. Gaudreau JD, Gagnon P. Psychotogenic drugs and delirium pathogenesis: the central role of the thalamus. Med Hypotheses. 2005;64(3):471–5.
    1. Young BK, Camicioli R, Ganzini L. Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment. Drugs Aging. 1997 May;10(5):367–83.
    1. 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 Jul;63(7):764–72.
    1. Lauretani F, Ceda GP, Maggio M, Nardelli A, Saccavini M, Ferrucci L. Capturing side-effect of medication to identify persons at risk of delirium. Aging Clin Exp Res. 2010 Oct-Dec;22(5–6):456–8.
    1. Hughes CG, Patel MB, Pandharipande PP. Pathophysiology of acute brain dysfunction: what's the cause of all this confusion? Curr Opin Crit Care. 2012 Oct;18(5):518–26.
    1. MacLullich AM, Edelshain BT, Hall RJ, de Vries A, Howie SE, Pearson A, et al. Cerebrospinal fluid interleukin-8 levels are higher in people with hip fracture with perioperative delirium than in controls. J Am Geriatr Soc. 2011 Jun;59(6):1151–3.
    1. 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 Jan;9(1):46–56.
    1. Jalleh R, Koh K, Choi B, Liu E, Maddison J, Hutchinson MR. Role of microglia and toll-like receptor 4 in the pathophysiology of delirium. Med Hypotheses. 2012 Dec;79(6):735–9.
    1. van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet. 2010 Feb 27;375(9716):773–5.
    1. Fong TG, Bogardus ST, Jr, Daftary A, Auerbach E, Blumenfeld H, Modur S, et al. Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT. J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1294–9.
    1. Pfister D, Siegemund M, Dell-Kuster S, Smielewski P, Ruegg S, Strebel SP, et al. Cerebral perfusion in sepsis-associated delirium. Crit Care. 2008;12(3):R63.
    1. Siepe M, Pfeiffer T, Gieringer A, Zemann S, Benk C, Schlensak C, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium. Eur J Cardiothorac Surg. 2011 Jul;40(1):200–7.
    1. Sabayan B, Jansen S, Oleksik AM, van Osch MJ, van Buchem MA, van Vliet P, et al. Cerebrovascular hemodynamics in Alzheimer's disease and vascular dementia: a meta-analysis of transcranial Doppler studies. Ageing Res Rev. 2012 Apr;11(2):271–7.
    1. Zampieri FG, Park M, Machado FS, Azevedo LC. Sepsis-associated encephalopathy: not just delirium. Clinics (Sao Paulo) 2011;66(10):1825–31.
    1. Choi SH, Lee H, Chung TS, Park KM, Jung YC, Kim SI, et al. Neural network functional connectivity during and after an episode of delirium. Am J Psychiatry. 2012 May;169(5):498–507.
    1. Hatherill S, Flisher AJ. Delirium in children and adolescents: A systematic review of the literature. J Psychosom Res. 2010 Apr;68(4):337–44.
    1. Izaks GJ, Westendorp RG. Ill or just old? Towards a conceptual framework of the relation between ageing and disease. BMC Geriatr. 2003 Dec 19;3:7.
    1. Cole MG. Delirium in elderly patients. Am J Geriatr Psychiatry. 2004 Jan-Feb;12(1):7–21.
    1. Davis DH, Muniz Terrera G, Keage H, Rahkonen T, Oinas M, Matthews FE, et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012 Sep;135(Pt 9):2809–16.
    1. Kolanowski AM, Fick DM, Clare L, Therrien B, Gill DJ. An intervention for delirium superimposed on dementia based on cognitive reserve theory. Aging Ment Health. 2010 Mar;14(2):232–42.
    1. Soiza RL, Sharma V, Ferguson K, Shenkin SD, Seymour DG, Maclullich AM. Neuroimaging studies of delirium: a systematic review. J Psychosom Res. 2008 Sep;65(3):239–48.
    1. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975 Oct;23(10):433–41.
    1. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000 Nov;15(11):1021–7.
    1. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695–9.
    1. Inouye SK, Zhang Y, Jones RN, Kiely DK, Yang F, Marcantonio ER. Risk factors for delirium at discharge: development and validation of a predictive model. Arch Intern Med. 2007 Jul 9;167(13):1406–13.
    1. Park M, Tang JH. Changing the practice of physical restraint use in acute care. J Gerontol Nurs. 2007 Feb;33(2):9–16.
    1. Hirano LA, Bogardus ST, Jr, Saluja S, Leo-Summers L, Inouye SK. Clinical yield of computed tomography brain scans in older general medical patients. J Am Geriatr Soc. 2006 Apr;54(4):587–92.
    1. Jacobson S, Jerrier H. EEG in delirium. Semin Clin Neuropsychiatry. 2000 Apr;5(2):86–92.
    1. Jenssen S. Electroencephalogram in the dementia workup. Am J Alzheimers Dis Other Demen. 2005 May-Jun;20(3):159–66.
    1. Hardy JE, Brennan N. Computerized tomography of the brain for elderly patients presenting to the emergency department with acute confusion. Emerg Med Australas. 2008 Oct;20(5):420–4.
    1. Lai MM, Wong Tin Niam DM. Intracranial cause of delirium: computed tomography yield and predictive factors. Intern Med J. 2012 Apr;42(4):422–7.
    1. Hufschmidt A, Shabarin V. Diagnostic yield of cerebral imaging in patients with acute confusion. Acta Neurol Scand. 2008 Oct;118(4):245–50.
    1. Marcantonio ER. In the clinic. Delirium. Ann Intern Med. 2011 Jun 7;154(11):ITC6–1–15.
    1. McDowell JA, Mion LC, Lydon TJ, Inouye SK. A nonpharmacologic sleep protocol for hospitalized older patients. J Am Geriatr Soc. 1998 Jun;46(6):700–5.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled clinical trials. 1996;17(1):1–12.
    1. Inouye SK, Bogardus ST, Jr, Baker DI, Leo-Summers L, Cooney LM., Jr The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. J Am Geriatr Soc. 2000 Dec;48(12):1697–706.
    1. Inouye SK, Baker DI, Fugal P, Bradley EH. Dissemination of the hospital elder life program: implementation, adaptation, and successes. J Am Geriatr Soc. 2006 Oct;54(10):1492–9.
    1. Rizzo JA, Bogardus ST, Jr, Leo-Summers L, Williams CS, Acampora D, Inouye SK. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Med Care. 2001 Jul;39(7):740–52.
    1. Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo-Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. J Am Geriatr Soc. 2005 Mar;53(3):405–9.
    1. Caplan GA, Harper EL. Recruitment of volunteers to improve vitality in the elderly: the REVIVE study. Intern Med J. 2007 Feb;37(2):95–100.
    1. Chen CC, Lin MT, Tien YW, Yen CJ, Huang GH, Inouye SK. Modified hospital elder life program: effects on abdominal surgery patients. J Am Coll Surg. 2011 Aug;213(2):245–52.
    1. Rubin FH, Neal K, Fenlon K, Hassan S, Inouye SK. Sustainability and scalability of the hospital elder life program at a community hospital. J Am Geriatr Soc. 2011 Feb;59(2):359–65.
    1. Bradley EH, Schlesinger M, Webster TR, Baker D, Inouye SK. Translating research into clinical practice: making change happen. J Am Geriatr Soc. 2004 Nov;52(11):1875–82.
    1. Bradley EH, Webster TR, Baker D, Schlesinger M, Inouye SK. After adoption: sustaining the innovation. A case study of disseminating the hospital elder life program. J Am Geriatr Soc. 2005 Sep;53(9):1455–61.
    1. Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care. 2012 May 4;16(3):R73.
    1. Flaherty JH, Steele DK, Chibnall JT, Vasudevan VN, Bassil N, Vegi S. An ACE unit with a delirium room may improve function and equalize length of stay among older delirious medical inpatients. J Gerontol A Biol Sci Med Sci. 2010 Dec;65(12):1387–92.
    1. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263–306.
    1. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010 Jul 28;304(4):443–51.
    1. Xie Z, Dong Y, Maeda U, Moir R, Inouye SK, Culley DJ, et al. Isoflurane-induced apoptosis: a potential pathogenic link between delirium and dementia. J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1300–6.
    1. Zhang Y, Xu Z, Wang H, Dong Y, Shi HN, Culley DJ, et al. Anesthetics isoflurane and desflurane differently affect mitochondrial function, learning, and memory. Ann Neurol. 2012 May;71(5):687–98.
    1. Zhang B, Tian M, Zhen Y, Yue Y, Sherman J, Zheng H, et al. The effects of isoflurane and desflurane on cognitive function in humans. Anesth Analg. 2012 Feb;114(2):410–5.
    1. Cunningham C, Campion S, Lunnon K, Murray CL, Woods JF, Deacon RM, et al. Systemic inflammation induces acute behavioral and cognitive changes and accelerates neurodegenerative disease. Biol Psychiatry. 2009 Feb 15;65(4):304–12.
    1. Cunningham C. Systemic inflammation and delirium: important co-factors in the progression of dementia. Biochem Soc Trans. 2011 Aug;39(4):945–53.
    1. Chedru F, Geschwind N. Disorders of higher cortical functions in acute confusional states. Cortex. 1972;8(4):395–411.
    1. Chester JG, Beth Harrington M, Rudolph JL. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med. 2012 May-Jun;7(5):450–3.
    1. Koponen H, Partanen J, Paakkonen A, Mattila E, Riekkinen PJ. EEG spectral analysis in delirium. J Neurol Neurosurg Psychiatry. 1989 Aug;52(8):980–5.
    1. Khoury M, Beaty T, Cohen H. Fundamentals of Genetic Epidemiology. Oxford: Oxford University Press; 1993.
    1. Maldonado JR. Pathoetiological model of delirium: a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment. Crit Care Clin. 2008 Oct;24(4):789–856. ix.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다