Transient Cognitive Disorders (Delirium, Acute Confusional Sates) in the Elderly

Abstract

Cognitive disorders are on the rise. Their growing importance as a medical and psychiatric problem reflects the continued increase in the number of the elderly worldwide.1,2 In the United States, there are 25.5 million persons aged 65 years and older. Dementia and delirium, the main cognitive disorders, are most common among the elderly. Recent medical editorials speak of dementia as a ``quiet epidemic'' and ``one of the greatest problems facing modern society.''3 4 The elderly, and especially the demented, are uniquely prone to transient cognitive disorders, usually referred to in the literature as delirium or acute confusional states.5 As the prevalence of dementia is expected to rise in the coming years because of the aging of the populaion, so the incidence of delirium is likely to follow suit. While dementia has attracted growing attention.6, 7 delirium in the elderly continues to be neglected.8, 9 A recent report of the Royal College of Physicians emphasizes that insufficient attention has been paid to this common and important mental disorder, one whose onset in an elderly patient usually heralds physical illness and hence calls for immediate medical evaluation.8 Furthermore, delirium is still often mistaken for an irreversible dementia. The present overview may help prevent such grave diagnostic errors in the future and stimulate sorely needed research on transient cognitive disorders.