An Overview of Delirium in Hospitalized Adults: Prevention, Identification, and Management

Abstract

Delirium is described as an acute cognitive and attentional disorder that occurs over a short period. A rigorous cognitive evaluation and an acute history of symptoms are required for a diagnosis. It affects up to 50% of hospitalized patients above 65 years of age, costing well over US$164billion in the USA and more than $182 billion in 18 different European nations combined yearly. Delirium can be prevented by taking necessary precautions. Promising preventive measures, including cognitive stimulation, early mobilization, and medication review, have shown efficacy in reducing the incidence and severity of delirium. However, further research is warranted to deepen our understanding of the intricate interplay of risk factors and to develop precise interventions for effectively preventing and managing delirium. In this comprehensive overview, we explain the significance of early recognition of delirium by identifying the signs, symptoms and how it can be prevented and treated. Specifically, searches were conducted in PubMed and Google Scholar for systematic reviews, meta-analyses, and reviews related to the above information. The pathophysiology of delirium is complex and multifactorial. Understanding the pathophysiology of delirium involves considering various contributing factors, including neurotransmitter imbalances, inflammation, oxidative stress, and neuronal network dysfunction. While several causes exist, up to 39% of delirium episodes are due to adverse drug effects. The diagnosis is based on a comprehensive assessment that integrates clinical history, physical examination, mental status examination, laboratory investigations, and, in some cases, neuroimaging. Several differential diagnoses should be considered when evaluating a patient with delirium, such as dementia, psychosis, and mood disorders. Management of delirium requires a multidimensional approach which includes addressing underlying causes, non-pharmacological and pharmacological interventions. Future research should focus on evaluating the long-term effects of different treatment modalities and identifying personalized approaches for specific patient populations.