3 DefinitionEtiologically non-specific global cerebral dysfunction associated with changes in LOC, attention, thinking, perception, memory, psychomotor behavior, emotion and the sleep/wake cycle
4 DSM-IV CriteriaA) Change in consciousness with reduced ability to focus, sustain or shift attentionB) Change in cognition (e.g., memory, disorientation, change in language, perceptual disturbance) that is not dementiaC) Abrupt onset (hours to days) with fluctuationD) Evidence of medical condition judged to be etiologically related to disturbance
5 Characteristics Abrupt onset Disorientation, fluctuation of symptoms Hypoactive vs hyperactive vs mixedEarly signs often mistaken asanger, anxiety, depression, psychosis
6 Delirium Types Hypoactive confusion, somnolence, alertness Hyperactiveagitation, hallucinations, aggressionMixed (>60%)features of both
7 Prevalence of Delirium Common in terminally illSteifel et al: 20% of medical in-ptsMassie et al: >75% terminally illPereira et al: 44% on admission62% at death30% reversible
8 Incidence Gagnon et al, (J Pall Care 1998) 89 consecutive pts, CRS used20% delirious on admission30-40% during stay44% reversed, >50% died in deliriumAss’d with high opioid dose
9 Incidence Lawlor et al (J Pall Care 1998) 103 pts, MDAS used 50% of episodes reversibleTerminal delirium in 88%Hyperactive (3%) vs hypoactive (47%)Mixed (48%) most common
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