Skip to main content
SpringerLink
Log in

Approach to the Elderly Patient with Delirium: A Neurologist’s Perspective

  • Chapter
  • First Online:
Delirium in Elderly Patients

  • 2125 Accesses

Abstract

Delirium is more commonly seen in patients with neurological conditions involving the CNS than in those involving non-CNS sites. Particularly in conditions such as stroke, dementia, encephalopathy, CNS infections, space-occupying lesions of the CNS, head trauma, or epilepsy that have a direct effect on CNS, the risk of delirium is higher. Prevalence of delirium in patients with neurological conditions was 14.9%, with an emphasis on the role of a number of variables such as demographic and neurobiological factors in the development of dementia. Also, coexistence of two or more neurological disorders or a systemic condition is associated with an increased risk of delirium.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Allen SJ, MacGowan SH, Tyler S et al (1997) Reduced cholinergic function in normal and Alzheimer’s disease brain is associated with apolipoprotein E4 genotype. Neurosci Lett 239:33–36

    Article  CAS  Google Scholar 

  • American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (text revision), 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  • Baddeley A, Wilson B, Watts F (eds) (1995) Handbook of memory disorders. Wiley, Chichester

    Google Scholar 

  • Breitbart W, Cohen K (2000) Delirium in the terminally ill. In: Chochinov H, Breitbart W (eds) Handbook of psychiatry in palliative medicine. Oxford University Press, New York, pp 75–90

    Google Scholar 

  • Broadhurst C, Wilson K (2001) Immunology of delirium: new opportunities for treatment and research. Br J Psychiatry 179:288–289

    Article  CAS  Google Scholar 

  • Brodaty H, Ames D, Snowdon J et al (2003) A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia. J Clin Psychiatry 64:134–143

    Article  CAS  Google Scholar 

  • Brown LJ, Fordyce C, Zaghdani H et al (2011) Detecting deficits of sustained visual attention in delirium. J Neurol Neurosurg Psychiatry 82:1334–1340

    Article  Google Scholar 

  • Caeiro L, Ferro JM, Albuquerque R, Figueira ML (2004) Delirium in the first days of acute stroke. J Neurol 251:171–178

    Article  Google Scholar 

  • Cole MG, McCusker J, Bellavance F et al (2002) Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial.[see comment]. Can Med Assoc J 167(7):753–759

    Google Scholar 

  • Cole MG (2004) Delirium in elderly patients. Am J Geriatr Psychiatry 12:7–21

    Article  Google Scholar 

  • Cummings J (1995) Neuropsychiatry. In: Simpson MG (ed) Psychiatric disorders. Impact Communications, New York, pp 109–136

    Google Scholar 

  • De Deyn PP, Rabheru K, Rasmussen A et al (1999) A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia. Neurology 53:946–955

    Article  CAS  Google Scholar 

  • Earnest MP, Parker WD (1993) Metabolic encephalopathies and coma from medical causes. In: Grotta J (ed) Management of the acutely ill neurological patient. Churchill Livingstone, New York, p 1

    Google Scholar 

  • Ely EW, Shintani A, Truman B et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291(14):1753–1762

    Article  CAS  Google Scholar 

  • Engel GL, Romano J (2004) Delirium, a syndrome of cerebral insufficiency. J Neuropsychiatry Clin Neurosci 16(4):526–538

    Article  Google Scholar 

  • Flacker JM, Cummings V, Mach JR Jr et al (1998) The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry 6:31–41

    Article  CAS  Google Scholar 

  • Fong TG, Bogardus ST Jr, Daftary A et al (2006) Cerebral perfusion changes in older delirious patients using 99mTc HMPAO SPECT. J Gerontol A Biol Sci Med Sci 61:1294–1299

    Article  Google Scholar 

  • Gustafson Y, Olsson T, Asplund K, Hägg E (1993) Acute confusional state (delirium) soon after stroke is associated with hypercortisolism. Cerebrovasc Dis 3:33

    Article  Google Scholar 

  • Gustafson Y, Olsson T, Erikkson S, Bucht G (1991) Acute confusional state (delirium) in stroke patients. Cerebrovasc Dis 1:257–264

    Article  Google Scholar 

  • Hales E, Yudofsky JA (eds) (2003) The American Psychiatric Press textbook of psychiatry. American Psychiatric Publishing, Washington, DC

    Google Scholar 

  • Henon H, Lebert F, Durieu I et al (1999) Confusional state in stroke: relation to preexisting dementia, patient characteristics, and outcome. Stroke 30:773–779

    Article  CAS  Google Scholar 

  • Inao S, Kawai T, Kabeya R et al (2001) Relation between brain displacement and local cerebral blood flow in patients with chronic subdural haematoma. J Neurol Neurosurg Psychiatry 71:741–746

    Article  CAS  Google Scholar 

  • Inouye SK, Bogardus ST, Charpentier PA et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676

    Article  CAS  Google Scholar 

  • Inouye SK, Foreman MD, Mion LC et al (2001) Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 161:2467–2473

    Article  CAS  Google Scholar 

  • Inouye S, van Dyck C, Alessi C (1990) Clarifying confusion: the confusion assessment method. Ann Intern Med 113(12):941–948

    Article  CAS  Google Scholar 

  • İnouye SK, Rushing JT, Foreman MD et al (1998) Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med 13(4):234–242

    Article  Google Scholar 

  • Jacobson S, Jerrier H (2000) EEG in delirium. Semin Clin Neuropsychiatry 5:86–92

    CAS  PubMed  Google Scholar 

  • Langhorne P, Stott DJ, Robertson L et al (2000) Medical complications after stroke: a multicenter study. Stroke 31(6):1223–1229

    Article  CAS  Google Scholar 

  • Lipowski ZJ (1990) Delirium: acute confusional states. Oxford University Press, New York

    Google Scholar 

  • Maldonado JR (2008) Pathoetiological model of delirium: a comprehensive understanding of the neurobiology of delirium and an evidence-based approach to prevention and treatment. Crit Care Clin 24:789–856

    Article  CAS  Google Scholar 

  • McCusker J, Cole M, Dendukuri N et al (2001) Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ 165:575–583

    CAS  PubMed  PubMed Central  Google Scholar 

  • Meagher DJ, O’Hanlon D, O’Mahony E et al (2000) Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatr Clin Neurosci 12(1):51–56

    Article  CAS  Google Scholar 

  • Milstein A, Arak Y, Kleinman G et al (2001) The incidence of delirium immediately following cataract removal surgery: a prospective study in the elderly. Aging Mental Health 4:178–181

    Article  Google Scholar 

  • Oldenbeuving AW, de Kort PLM, Jansen BPW et al (2011) Delirium in the acute phase after stroke: incidence, risk factors, and outcome. Neurology 76:993–999

    Article  CAS  Google Scholar 

  • Oldenbeuving AW, de Kort PL, Jansen BP et al (2008) A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurol 8:34

    Article  Google Scholar 

  • Plum F, Posner JB (1982) The diagnosis of stupor and coma. FA Davis Company, Philadelphia, p 177

    Google Scholar 

  • Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. U.S. Government Printing Office, Washington, DC

    Google Scholar 

  • van Rijsbergen MWA, Oldenbeuving AW, Nieuwenhuis-Mark RE et al (2011) Delirium in acute stroke: a predictor of subsequent cognitive impairment? A two-year follow-up study. J Neurol Sci 306:138–142

    Article  Google Scholar 

  • Schuurmans MJ, Deschamps PI, Markham SW, Shortridge-Baggett LM, Duursma SA (2003) The measurement of delirium: review of scales. Res Theory Nurs Pract 17(3):207–224

    Article  Google Scholar 

  • Sharon K, Inouye SK (2006) Delirium in older persons. N Engl J Med 354:1157–1165

    Article  Google Scholar 

  • Sheng AZ, Shen Q, Cordato D et al (2006) Delirium within three days of stroke in a cohort of elderly patients. J Am Geriatr Soc 54:1192–1198

    Article  Google Scholar 

  • Siddiq N, House A, Holmes J (2006) Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Aging 35:350–364

    Article  Google Scholar 

  • Street JS, Clark WS, Gannon KS et al (2000) Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group. Arch Gen Psychiatry 57:968–976

    Article  CAS  Google Scholar 

  • Thomas C, Hestermann U, Kopitz J et al (2008) Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium. BMC Neurosci 86:1–10

    Google Scholar 

  • Trzepacz P, Mittal D, Torres R et al (2001) Validation of the delirium rating scale-revised-98: comparison with the Delirium Rating Scale and the Cognitive Test for Delirium. J Neuropsychiatry Clin Neurosci 13:229–242

    Article  CAS  Google Scholar 

  • Trzepacz PT (2000) Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 5:132–148

    CAS  PubMed  Google Scholar 

  • Van Munster BC, Korevaar JC, Zwinderman AH et al (2009) The association between delirium and the apolipoprotein E epsilon 4 allele: new study results and a meta-analysis. Am J Geriatr Psychiatry 17:856–862

    Article  Google Scholar 

  • Wolters EC, Berendese HW (2001) Management of psychosis in Parkinson’s disease. Curr Op Neurol 14:499–504

    Article  CAS  Google Scholar 

  • Young J, Inouye SK (2007) Delirium in older people. BMJ 334:842–846

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Medical Faculty, Bezmi Alem Vakıf University, Adnan Menderes Bulvarı, 34093, Fatih/Istanbul, Turkey

    Gülsen Babacan-Yildiz M.D.

Authors
  1. Gülsen Babacan-Yildiz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gülsen Babacan-Yildiz M.D. .

Editor information

Editors and Affiliations

  1. Department of Geriatric Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey

    Ahmet Turan Isik

  2. Department of Neurology and Psychiatry, Saint Louis University, School of Medicine, St. Louis, MO, USA

    George T. Grossberg

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Babacan-Yildiz, G. (2018). Approach to the Elderly Patient with Delirium: A Neurologist’s Perspective. In: Isik, A., Grossberg, G. (eds) Delirium in Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-65239-9_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-65239-9_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65237-5

  • Online ISBN: 978-3-319-65239-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation