Materiały źródłowe

• #1 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  Delirium is a clinical syndrome that usually develops in the elderly. By definition, delirium is caused by an underlying medical condition and is not better explained by another preexisting, evolving, or established neurocognitive disorder. The underlying cause of delirium can vary widely and involve anything that stresses the baseline homeostasis of a vulnerable patient. Examples include substance intoxication or withdrawal, medication side effects, infection, surgery, metabolic derangements, pain, or even simple conditions such as constipation or urinary retention. […] Delirium is a manifestation of stress on the function of the central nervous system in a vulnerable patient. The pathophysiology is not fully understood, and there is likely no single etiology. Multiple theories describe the potential pathophysiologic causes of delirium, and any single case of delirium probably involves one or more of these theories in a complex and interconnected process.

• #1 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  There are 2 risk factors related to delirium: predisposing and precipitant factors. The most common predisposing factors are older age (older than 70 years), dementia (often not recognized clinically), functional disabilities, male gender, poor vision and hearing, and mild cognitive impairment. Alcohol use disorder and laboratory abnormalities have also been associated with an increased risk. Precipitating factors vary. However, medication side effects account for up to 39% of delirium cases. […] Other precipitating factors include surgery, anesthesia, hypoxia, untreated pain, infections, acute illness, and an acute exacerbation of chronic illness. If the patient is highly vulnerable, possibly a patient with advanced dementia, smaller disturbances such as constipation, dehydration, sleep deprivation, urinary retention, or minor medical procedures can also precipitate delirium. […] The nature of delirium is transient but can persist in patients with predisposing factors. A systematic review showed that hospital delirium persisted until discharge in 45% of cases and persisted one month later in 33% of cases.

• #1 Delirium – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386

  Delirium can often be traced to one or more factors. Factors may include a severe or long illness or an imbalance in the body, such as low sodium. The disorder also may be caused by certain medicines, infection, surgery, or alcohol or drug use or withdrawal. […] The disorder may have a single cause or more than one cause. For example, a medical condition combined with the side effects of a medicine could cause delirium. Sometimes no cause can be found. Possible causes include: Certain medicines or medicine side effects, Alcohol or drug use or withdrawal, A medical condition such as a stroke, heart attack, worsening lung or liver disease, or an injury from a fall, An imbalance in the body, such as low sodium or low calcium, Severe, long-lasting illness or an illness that will lead to death, Fever and a new infection, particularly in children, Urinary tract infection, pneumonia, the flu or COVID-19, especially in older adults, Exposure to a toxin, such as carbon monoxide, cyanide or other poisons, Poor nutrition or a loss of too much body fluid, Lack of sleep or severe emotional distress, Pain, Surgery or another medical procedure that requires being put in a sleep-like state.

• #1 Sudden confusion (delirium)

  https://www.nhs.uk/conditions/confusion/

  Sudden confusion (delirium) can have many different causes. […] Many causes of sudden confusion need to be assessed and treated as soon as possible. Sometimes it may be life threatening. […] Sudden confusion can be caused by many different things. Do not try to self-diagnose. Get medical help if someone suddenly becomes confused or delirious. […] Some of the most common causes of sudden confusion include: an infection urinary tract infections (UTIs) are a common cause in older people or people with dementia, a stroke or TIA („mini-stroke”), a low blood sugar level in people with diabetes, a head injury, some types of prescription medicine, alcohol poisoning or alcohol withdrawal, taking drugs, carbon monoxide poisoning especially if other people you live with also become unwell, a severe asthma attack or other problems with the lungs or heart, certain types of seizures caused by epilepsy.

• #1 Delirium (Causes, Symptoms, and Treatment) | Doctor

  https://patient.info/doctor/delirium-pro

  Delirium causes (aetiology)1 […] Acute infections: […] Urinary tract infection. […] Pneumonia. […] Sepsis. […] Viral infections. […] Meningitis. […] Encephalitis. […] Cerebral abscess. […] Malaria. […] Prescribed drugs: […] Benzodiazepines. […] Analgesics – eg, morphine. […] Anticholinergics. […] Anticonvulsants. […] Anti-Parkinsonism medications. […] Steroids. […] Surgical: […] Postoperative. […] Toxic substances: […] Substance misuse or withdrawal. […] Alcohol – acute intoxication or withdrawal. […] Carbon monoxide (CO) poisoning. […] Exposure to heavy metals. […] Barbiturate withdrawal. […] Vascular disorders: […] Cerebrovascular haemorrhage or infarction. […] Cardiac failure or ischaemia. […] Subdural haemorrhage. […] Subarachnoid haemorrhage.

• #1 Delirium Tremens: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/25052-delirium-tremens

  Delirium tremens (DTs) is the most severe form of alcohol withdrawal. This condition can sometimes be life-threatening. DTs is possible when someone with alcohol use disorder, especially moderate or severe alcohol use disorder, suddenly stops drinking entirely. […] The only cause of DTs is withdrawal that happens when someone with alcohol use disorder stops drinking alcohol suddenly. They usually appear between one and three days after your last drink and are usually most intense four to five days after your last drink. […] Several risk factors can make DTs more likely to happen. They include: A personal history of alcohol withdrawal symptoms, including seizures and DTs. Multiple instances of stopping heavy alcohol use. Heavy alcohol intake (the heavier the intake, the greater the risk). Any other kind of substance use disorder happening at the same time, especially sedatives or hypnotics (sleep-inducing medications). These substances also slow down your CNS. Increasing age. It becomes easier to develop DTs as you get older. Alcohol withdrawal and DTs are rare in people under age 30. Other medical problems. These include nutrition deficiencies or other medical conditions like cardiovascular disease and liver disease.

• #1 Table: Causes of Delirium-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/causes-of-delirium

  Endocrine disorders […] Adrenal insufficiency, pituitary insufficiency, Cushing syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidism […] Hematologic disorders […] Hyperviscosity syndrome, leukemic blast cell crisis, polycythemia, thrombocytosis […] Infections […] Pneumonia, sepsis, systemic infections, UTIs […] Injuries […] Burns, electrical injuries, fat embolism, heatstroke, hypothermia […] Metabolic disorders […] Acid-base disturbances, fluid and electrolyte abnormalities (eg, dehydration, hypercalcemia, hypernatremia, hypocalcemia, hyponatremia, hypomagnesemia), hepatic or uremic encephalopathy, hyperosmolality, hyperglycemia, hypoglycemia, hypoxia, Wernicke encephalopathy […] Vascular or circulatory disorders […] Anemia, cardiac arrhythmias, heart failure, hypoperfusion states, shock

• #1 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Although numerous risk factors have been described, a recent study identified 5 important independent risk factors: Use of physical restraints, Malnutrition, Use of a bladder catheter, Any iatrogenic event, Use of 3 or more medications. […] Dementia is one of the strongest most consistent risk factors. Underlying dementia is observed in 25-50% of patients. The presence of dementia increases the risk of delirium 2-3 times. Low educational level, which may be an indicator of low cognitive reserve, is associated with increased vulnerability to delirium. […] Dysphoric mood and hopelessness are also risk factors for incident delirium. […] Structural changes that may contribute to delirium include the following: Closed head injury or cerebral hemorrhage, Cerebrovascular accidents, such as cerebral infarction, subarachnoid hemorrhage, and hypertensive encephalopathy, Primary or metastatic brain tumors, Brain abscess.

• #1 Postoperative Delirium | Ausmed

  https://www.ausmed.com/learn/articles/postoperative-delirium

  Delirium can often be a direct physical consequence of a general medical condition, such as a fluid-electrolyte imbalance following surgery. It is not a degenerative process, rather, one linked with a specific medical condition that has caused changes to the individual’s normal homeostasis and bodily function (Koutoukidis et al. 2017). […] Postoperative delirium is, as the name suggests, a delirium that presents in individuals following surgery. It can be triggered by a variety of factors including: Fluid and electrolyte imbalances, Dehydration, Hypoxia, Hypercarbia, Acid-base disturbances, Infections such as respiratory, wound or urinary tract infections, Medications including anticholinergics, benzodiazepines, opioids and central nervous system depressants, Unrelieved pain, Blood loss, Decreased cardiac output, Vertebral hypoxia, Heart failure, Acute myocardial infarction, Hypothermia or hyperthermia, Unfamiliar surroundings and sensory deprivation, Emergency surgery, Alcohol withdrawal, Urinary retention, Fecal impaction. (Alagiakrishnan 2019; Farrell Dempsey 2013) […] Its important that the cause of the delirium is identified and then promptly treated in order to reverse the delirium. This is done in conjunction with the implementation of management strategies for the patient (Vijayakumar et al. 2014).

• #1 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Most causes originate outside of the brain, but delirium with primary neurological causes, such as stroke, is also recognized. […] The DSM-5 criteria for delirium are broad, with these criteria also often applying in numerous other acute neurological conditions. […] Most patients with delirium have been exposed to a variety of both predisposing and precipitating risk factors, and it can be difficult to assign one specific cause in a given case of delirium. […] Despite being described in Roman times, delirium has received little attention until the past three to four decades. […] Although funding for delirium research and public awareness of this condition have increased, they still lag far behind other important public health care issues. […] As several different factors are implicated in the aetiology of delirium, including sepsis, fractures, surgery, medication changes, hypoglycaemia and liver failure, it follows that distinct neurobiological mechanisms or combinations of them are involved in delirium pathogenesis.

• #1 What drives post-surgical delirium risk among older patients | American Medical Association

  https://www.ama-assn.org/delivering-care/population-care/what-drives-post-surgical-delirium-risk-among-older-patients

  Post-operative delirium poses challenges and concerns to doctors and patients alike in the U.S. and worldwide, said Susana Vacas, MD, PhD, a neuroanesthesiologist at Massachusetts General Hospital and Harvard Medical School. […] Trauma-induced inflammation appears to be the underlying mechanism of post-operative delirium, said Dr. Vacas during her presentation at the 2022 AMA Annual Meeting. […] This syndrome appears to affect 26% of all patients. While the reasons aren’t clear, a variety of risk factors play a role in the etiology of delirium. […] Predisposing factors include age, cognition, frailty, education, poor nutrition, alcohol-use disorder, depression and comorbidities. Type of surgery and depth of anesthesia can affect risk. Post-operative factors may include pain, sepsis or infection, electrolyte imbalance, and whether the patient had invasive lines, restraints, immobility problems or a transfusion. […] Absence of family members following a surgery is also a risk factor, said Dr. Vacas.

• #1 Delirium (Causes, Symptoms, and Treatment) | Doctor

  https://patient.info/doctor/delirium-pro

  Vasculitis – eg, systemic lupus erythematosus (SLE). […] Cerebral venous thrombosis. […] Migraines. […] Metabolic causes: […] Hypoxia. […] Electrolyte abnormalities – eg, hyponatraemia and hypercalcaemia. […] Hypoglycaemia or hyperglycaemia. […] Hepatic impairment. […] Renal impairment. […] Vitamin deficiencies: […] Thiamine deficiency. […] Nicotinic acid deficiency. […] Vitamin B12 deficiency. […] Endocrinopathies: […] Hypothyroidism and hyperthyroidism. […] Hypopituitarism. […] Hypoparathyroidism or hyperparathyroidism. […] Cushing’s syndrome. […] Porphyria. […] Carcinoid syndrome. […] Trauma: […] Head injury. […] Epilepsy: […] For example, postictally. […] Neoplasia: […] Primary cerebral malignancy. […] Secondaries in the brain. […] Paraneoplastic syndromes.

• #1 2. Causes of Delirium | ATrain Education

  https://www.atrainceu.com/content/2-causes-delirium-0

  Infections, especially widespread illness like sepsis, can cause delirium (Sonneville et al., 2013). […] A number of metabolic conditions can cause delirium. Too little or too much of some electrolytes has been implicated in delirium, specifically sodium, calcium, and magnesium. […] Vitamin deficiencies have been known to cause delirium. Wernickes encephalopathy, a severe form of thiamine (Vitamin B1) deficiency often seen in chronic alcohol abuse, is a noted cause of delirium (Oudman et al., 2014). […] Perhaps one of the most common causes of reversible delirium is abnormal blood sugar. Delirium can occur with hypoglycemia or diabetic ketoacidosis as a result of hyperglycemia (Maneeton Maneeton, 2013). […] Delirium tremens is a form of delirium that occurs during withdrawal, most notably of alcohol, but also with some drugs, such as benzodiazepines, barbiturates, other sedatives, and hypnotics (NIH, MedLine Plus, 2015; Maneeton Maneeton, 2013). […] Heavy metal toxicity is a rare but noted cause of delirium (Maneeton Maneeton, 2013).

• #1 Delirium – symptoms, diagnosis and treatment | healthdirect

  https://www.healthdirect.gov.au/delirium

  Delirium is often caused by changes in your health, such as a physical illness or infection. It can also result from a change in your prescription medicines. […] Other causes for delirium include: difficulty going to the toilet (constipation or not being able to empty your bladder), dehydration or not eating enough food, severe pain, some over-the-counter medicines, drinking a lot of alcohol, withdrawal from alcohol, cigarettes or medicines especially sleeping pills, changes in your environment, such as being in hospital. […] It is not always possible to find the cause of delirium.

• #1 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Therefore, in both rodents and humans, less-severe acute stressors, such as surgery or infections, now become sufficient to trigger delirium. […] In higher-risk individuals, delirium is a failure of the vulnerable brain to show resilience in response to an acute stressor. […] This vulnerability can be caused by a multitude of processes that are not mutually exclusive. […] Key processes include changes in brain connectivity, neuroinflammatory and glial cell alterations and vascular changes. […] First, brain network connectivity is impaired by ageing and neurodegeneration and cholinergic and noradrenergic neuronal populations degenerate with increasing age and dementia, both of which have consequences for network and cognitive function in response to acute stressors. […] Second, animal model studies show that both microglia and astrocytes are primed by existing neurodegeneration to produce exaggerated pro-inflammatory responses to secondary inflammatory stimuli, thereby exacerbating inflammation specifically in areas made vulnerable by neurodegeneration.

• #1 Delirium – PsychDB

  https://www.psychdb.com/cl/1-delirium

  Delirium is a serious neuropsychiatric syndrome characterized by an acute confusional state with global impairments in attention and cognition. […] The development of delirium can be due to multiple risk factors. Some of these risk factors are modifiable and thus a target in delirium prevention. Up to 40% of cases of delirium are preventable. […] One of the prevailing theories of the pathogenesis of delirium is acetylcholine deficiency. Acetylcholine plays an extensive role in attention and consciousness, and deficiencies are thought to result in the core symptoms of both hypoactive and hyperactive delirium. These symptoms include inattention, disorganized thinking, and hallucinations. […] Delirium etiology is typically multifactorial.

• #1 Delirium: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/288890-overview

  Delirium is defined as a transient, usually reversible, cause of mental dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. It can occur at any age, but it occurs more commonly in patients who are elderly and have a previously compromised mental status. […] Delirium is not a disease but a syndrome with multiple causes that result in a similar constellation of signs and symptoms. […] The mechanism of delirium still is not fully understood. Delirium results from a wide variety of structural or physiological insults. […] Studies have suggested a role for cytokines, such as interleukin-1 and interleukin-6, in the pathogenesis of delirium. […] Studies indicate psychosocial stress and sleep deprivation facilitate the onset of delirium. […] The specific neuronal pathways that cause delirium are unknown. Imaging studies of metabolic (eg, hepatic encephalopathy) and structural (eg, traumatic brain injury, stroke) factors support the hypothesis that certain anatomical pathways may play a more important role than others. […] Disrupted bloodbrain barrier can allow neurotoxic agents and inflammatory cytokines to enter the brain and may cause delirium.

• #1 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Furthermore, astrocytes are metabolically impaired by losing interactions with healthy neurons during neurodegeneration, further undermining their support for neuronal metabolism. […] Third, ageing and neurodegeneration also trigger alterations in the brain vasculature. […] These vascular changes lead to impaired brain perfusion and vascular reactivity, disruption of the transport of important plasma proteins into the brain and leakiness of the blood-brain barrier (BBB), potentially making the brain more vulnerable to disruption of energy or oxygen supply and the effects of circulating inflammatory molecules. […] This list is not exhaustive, and the potential for acute stress to disrupt function in the vulnerable brain can be further potentiated by poor nutrition and hydration and by ageing-associated renal and hepatic impairment, causing slower metabolism and clearance of potentially neurotoxic drugs and metabolites. […] Therefore, acute derangements occurring during acute illness or trauma have greater effects on a vulnerable brain than on a young healthy brain.

• #1 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Delirium, a condition characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. […] Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. […] Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes contributing to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity. […] Delirium is triggered by multiple potential causes, including acute medical illness, drug use or withdrawal, trauma or surgery.

• #1 Delirium | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-020-00223-4

  Delirium, a syndrome characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. […] Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. […] Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity. […] Pharmacological treatments for delirium (such as antipsychotic drugs) are not effective, reflecting substantial gaps in our understanding of its pathophysiology.

• #1 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Unraveling these mechanisms in different patient populations and clinical settings is necessary. […] However, given that multiple aetiological factors may contribute to delirium in a patient, several neurobiological mechanisms may also interact to produce the observed syndrome and it remains difficult to classify delirium based either on distinct aetiologies or on distinct neurobiological mechanisms. […] The interaction between an underlying predisposition and a superimposed acute stressor is key to delirium pathophysiology. […] Although major acute stressors (such as head injury, stroke and septic shock) can trigger delirium, even in resilient individuals, predisposing factors, such as old age, frailty and existing cognitive impairment, also substantially increase delirium risk. […] Prior cognitive impairment is a progressive risk factor: as baseline cognition decreases, delirium risk increases in a linear fashion.

• #1 Elderly delirium: possible causes & treatments | Alina Homecare

  https://alinahomecare.com/elderly-care/elderly-delirium/

  Although anyone can get delirium, there are factors which can put people at higher risk, especially those aged over 65. These include dementia, frailty, multiple medical conditions, poor hearing or vision, taking multiple medications and brain/mood disorders. […] Dementia is the biggest risk factor for delirium; as a result, delirium can be confused with dementia. […] People over 65 are particularly susceptible to delirium. Frailty in older adults can increase the risk of falls which may then result in hospital admissions or the need for surgical procedures. Hospitalisation delirium is especially common. […] People with medical conditions and existing health concerns are more susceptible to delirium. In fact, the chances of developing delirium are highest in people with cancer, AIDS and terminal illness as well as those who have invasive surgical procedures such as hip replacement and cardiac surgery.

• #1 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics

  Sudden withdrawal of a regular prescribed or nonprescribed drug or cessation of regular alcohol use can cause delirium. […] However, in other cases, delirium can be due to temporary dysfunction arising in the brain, such as an epileptic seizure, a threatened stroke (transient ischemic attack [TIA]), or a concussion. […] Certain underlying conditions increase the risk of delirium: Advanced age, underlying brain diseases such as dementia, stroke, or Parkinson disease, particularly when there are current problems with memory, use of multiple medications (particularly psychiatric drugs and sedatives), or multiple medical problems, frailty, malnutrition, immobility, advanced cancer, undertreated pain, immobilization, including physical restraints, use of bladder catheters, limb fractures, interventions, including diagnostic tests, poor eyesight or hearing, sleep deprivation, organ failure (eg, chronic lung disease; heart, kidney, or liver failure). […] Nearly 30 percent of older patients experience delirium at some time during hospitalization; the incidence is higher in intensive care units. Among older patients who have had surgery, the risk of delirium varies from 10 to greater than 50 percent.

• #1 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Other causes may include postictal state and unfamiliar environment. […] Delirium may come about as a result of surgery or operation. Preoperative (dementia, polypharmacy, fluid and electrolyte imbalance), Intraoperative (meperidine, long-acting benzodiazepines, anticholinergics such as atropine; however, medications such as glycopyrrolate can be used because, in contrast to atropine, they do not cross the blood brain barrier), Postoperative (hypoxia, hypotension, drug withdrawal). […] Mild cognitive impairment and vascular risk factors can be independent risk factors for postoperative delirium. […] Drugs are a common risk factor for delirium, and drug-induced delirium is commonly seen in medical practice, especially in hospital settings. The risk of anticholinergic toxicity is greater in elderly persons, and the risk of inducing delirium by medications is high in frail, elderly persons and in those with dementia.

• #1 Patients and Families Overview

  https://www.icudelirium.org/patients-and-families/overview

  Delirium is common. About 2 out of 3 patients in ICUs get delirium. Seven out of 10 patients get delirium while they are on a breathing machine or soon after. Experts think delirium is caused by a change in the way the brain is working. This can be caused by: […] Delirium was the number one predictive factor for cognitive impairment. […] People most likely to get delirium are those who: […] Patients with dementia are more likely to develop delirium. […] Research shows that patients who develop delirium might have dementia-like thinking problems that can last for months.

• #1 Delirium Etiology

  https://www.icudelirium.org/medical-professionals/delirium/delirium-etiology

  Most patients with delirium in the ICU likely have multiple causes, though these causes are often very difficult to determine with clinical precision. […] The exact pathophysiological mechanisms involved in the development and progression of delirium are a point of controversy. However, these mechanisms are thought to be related both to: […] Higher cortical areas of the brain such as the prefrontal and non-dominant posterior parietal regions are implicated by CT/MRI or SPECT scans in delirium. […] Derangements in levels of serotonin, acetylcholine deficiency and dopamine excess (to name 3) are thought to contribute to delirium, but there are many other neurotransmitters that may be involved. […] Such derangements could be secondary to a number of causal factors that include reduction in cerebral metabolism, primary intracranial disease, systemic diseases, secondary infection of the brain, exogenous toxic agents, withdrawal from substances of abuse such as alcohol or sedative-hypnotics agents, hypoxemia and metabolic disturbances, and the administration of psychoactive medications such as benzodiazepines and narcotics. […] Minimizing the use of benzodiazepines such as lorazepam is likely an area of focus that may reduce either the onset or duration of delirium.

• #1 End of Life Care in Frailty: Delirium | British Geriatrics Society

  https://www.bgs.org.uk/resources/end-of-life-care-in-frailty-delirium

  Delirium acute confusion – is important to consider at the end of life. […] Delirium is 10 times more common in those with dementia. […] Any medical condition can cause delirium, and more than half of cases have multiple potential causes. […] At the end of life this may be the underlying condition (cancer, hypoxia, infection), surgery, a complication, a drug side-effect (especially higher doses of opiates, anticholinergics such as hyoscine, and polypharmacy), or drug withdrawal (following de-prescribing, or alcohol withdrawal). […] Estimates are difficult, but up to half of delirium at the end of life can be alleviated.

• #1

  https://link.springer.com/article/10.1007/s41999-019-00276-z

  Distress in delirium causes significant morbidity for patients and their relatives, but it remains under recognised. […] This review discusses the current literature regarding distress in delirium: its aetiology, available assessment tools and potential avenues for management. […] Both significant illness and delirium cause distress. […] Evidence shows that delirium in this setting is associated with psychological morbidity, including symptoms of Post-traumatic Stress Disorder (PTSD), anxiety and depression. […] However, persistent delusional memories at 3 months are associated with development of PTSD, independent of illness severity, suggesting that the presence of delirium may in itself be an independent cause of distress. […] Delirium is common at the end of life. […] The phenotypic features of delirium and association with DID vary between clinical settings.

• #1 What is Delirium? | American Delirium Society

  https://americandeliriumsociety.org/patients-families/what-is-delirium/

  Many things can cause delirium including medications, infections and lack of sleep. […] Often, a combination of factors precipitate delirium. […] The important point is that doctors and other health care providers should look for the causes and treat them; and they should be aware of medical interventions that might bring about or worsen delirium. […] Identifying the underlying causes of delirium and treating them quickly can help mitigate the length and severity of delirious episodes.

• #1 Delirium – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371391

  A health care provider can diagnose delirium based on medical history and tests of mental status. The provider also will consider factors that may have caused the disorder. […] The first goal of delirium treatment is to address any causes or triggers. That may include stopping certain medicines, treating an infection or treating an imbalance in the body. […] If you’re a family member or caregiver of someone who has delirium, talk with the health care provider about medicines that may trigger the symptoms. […] Other types of medicines may help calm a person who is agitated or confused. Or medicines may be needed if the person is showing distrust of others, is fearful or is seeing things that others don’t see.

• #1 Delirium | health.vic.gov.au

  https://www.health.vic.gov.au/older-people-in-hospital/cognition-dementia-delirium-and-depression/delirium

  Delirium is an acute disturbance in a persons attention, awareness and cognition that can be caused by an acute medical condition or medication changes. Delirium may be caused by general medical conditions (for example, infections, hypoxia), certain medications, intoxicating substances or a combination of these. […] Delirium is common in older patients, yet it is often overlooked, misdiagnosed and poorly managed. This can lead to the person experiencing falls, incontinence, malnutrition, dehydration, infections and pressure injuries. […] Delirium can cause longer lasting cognitive impairments in patients after surgery and may lead to permanent cognitive decline and dementia in some patients. […] A range of factors affects an older persons risk of developing delirium in hospital. Some factors are predisposing, that is they are related to characteristics of the person; some are precipitating, that is they are related to the persons illness or the hospital environment. Delirium involves an interaction between the patients predisposing vulnerabilities, which puts them at greater risk when faced with precipitating factors. […] Delirium is preventable in 30-40 per cent of cases.

• #2 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Delirium, a condition characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. […] Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. […] Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes contributing to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity. […] Delirium is triggered by multiple potential causes, including acute medical illness, drug use or withdrawal, trauma or surgery.

• #2 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics

  Sudden withdrawal of a regular prescribed or nonprescribed drug or cessation of regular alcohol use can cause delirium. […] However, in other cases, delirium can be due to temporary dysfunction arising in the brain, such as an epileptic seizure, a threatened stroke (transient ischemic attack [TIA]), or a concussion. […] Certain underlying conditions increase the risk of delirium: Advanced age, underlying brain diseases such as dementia, stroke, or Parkinson disease, particularly when there are current problems with memory, use of multiple medications (particularly psychiatric drugs and sedatives), or multiple medical problems, frailty, malnutrition, immobility, advanced cancer, undertreated pain, immobilization, including physical restraints, use of bladder catheters, limb fractures, interventions, including diagnostic tests, poor eyesight or hearing, sleep deprivation, organ failure (eg, chronic lung disease; heart, kidney, or liver failure). […] Nearly 30 percent of older patients experience delirium at some time during hospitalization; the incidence is higher in intensive care units. Among older patients who have had surgery, the risk of delirium varies from 10 to greater than 50 percent.

• #2 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Unraveling these mechanisms in different patient populations and clinical settings is necessary. […] However, given that multiple aetiological factors may contribute to delirium in a patient, several neurobiological mechanisms may also interact to produce the observed syndrome and it remains difficult to classify delirium based either on distinct aetiologies or on distinct neurobiological mechanisms. […] The interaction between an underlying predisposition and a superimposed acute stressor is key to delirium pathophysiology. […] Although major acute stressors (such as head injury, stroke and septic shock) can trigger delirium, even in resilient individuals, predisposing factors, such as old age, frailty and existing cognitive impairment, also substantially increase delirium risk. […] Prior cognitive impairment is a progressive risk factor: as baseline cognition decreases, delirium risk increases in a linear fashion.

• #2 Delirium | MedlinePlus

  https://medlineplus.gov/delirium.html

  There are many different problems that can cause delirium. Some of the more common causes include: […] Advanced cancer. […] Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol use disorder (AUD). […] Dehydration and electrolyte imbalances. […] Dementia. […] Hospitalization, especially in intensive care. […] Infections, such as urinary tract infections, pneumonia, and the flu. […] Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be from withdrawal after stopping a medicine. […] Metabolic disorders. […] Organ failure, such as kidney or liver failure. […] Poisoning. […] Serious illnesses. […] Severe pain. […] Sleep deprivation. […] Surgeries, including reactions to anesthesia.

• #2 Patient education: Delirium (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/delirium-beyond-the-basics

  Delirium can be triggered by a serious medical illness such as an infection, certain medications, and other causes, such as drug withdrawal or intoxication. […] It is not clear why or how delirium develops. There are many potential causes, with the most common including infections, medications, and organ failure (such as severe lung or liver disease). […] Sepsis, a life-threatening illness caused by the body’s response to severe infection, is often associated with changes in brain function even among people who are young and previously healthy. […] A urinary tract infection or dehydration can cause delirium in certain people. […] The time after surgery (called the postoperative period) is a common time for delirium to develop, especially in older people. […] Patients with respiratory infections (eg, coronavirus disease 2019 [COVID-19]) may experience delirium during the acute phase of their illness, and some may also experience persistent memory and attention deficits („brain fog”) for months thereafter.

• #2 Delirium: Types, Causes, and Treatment

  https://www.healthline.com/health/delirium

  Delirium happens when stressors like inflammation or infection interfere with your brain function. There are many possible causes. […] Any condition or factor that significantly changes your brain function can cause severe mental confusion. These include: […] Medication side effects are a major cause of delirium. Up to 39% of the time, delirium is caused by medications.

• #2 Delirium (Causes, Symptoms, and Treatment) | Doctor

  https://patient.info/doctor/delirium-pro

  Vasculitis – eg, systemic lupus erythematosus (SLE). […] Cerebral venous thrombosis. […] Migraines. […] Metabolic causes: […] Hypoxia. […] Electrolyte abnormalities – eg, hyponatraemia and hypercalcaemia. […] Hypoglycaemia or hyperglycaemia. […] Hepatic impairment. […] Renal impairment. […] Vitamin deficiencies: […] Thiamine deficiency. […] Nicotinic acid deficiency. […] Vitamin B12 deficiency. […] Endocrinopathies: […] Hypothyroidism and hyperthyroidism. […] Hypopituitarism. […] Hypoparathyroidism or hyperparathyroidism. […] Cushing’s syndrome. […] Porphyria. […] Carcinoid syndrome. […] Trauma: […] Head injury. […] Epilepsy: […] For example, postictally. […] Neoplasia: […] Primary cerebral malignancy. […] Secondaries in the brain. […] Paraneoplastic syndromes.

• #2 Delirium Tremens: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/25052-delirium-tremens

  The main underlying issue that causes DTs is alcohol use disorder. The long-term goal after treating DTs is to treat alcohol use disorder. There are many treatment approaches for alcohol use disorder. Receiving treatment for it can help reduce the odds of developing DTs in the future. […] The only definitive way to prevent DTs is to avoid alcohol entirely.

• #2 Delirium – Brain, Spinal Cord, and Nerve Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/brain-spinal-cord-and-nerve-disorders/delirium-and-dementia/delirium

  Delirium can result from less severe conditions in older adults and in people who have had a stroke or who have dementia, Parkinson disease, or brain damage due to another condition. […] In some people, no cause can be identified. […] Delirium is also very common after surgery, probably because of the stress of surgery, the anesthetics used during surgery, and the pain relievers (analgesics) used after surgery. […] The most common reversible cause of delirium is use of medications and recreational or illicit drugs. […] Delirium can also result from suddenly stopping a medication or drug that has been taken for a long timefor example, a sedative (such as a benzodiazepine or barbiturate) or an opioid pain reliever. […] Abnormal blood levels of electrolytes, such as calcium, sodium, or magnesium, can interfere with the metabolic activity of nerve cells and lead to delirium.

• #2 Table: Causes of Delirium-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/causes-of-delirium

  Endocrine disorders […] Adrenal insufficiency, pituitary insufficiency, Cushing syndrome, hyperparathyroidism, hyperthyroidism, hypothyroidism […] Hematologic disorders […] Hyperviscosity syndrome, leukemic blast cell crisis, polycythemia, thrombocytosis […] Infections […] Pneumonia, sepsis, systemic infections, UTIs […] Injuries […] Burns, electrical injuries, fat embolism, heatstroke, hypothermia […] Metabolic disorders […] Acid-base disturbances, fluid and electrolyte abnormalities (eg, dehydration, hypercalcemia, hypernatremia, hypocalcemia, hyponatremia, hypomagnesemia), hepatic or uremic encephalopathy, hyperosmolality, hyperglycemia, hypoglycemia, hypoxia, Wernicke encephalopathy […] Vascular or circulatory disorders […] Anemia, cardiac arrhythmias, heart failure, hypoperfusion states, shock

• #2 Table: Causes of Delirium-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/causes-of-delirium

  Causes of Delirium […] Neurologic causes […] Cerebrovascular disorders […] Hemorrhagic stroke, ischemic stroke, transient ischemia attack […] Inflammation or infection […] Acute demyelinating encephalomyelitis, brain abscess, CNS vasculitis, autoimmune encephalopathy, encephalitis, meningitis, meningoencephalitis […] Seizure disorders […] Nonconvulsive status epilepticus, postictal state […] Trauma […] Subdural hematoma, traumatic brain injury […] Tumor […] Meningeal carcinomatosis, primary or metastatic brain tumor […] Nonneurologic causes […] Medications and recreational drugs (numerous) […] Anticholinergics, antiemetics, antihistamines (eg, diphenhydramine), antihypertensives, some antimicrobials, antipsychotics, antispasmodics, benzodiazepines, cardiovascular medications (often beta-blockers), cimetidine, corticosteroids, digoxin, dopamine agonists, hypnotics, muscle relaxants, NSAIDs, opioids, recreational drugs, sedatives, tricyclic antidepressants

• #2 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Other causes may include postictal state and unfamiliar environment. […] Delirium may come about as a result of surgery or operation. Preoperative (dementia, polypharmacy, fluid and electrolyte imbalance), Intraoperative (meperidine, long-acting benzodiazepines, anticholinergics such as atropine; however, medications such as glycopyrrolate can be used because, in contrast to atropine, they do not cross the blood brain barrier), Postoperative (hypoxia, hypotension, drug withdrawal). […] Mild cognitive impairment and vascular risk factors can be independent risk factors for postoperative delirium. […] Drugs are a common risk factor for delirium, and drug-induced delirium is commonly seen in medical practice, especially in hospital settings. The risk of anticholinergic toxicity is greater in elderly persons, and the risk of inducing delirium by medications is high in frail, elderly persons and in those with dementia.

• #2 Table: Causes of Delirium-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/causes-of-delirium

  Vitamin deficiency […] Thiamin deficiency, vitamin B12 deficiency […] Withdrawal syndromes […] Alcohol, barbiturates, benzodiazepines, opioids […] Other causes […] Change of environment, fever, fecal impaction, hypertensive encephalopathy, liver failure, long stays in an ICU, mental disorders, postoperative states, sensory deprivation, sleep deprivation, hyperthermia, toxins that affect the CNS, urinary retention.

• #2 2. Causes of Delirium | ATrain Education

  https://www.atrainceu.com/content/2-causes-delirium-0

  One of the difficulties in adequately recognizing delirium is that so many conditions can cause it. Some of the major causes leading to delirium include neurologic issues, medications, infection, dehydration, metabolic changes, fecal impaction, and urinary retention (Maneeton Maneeton, 2013; Cavallazzi et al., 2012). […] Urinary retention and fecal impaction are commonly cited causes delirium (Gower et al., 2012). […] Issues with the central nervous system (CNS) can cause delirium. This might seem obvious because delirium is, in fact, a CNS manifestation. While head trauma or even stroke may first come to mind as causes, other conditions such as hypertensive encephalopathy, intracranial neoplasm, and epilepsy can also cause delirium (Maneeton Maneeton, 2013). […] A wide variety of medications can trigger delirium, and can include everything from antibiotics, antidepressants, antipsychotics, lithium, to sedatives and many more.

• #2 Sudden confusion (delirium)

  https://www.nhs.uk/conditions/confusion/

  Sudden confusion (delirium) can have many different causes. […] Many causes of sudden confusion need to be assessed and treated as soon as possible. Sometimes it may be life threatening. […] Sudden confusion can be caused by many different things. Do not try to self-diagnose. Get medical help if someone suddenly becomes confused or delirious. […] Some of the most common causes of sudden confusion include: an infection urinary tract infections (UTIs) are a common cause in older people or people with dementia, a stroke or TIA („mini-stroke”), a low blood sugar level in people with diabetes, a head injury, some types of prescription medicine, alcohol poisoning or alcohol withdrawal, taking drugs, carbon monoxide poisoning especially if other people you live with also become unwell, a severe asthma attack or other problems with the lungs or heart, certain types of seizures caused by epilepsy.

• #2 Delirium Etiology

  https://www.icudelirium.org/medical-professionals/delirium/delirium-etiology

  Most patients with delirium in the ICU likely have multiple causes, though these causes are often very difficult to determine with clinical precision. […] The exact pathophysiological mechanisms involved in the development and progression of delirium are a point of controversy. However, these mechanisms are thought to be related both to: […] Higher cortical areas of the brain such as the prefrontal and non-dominant posterior parietal regions are implicated by CT/MRI or SPECT scans in delirium. […] Derangements in levels of serotonin, acetylcholine deficiency and dopamine excess (to name 3) are thought to contribute to delirium, but there are many other neurotransmitters that may be involved. […] Such derangements could be secondary to a number of causal factors that include reduction in cerebral metabolism, primary intracranial disease, systemic diseases, secondary infection of the brain, exogenous toxic agents, withdrawal from substances of abuse such as alcohol or sedative-hypnotics agents, hypoxemia and metabolic disturbances, and the administration of psychoactive medications such as benzodiazepines and narcotics. […] Minimizing the use of benzodiazepines such as lorazepam is likely an area of focus that may reduce either the onset or duration of delirium.

• #2 Delirium – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium

  Stress of any kind upregulates sympathetic tone and downregulates parasympathetic tone, impairing cholinergic function and thus contributing to delirium. Older adults are particularly vulnerable to reduced cholinergic transmission, increasing their risk of delirium. […] Delirium can be a common presenting symptom in older patients with infection.

• #2 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Furthermore, astrocytes are metabolically impaired by losing interactions with healthy neurons during neurodegeneration, further undermining their support for neuronal metabolism. […] Third, ageing and neurodegeneration also trigger alterations in the brain vasculature. […] These vascular changes lead to impaired brain perfusion and vascular reactivity, disruption of the transport of important plasma proteins into the brain and leakiness of the blood-brain barrier (BBB), potentially making the brain more vulnerable to disruption of energy or oxygen supply and the effects of circulating inflammatory molecules. […] This list is not exhaustive, and the potential for acute stress to disrupt function in the vulnerable brain can be further potentiated by poor nutrition and hydration and by ageing-associated renal and hepatic impairment, causing slower metabolism and clearance of potentially neurotoxic drugs and metabolites. […] Therefore, acute derangements occurring during acute illness or trauma have greater effects on a vulnerable brain than on a young healthy brain.

• #2 What drives post-surgical delirium risk among older patients | American Medical Association

  https://www.ama-assn.org/delivering-care/population-care/what-drives-post-surgical-delirium-risk-among-older-patients

  Post-operative delirium poses challenges and concerns to doctors and patients alike in the U.S. and worldwide, said Susana Vacas, MD, PhD, a neuroanesthesiologist at Massachusetts General Hospital and Harvard Medical School. […] Trauma-induced inflammation appears to be the underlying mechanism of post-operative delirium, said Dr. Vacas during her presentation at the 2022 AMA Annual Meeting. […] This syndrome appears to affect 26% of all patients. While the reasons aren’t clear, a variety of risk factors play a role in the etiology of delirium. […] Predisposing factors include age, cognition, frailty, education, poor nutrition, alcohol-use disorder, depression and comorbidities. Type of surgery and depth of anesthesia can affect risk. Post-operative factors may include pain, sepsis or infection, electrolyte imbalance, and whether the patient had invasive lines, restraints, immobility problems or a transfusion. […] Absence of family members following a surgery is also a risk factor, said Dr. Vacas.

• #2 Delirium

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/

  Therefore, in both rodents and humans, less-severe acute stressors, such as surgery or infections, now become sufficient to trigger delirium. […] In higher-risk individuals, delirium is a failure of the vulnerable brain to show resilience in response to an acute stressor. […] This vulnerability can be caused by a multitude of processes that are not mutually exclusive. […] Key processes include changes in brain connectivity, neuroinflammatory and glial cell alterations and vascular changes. […] First, brain network connectivity is impaired by ageing and neurodegeneration and cholinergic and noradrenergic neuronal populations degenerate with increasing age and dementia, both of which have consequences for network and cognitive function in response to acute stressors. […] Second, animal model studies show that both microglia and astrocytes are primed by existing neurodegeneration to produce exaggerated pro-inflammatory responses to secondary inflammatory stimuli, thereby exacerbating inflammation specifically in areas made vulnerable by neurodegeneration.

• #2 Elderly delirium: possible causes & treatments | Alina Homecare

  https://alinahomecare.com/elderly-care/elderly-delirium/

  Elderly people are more likely to develop cognitive impairment as a result of taking medications. Multiple medications have been associated with the development of delirium in the elderly, so a preventative factor is to avoid prescribing new medications to someone whos at higher risk of developing the condition. The successful treatment of delirium depends on identifying contributing factors and reversing them; therefore, early diagnosis of drug-induced delirium and withdrawing medications is essential.

• #2 What is delirium? Symptoms, causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/326684

  Medical professionals do not yet fully understand delirium, but it seems to have an association with older age, alcohol withdrawal, and certain medical conditions. […] Delirium can occur as a result of aging, alcohol withdrawal, certain medications, and underlying medical conditions. […] According to the authors of a 2013 article, there is a link between delirium and adverse health outcomes, such as extended hospital stays, faster cognitive decline, and a higher likelihood of developing dementia. […] Medical professionals do not know the exact cause of delirium. However, inflammation of the brain, imbalances in neurotransmitters, and chronic stress may all play a role in the onset of symptoms. […] Causes of delirium can include: infections, such as pneumonia and urinary tract infections; imbalances in acetylcholine or dopamine levels; brain tumors; head trauma; kidney or liver failure; alcohol, medicine, or drug misuse; certain medications, such as blood pressure medications, sleeping pills, and sedatives; exposure to toxic substances; extreme sleep deprivation. […] People over the age of 70 years have a higher risk of delirium. […] Infections, chemical imbalances, and certain medications can cause delirium.

• #2

  https://link.springer.com/article/10.1007/s41999-019-00276-z

  Severity of DID is associated with extent of recall of the delirium episode. […] Duration of delirium is an independent predictor of subsequent severity of global cognition and executive dysfunction. […] Distress in delirium occurs during the episode of delirium, can persist for months or years and is associated with long-term psychological morbidity. […] Patients experience long term psychological consequences from DID. […] Relatives experience distress in witnessing family members with delirium. […] Importantly, relatives degree of distress can be higher than those reported by the patients themselves, and can cause relatives long term psychological harm. […] Professional carers and healthcare staff experience distress when caring for patients with delirium. […] While there is a significant body of literature investigating both management and prevention of delirium, the existing evidence for managing DID is limited.

• #2 Ask the Expert: Prevention and Treatment of Post-Operative Delirium | HealthInAging.org

  https://www.healthinaging.org/tools-and-tips/ask-expert-prevention-and-treatment-post-operative-delirium

  Delirium can have many causes for example, drugs, infection, electrolyte imbalance, and not being able to move around (immobilization). The impact of surgery alone can cause delirium in some older adults. […] Studies have shown delirium is preventable up to 40% of the time for older adults in the hospital. Some causes of delirium can be managed so they do not happen or get worse. […] Delirium can affect how an older person recovers from illness or surgery. If delirium is not treated, or treatment is delayed, it can cause an older persons mental and physical functions to get worse. […] The initial goal in treating delirium is to figure out what is causing the delirium, and correcting the problem. The healthcare professional will try to identify the condition and the specific cause as quickly as possible. […] The healthcare professional should identify and manage underlying causes of delirium.

• #2 Delirium: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000740.htm

  Delirium is sudden severe confusion due to rapid changes in brain function that can occur with physical or mental illness. […] Delirium is most often caused by physical or mental illness and is usually temporary and reversible. Many disorders may cause delirium. Often, these disorders do not allow the brain to get oxygen or other substances. They may also cause dangerous chemicals (toxins) to build up in the brain. […] Causes include: Alcohol or medicine overdose or withdrawal, Drug use or overdose, including being sedated in the ICU, Electrolyte or other body chemical disturbances, Infections such as urinary tract infections, pneumonia, or meningitis, Severe lack of sleep, Poisons, General anesthesia and surgery, Autoimmune disease. […] Treating the conditions that cause delirium can reduce its risk.

• #2 Causes of Delirium | American Geriatrics Society | HealthInAging.org

  https://www.healthinaging.org/a-z-topic/delirium/causes

  People at higher risk of delirium include older adults and people: […] Delirium can have one cause or multiple causes. Treating just one cause probably wont be enough. All possible causes need treatment when possible. The healthcare provider needs to find as many causes as possible and treat those that are reversible. […] These causes are related to: […] Delirium can also come from:

• #2 Delirium | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-020-00223-4

  This paper represents the clearest demonstration that progressive cognitive decline is a progressively increasing risk factor for delirium and also demonstrates, in mice, that this decline is correlated with increasing synaptic loss and can precede frank neurodegeneration. […] A joint position paper of ten international societies on the near complete segregation of the literature on delirium from that on encephalopathy, with recommendations to separate the underlying brain pathological state, namely encephalopathy, from the manifest clinical features, namely delirium.

• #3 Delirium: What It Is, Symptoms, Treatment & Types

  https://my.clevelandclinic.org/health/diseases/15252-delirium

  Delirium is a type of confusion that happens when the combined strain of illnesses, environmental circumstances or other risk factors disrupts your brain function. […] Available research indicates that delirium is a complex condition that doesn’t happen for a single reason. Instead, delirium occurs when the balancing act between your functional capacity, your functional limitations and other stressors gets pushed too far. […] The possible factors that can contribute to developing delirium in a medical setting include: Conditions you have. People with dementia have a higher risk of developing delirium. Many conditions, such as cancer, infections (including HIV, pneumonia or COVID-19), sepsis or stroke can make it more likely to happen. […] Several risk factors can make it easier to develop delirium. They include: Age (especially 65 and older). Many changes that happen naturally as you age also increase your risk of developing delirium. […] Delirium can affect your physical and mental health, quality of life and your overall sense of well-being, especially when it’s severe. In more severe or long-lasting cases, delirium can cause you to develop dementia or make existing dementia worse.

• #3 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Although numerous risk factors have been described, a recent study identified 5 important independent risk factors: Use of physical restraints, Malnutrition, Use of a bladder catheter, Any iatrogenic event, Use of 3 or more medications. […] Dementia is one of the strongest most consistent risk factors. Underlying dementia is observed in 25-50% of patients. The presence of dementia increases the risk of delirium 2-3 times. Low educational level, which may be an indicator of low cognitive reserve, is associated with increased vulnerability to delirium. […] Dysphoric mood and hopelessness are also risk factors for incident delirium. […] Structural changes that may contribute to delirium include the following: Closed head injury or cerebral hemorrhage, Cerebrovascular accidents, such as cerebral infarction, subarachnoid hemorrhage, and hypertensive encephalopathy, Primary or metastatic brain tumors, Brain abscess.

• #3 Causes of Delirium | Geri-EM

  https://geri-em.com/cognitive-impairment/causes-of-delirium/

  Almost any medical illness, intoxication, or medication can cause delirium. Delirium is often multifactorial in etiology and each potential cause should be investigated. […] Infections are the most commonly encountered cause of geriatric delirium. […] Medications are the most common reversible causes of geriatric delirium. […] Causes of delirium can vary from patient to patient but most common is a source of infection like a UTI or even skin or wound infection. […] The most common cause may be a UTI in women but not necessarily in men. […] We find frequently in the ED that UTIs are a common cause of delirium. […] Obtaining a decent history is the cornerstone to determining the patient’s baseline and potential underlying causes.

• #3 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Metabolic causes may include the following: Fluid and electrolyte abnormalities, acid-base disturbances, and hypoxia, Hypoglycemia, Hepatic or renal failure, Vitamin deficiency states (especially thiamine and cyanocobalamin), Endocrinopathies associated with the thyroid and parathyroid. […] Hypoperfusion states such as shock congestive heart failure, cardiac arrhythmias, and anemias may contribute to delirium. […] Infectious causes may include the following: CNS infections such as meningitis, Encephalitis, HIV-related brain infections, Septicemia, Pneumonia, Urinary tract infections. […] Substance intoxication with alcohol, heroin, cannabis, PCP, and LSD may cause symptoms of delirium. Withdrawal from these substances may also contribute. […] Medication-induced delirium can be caused by any of the following agents: Anticholinergics (Benadryl, tricyclic antidepressants), Narcotics (meperidine), Sedative hypnotics (benzodiazepines), Histamine-2 (H2) blockers (cimetidine), Corticosteroids, Centrally acting antihypertensives (methyldopa, reserpine), Anti-Parkinson drugs (levodopa).

• #3 2. Causes of Delirium | ATrain Education

  https://www.atrainceu.com/content/2-causes-delirium-0

  Infections, especially widespread illness like sepsis, can cause delirium (Sonneville et al., 2013). […] A number of metabolic conditions can cause delirium. Too little or too much of some electrolytes has been implicated in delirium, specifically sodium, calcium, and magnesium. […] Vitamin deficiencies have been known to cause delirium. Wernickes encephalopathy, a severe form of thiamine (Vitamin B1) deficiency often seen in chronic alcohol abuse, is a noted cause of delirium (Oudman et al., 2014). […] Perhaps one of the most common causes of reversible delirium is abnormal blood sugar. Delirium can occur with hypoglycemia or diabetic ketoacidosis as a result of hyperglycemia (Maneeton Maneeton, 2013). […] Delirium tremens is a form of delirium that occurs during withdrawal, most notably of alcohol, but also with some drugs, such as benzodiazepines, barbiturates, other sedatives, and hypnotics (NIH, MedLine Plus, 2015; Maneeton Maneeton, 2013). […] Heavy metal toxicity is a rare but noted cause of delirium (Maneeton Maneeton, 2013).

• #3 Delirium – Brain, Spinal Cord, and Nerve Disorders – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/brain-spinal-cord-and-nerve-disorders/delirium-and-dementia/delirium

  Blood sugar levels that are extremely high (hyperglycemia) or low (hypoglycemia) commonly cause delirium. […] An underactive thyroid gland (hypothyroidism) causes delirium with sluggishness (lethargy). An overactive thyroid gland (hyperthyroidism) causes delirium with hyperactivity. […] If liver failure or kidney failure develops and is not diagnosed, a medication that a person has been taking for a long time can cause delirium, even though it previously caused no problems. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium may be the first symptom in older adults with a viral disease, such as COVID-19 or influenza. […] In older adults, delirium can result from any condition that causes delirium in younger people. But it can also result from less severe conditions, such as dehydration, a disorder that normally does not affect thinking, such as a urinary tract infection, influenza, or deficiency of thiamin or vitamin B12.

• #3 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Almost any medical illness, intoxication, or medication can cause delirium. Often, delirium is multifactorial in etiology, and the physician treating the delirium should investigate each cause contributing to it. Medications are the most common reversible cause of delirium. […] Some of the other common reversible causes include the following: Hypoxia, Hypoglycemia, Hyperthermia, Anticholinergic delirium, Alcohol or sedative withdrawal. […] Other causes of delirium include the following: Infections, Metabolic abnormalities, Structural lesions of the brain, Postoperative states, Miscellaneous causes, such as sensory deprivation, sleep deprivation, fecal impaction, urinary retention, and change of environment. […] In persons who are elderly, medications at therapeutic doses and levels can cause delirium.

• #3 Delirium: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/288890-overview

  Delirium is defined as a transient, usually reversible, cause of mental dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. It can occur at any age, but it occurs more commonly in patients who are elderly and have a previously compromised mental status. […] Delirium is not a disease but a syndrome with multiple causes that result in a similar constellation of signs and symptoms. […] The mechanism of delirium still is not fully understood. Delirium results from a wide variety of structural or physiological insults. […] Studies have suggested a role for cytokines, such as interleukin-1 and interleukin-6, in the pathogenesis of delirium. […] Studies indicate psychosocial stress and sleep deprivation facilitate the onset of delirium. […] The specific neuronal pathways that cause delirium are unknown. Imaging studies of metabolic (eg, hepatic encephalopathy) and structural (eg, traumatic brain injury, stroke) factors support the hypothesis that certain anatomical pathways may play a more important role than others. […] Disrupted bloodbrain barrier can allow neurotoxic agents and inflammatory cytokines to enter the brain and may cause delirium.

• #3 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  Anyone can get delirium, but some people are more likely to develop it. These factors put people at higher risk: having dementia this is the biggest single risk factor for delirium, being older than 65, being frail or having multiple medical conditions, poor hearing or vision, being in an unfamiliar or disorientating environment, being sleep deprived, not being able to sit up or move around, taking certain medications, particularly those that cause drowsiness, having already had delirium in the past. […] Delirium is treated by resolving the health problems that have caused it. Once this is done, its important to make conditions as ideal as possible for the persons brain to recover. […] However, the symptoms of delirium will usually improve once its causes are found and treated. […] Having prolonged and severe delirium over several weeks can increase a persons risk of developing dementia. This doesn’t mean that delirium causes dementia. But if someone was already having problems with memory and thinking, having delirium may speed up their decline so they develop dementia sooner than they would have done otherwise.

• #3 Delirium in palliative care | Information for professionals | Marie Curie

  https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/delirium

  Delirium may have more than one cause. […] Many conditions can cause delirium. Causes may include: having an infection, being dehydrated, having poorly controlled pain, being constipated or in urinary retention, liver or renal failure, electrolyte imbalances like hypercalcaemia (high levels of calcium in the blood) or hypoglycaemia (low blood glucose levels), hypoxia (low oxygen levels), medicines, especially sedatives or strong analgesics, having surgery, having a stroke, withdrawal from medicines and alcohol. […] Delirium usually improves if healthcare professionals can find and treat the underlying causes. For example, giving antibiotics for an infection, encouraging the person to drink more fluids if they’re dehydrated, or reviewing their medication. Delirium may have more than one cause.

• #3 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  Delirium can have many different causes. The key to getting better is to find the causes of delirium and then try to resolve them. […] Delirium is common, particularly among older people in hospital. Its usually the reaction of the brain to a separate problem, such as: pain, infection, having a major operation with general anaesthetic, physical injury, such as a bone fracture or head injury, poor nutrition or dehydration, constipation (not pooing) or urinary retention (not peeing), low levels of blood oxygen, effects of medication, abnormal metabolism (for example, low levels of salts or sugar in the blood), organ failure. […] Often there is more than one cause, which is why its so important to do a thorough examination when someone has delirium. All of the causes need to be treated for the person to get better.

• #4 Delirium – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470399/

  There are 2 risk factors related to delirium: predisposing and precipitant factors. The most common predisposing factors are older age (older than 70 years), dementia (often not recognized clinically), functional disabilities, male gender, poor vision and hearing, and mild cognitive impairment. Alcohol use disorder and laboratory abnormalities have also been associated with an increased risk. Precipitating factors vary. However, medication side effects account for up to 39% of delirium cases. […] Other precipitating factors include surgery, anesthesia, hypoxia, untreated pain, infections, acute illness, and an acute exacerbation of chronic illness. If the patient is highly vulnerable, possibly a patient with advanced dementia, smaller disturbances such as constipation, dehydration, sleep deprivation, urinary retention, or minor medical procedures can also precipitate delirium. […] The nature of delirium is transient but can persist in patients with predisposing factors. A systematic review showed that hospital delirium persisted until discharge in 45% of cases and persisted one month later in 33% of cases.

• #4 Delirium Clinical Presentation: History, Physical, Causes

  https://emedicine.medscape.com/article/288890-clinical

  Metabolic causes may include the following: Fluid and electrolyte abnormalities, acid-base disturbances, and hypoxia, Hypoglycemia, Hepatic or renal failure, Vitamin deficiency states (especially thiamine and cyanocobalamin), Endocrinopathies associated with the thyroid and parathyroid. […] Hypoperfusion states such as shock congestive heart failure, cardiac arrhythmias, and anemias may contribute to delirium. […] Infectious causes may include the following: CNS infections such as meningitis, Encephalitis, HIV-related brain infections, Septicemia, Pneumonia, Urinary tract infections. […] Substance intoxication with alcohol, heroin, cannabis, PCP, and LSD may cause symptoms of delirium. Withdrawal from these substances may also contribute. […] Medication-induced delirium can be caused by any of the following agents: Anticholinergics (Benadryl, tricyclic antidepressants), Narcotics (meperidine), Sedative hypnotics (benzodiazepines), Histamine-2 (H2) blockers (cimetidine), Corticosteroids, Centrally acting antihypertensives (methyldopa, reserpine), Anti-Parkinson drugs (levodopa).

• #4 Delirium – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium

  Delirium is an acute, transient, usually reversible, fluctuating disturbance in attention, cognition, and consciousness level. Causes include almost any medical condition (especially when patients are in stressful environments such as hospital settings) or drug exposure. […] The most common causes of delirium are the following: Medications, particularly anticholinergics and opioids or other medications and substances with psychoactive effects, Dehydration, Infection. […] Multiple other conditions can cause delirium. In some cases, no cause can be identified. […] Predisposing factors include brain disorders (eg, dementia, stroke, Parkinson disease), advanced age, sensory impairment (eg, impaired vision or hearing), alcohol intoxication, and multiple coexisting disorders. […] Precipitating factors include use of medications (particularly 3 new medications), infection (eg, urinary tract infection, viral disease), dehydration, shock, hypoxia, anemia, immobility, undernutrition, use of bladder catheters (whether urinary retention is present or not), hospitalization, pain, sleep deprivation, decreased sensory stimuli at night, and emotional stress.

• #4 Table: Causes of Delirium-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/causes-of-delirium

  Causes of Delirium […] Neurologic causes […] Cerebrovascular disorders […] Hemorrhagic stroke, ischemic stroke, transient ischemia attack […] Inflammation or infection […] Acute demyelinating encephalomyelitis, brain abscess, CNS vasculitis, autoimmune encephalopathy, encephalitis, meningitis, meningoencephalitis […] Seizure disorders […] Nonconvulsive status epilepticus, postictal state […] Trauma […] Subdural hematoma, traumatic brain injury […] Tumor […] Meningeal carcinomatosis, primary or metastatic brain tumor […] Nonneurologic causes […] Medications and recreational drugs (numerous) […] Anticholinergics, antiemetics, antihistamines (eg, diphenhydramine), antihypertensives, some antimicrobials, antipsychotics, antispasmodics, benzodiazepines, cardiovascular medications (often beta-blockers), cimetidine, corticosteroids, digoxin, dopamine agonists, hypnotics, muscle relaxants, NSAIDs, opioids, recreational drugs, sedatives, tricyclic antidepressants

• #5 Delirium (Causes, Symptoms, and Treatment) | Doctor

  https://patient.info/doctor/delirium-pro

  Others: […] Urinary retention. […] Faecal impaction. […] Multiple aetiology. […] Unknown aetiology. […] The most common causes are medical conditions such as infections, medications or drug withdrawal. […] […] Delirium typically occurs in people with predisposing risk factors when new precipitating factors (such as some medications or infection) are added. The following are risk factors which are associated with an increased risk of delirium: […] Age 65 years or older. […] Male sex. […] Pre-existing cognitive deficit – eg, dementia, stroke. […] Severity of dementia. […] Multiple comorbidities. […] Previous episode of delirium. […] Operative factors – eg, type of operation. Hip fracture repairs are more likely to be associated with delirium, as are emergency operations.

• #5 Delirium – symptoms, diagnosis and treatment | Alzheimer’s Society

  https://www.alzheimers.org.uk/get-support/daily-living/delirium

  Anyone can get delirium, but some people are more likely to develop it. These factors put people at higher risk: having dementia this is the biggest single risk factor for delirium, being older than 65, being frail or having multiple medical conditions, poor hearing or vision, being in an unfamiliar or disorientating environment, being sleep deprived, not being able to sit up or move around, taking certain medications, particularly those that cause drowsiness, having already had delirium in the past. […] Delirium is treated by resolving the health problems that have caused it. Once this is done, its important to make conditions as ideal as possible for the persons brain to recover. […] However, the symptoms of delirium will usually improve once its causes are found and treated. […] Having prolonged and severe delirium over several weeks can increase a persons risk of developing dementia. This doesn’t mean that delirium causes dementia. But if someone was already having problems with memory and thinking, having delirium may speed up their decline so they develop dementia sooner than they would have done otherwise.

• #6 Delirium (Causes, Symptoms, and Treatment) | Doctor

  https://patient.info/doctor/delirium-pro

  Certain conditions – burns, AIDS, fractures, infection, low albumin, dehydration. […] Current hip fracture or severe illness. […] Drug use (implicated in nearly half of cases) and dependence – eg, benzodiazepines. […] Substance misuse – eg, alcohol. […] Extremes of sensory experience – eg, hypothermia or hyperthermia. […] Visual or hearing problems. […] Poor mobility. […] Social isolation. […] Stress. […] Terminally ill. […] Movement to a new environment. […] ICU admission. […] Urea/creatinine abnormalities.

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