Delirium

Abstract

Delirium in older patients is usually multifactorial in origin, and there is an inverse relationship between the severity of the insult necessary to precipitate delirium and the pre-existing vulnerability of the patient. Delirium associated with impaired cholinergic neurotransmission is contributed to by metabolites of drugs not usually thought of as having major anticholinergic effects. The cognitive effects of delirium may resolve only slowly or not at all. Neuroleptic agents appear to be superior to benzodiazepines in the pharmacological treatment of delirium. Measures to promote orientation and sleep and to avoid sensory deprivation and dehydration can prevent delirium in high-risk patients.