International drive to illuminate delirium: A developing public health blueprint for action

Abstract

Presently, there is a clear societal and demographic imperative to identify and deliver interventions that are effective in reducing dementia. With the high failure rate of compounds in clinical trials, and with pharmaceutical development cycles typically lasting decades, 1 a hybrid person-with-dementia-centered approach that precisely integrates pharmaceutical, non-pharmaceutical, lifestyle modification, and care interventions for the individual may offer more immediate results for reducing dementia burden. One important, tangible, and overlooked strategy with this proposed approach may be through the recognition and prevention of delirium. Delirium is an acute, often fluctuating syndrome characterized by inattention and global cognitive dysfunction, typically triggered by sudden and severe illness, surgery, hospitalization, or by medications. Commonly manifesting as either hypoactive, hyperactive, normoactive, or mixed forms, delirium is common in older adults, especially among persons with dementia. Although dementia increases the risk for delirium, there is growing evidence that suggests that delirium may also increase the risk for dementia. This negative-feedback relationship between delirium and dementia contributes to increased suffering, morbidity, mortality, and disability costs. Delirium may accelerate How to cite this article: Khachaturian AS, Hayden KM, Devlin JW, et al. International drive to illuminate delirium: A developing public health blueprint for action. Alzheimer's

Delirium

“…Major challenges remain in the implementation of effective detection, prevention and treatment methods in mainstream clinical practice. Undoubtedly, these challenges are due to the generally poor coverage of delirium in the education and training of medical practitioners and nurses 249 as well as to the consequent low levels of awareness and skill and lack of appropriate attitudes with respect to 'ownership' of delirium care as one of the most common and serious acute medical conditions 14,250 . Another key issue is the lack of clinical implementation studies 353 .…”

“…Despite being described in Roman times, delirium has received little attention until the past three to four decades 12,13 . Although funding for delirium research and public awareness of this condition have increased, they still lag far behind other important public health-care issues 14 . In this Primer, we describe the epidemiology of delirium in different populations, the current understanding of delirium pathophysiology, and the various criteria and tools for the diagnosis, screening and monitoring of delirium.…”

Evaluation of a delirium awareness podcast for undergraduate nursing students in Northern Ireland: a pre−/post-test study

“…It is postulated that delirium affects up to 30% of hospitalised patients, nearly 80% of mechanically ventilated patients and 60% of people living in care homes [5]. Crucially, delirium is a symptom of acute illness that is often avoidable and reversible [6,7].…”

“…Internationally, delirium is poorly recognised, and this is due to a lack of a unifying definition, a lack of education, and a lack of consistent application of clinically effective assessment tools [7][8][9]. In the context of the recent COVID-19 pandemic, evidence also suggests that people who contract the virus are more likely to develop delirium as a consequence [10][11][12].…”

Delirium researchers’ perspectives of the challenges in delirium biomarker research: A qualitative study

“…To date, there has been remarkably high heterogeneity of delirium biomarker findings addressing these hypotheses. Other challenges to understanding include unsettled questions about whether delirium represents a single, unified physiological condition or whether there are physiologically discrete subtypes [ 9 ]; and ongoing terminological confusion (e.g., delirium vs acute encephalopathy) that drives specialty-specific silos [ 10 ]. These high-level issues in the conceptualization of delirium mean that high quality methodological approaches to biomarker research are critical to accelerate understanding of delirium pathophysiology in order to lead to potential therapies.…”