Therapeutische Umschau. Revue thérapeutique
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Based on actual evidence, about one third of deliria can be prevented. Hereby, preventive measures can address both delirium predisposing as well as delirium precipitating factors. ⋯ An interprofessional and interdisciplinary approach for the prevention of delirium has multiple winners: the patient, nurses and doctors.
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Deliria are a common phenomenon in clinical practise. Predisposing factors are age > 70 yr, dementia, substance abuse, and polypharmacy. ⋯ Anticholinergic and/or dopaminergic substances may also trigger deliria. This review presents medical treatment options for delirium from current literature and points out substances, which may potentially cause deliria.
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Delirium is a clinical diagnosis, which is based on observed disturbances of consciousness and cognitive dysfunction. Associated neuropsychiatric and psychomotoric symptoms are common. Many elderly delirious patients are hypoactive, manifesting a passive demeanor, reduced activity and, in extreme cases, stupor and coma. ⋯ Especially in the elderly delirium can be the only symptom of an acute and severe illness. The typical clinical findings of this illness can be missing. The clinical examination and careful use of diagnostic tools is therefore essential in the identification and treatment of delirium.
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Dementia and delirium are nosologic entities with overlapping presenting symptoms. The diagnostic criteria of dementia and of mild cognitive impairment-conceptualized as prodromal state of dementia-are discussed here and the importance of very early diagnosis of cognitive decline and the integration of information from informants in the diagnostic process is highlighted. Prominent features of vascular dementia and of dementia with Lewy bodies which are important for differential diagnosis and therapy are described.
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Drugs have been strongly associated with the development of delirium, and they are one of the most easily reversible triggers. In addition to polypharmacy, physiological changes with aging including pharmacokinetic and pharmacodynamic changes as well as medical co-morbidities can increase the susceptibility to a drug induced delirium. Since it is widely accepted that delirium represents reversible impairment of cerebral oxidative metabolism and neurotransmission [37], it is not surprising that any drug interfering with the function, the supply or the use of substrates for neurotransmitter metabolism can cause delirium. ⋯ Misinterpretation of an adverse drug reaction as another medical condition may lead to the prescription of additional medications with their own potential to cause side effects. To reduce the morbidity and mortality associated with drug induced delirium and also to prevent it, patients' medications should be closely monitored. Wherever possible, drugs with anticholinergic effects should be avoided in elderly patients, particularly in those suffering from dementia.