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.

• #2 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. […] 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 Sudden confusion (delirium) | nidirect

  https://www.nidirect.gov.uk/conditions/sudden-confusion-delirium

  Sudden confusion (delirium) describes a state of sudden confusion and changes in a persons behaviour and alertness. […] The most common causes of sudden confusion include: a lack of oxygen in the blood (hypoxia) the cause could be anything from a severe asthma attack to a problem with the lungs or heart […] an infection anywhere in the body, especially in elderly people […] a stroke or TIA (mini stroke) […] a low blood sugar level (hypoglycaemia) […] diabetic ketoacidosis, a serious complication of diabetes caused by a lack of insulin in the body […] certain medications, including digoxin, diuretics, steroids, and opiates […] alcohol poisoning or alcohol withdrawal […] drug misuse. […] Less common causes of sudden confusion include: an infection of the brain or its lining (encephalitis or meningitis)

• #4 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. […] 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.

• #5 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  In younger people, the cause of delirium is usually a condition that directly affects the brain for example, a brain infection, such as meningitis or encephalitis. […] In older adults, the cause is often a common infection, such as a urinary tract infection, pneumonia, or influenza. […] Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, most often associated with chronic heavy alcohol use, can cause confusion and delirium. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium is more common among older adults. […] 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, pain, retention of urine or severe constipation, sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid, sleep deprivation, stress (any type), mild infection, such as urinary tract infection.

• #6 What Causes Sudden Confusion in Elderly Adults?

  https://www.griswoldcare.com/blog/what-causes-sudden-confusion-in-elderly-adults/

  Sudden confusion in the elderly, often referred to as delirium, is alarming for both the elderly person and those who love them. […] Assessing confusion in the elderly is necessary to determine whether there is an underlying cause or medical reason for it, especially if elderly confusion comes and goes. […] A common urinary tract infection (UTI) can cause extreme confusion and delirium in an elderly person. […] If an elderly person has a sudden change in behavior, including extreme agitation, hallucinations, and overall disoriented thinking, an untreated UTI is often the cause. […] An infection anywhere in the body can cause these symptoms, so a visit to the doctor is necessary to determine the reason for the sudden confusion. […] A lack of oxygenated blood circulating through the body can cause sudden mental disorientation.

• #7 Sudden confusion (delirium) | nidirect

  https://www.nidirect.gov.uk/conditions/sudden-confusion-delirium

  Sudden confusion (delirium) describes a state of sudden confusion and changes in a persons behaviour and alertness. […] The most common causes of sudden confusion include: a lack of oxygen in the blood (hypoxia) the cause could be anything from a severe asthma attack to a problem with the lungs or heart […] an infection anywhere in the body, especially in elderly people […] a stroke or TIA (mini stroke) […] a low blood sugar level (hypoglycaemia) […] diabetic ketoacidosis, a serious complication of diabetes caused by a lack of insulin in the body […] certain medications, including digoxin, diuretics, steroids, and opiates […] alcohol poisoning or alcohol withdrawal […] drug misuse. […] Less common causes of sudden confusion include: an infection of the brain or its lining (encephalitis or meningitis)

• #8 What Causes Sudden Confusion in the Elderly?

  https://assistinghands.com/98/ohio/westlake/blog/elder-sudden-confusion/

  Sudden confusion is a serious condition that demands immediate medical care. Also known as delirium, sudden confusion causes changes in an older adults behavior and alertness. A number of causes can be responsible for triggering this condition in the elderly. […] Sudden confusion may appear over time in dementia patients. Other medical conditions that cause delirium include stroke, seizure, and transient ischemic attack (TIA is a condition that occurs when the blood supply to the brain is temporarily blocked). A stroke can occur after a TIA. […] Hypoxia, which is a lack of oxygen in the blood, is another cause of sudden confusion in the elderly. A severe asthma attack can cause hypoxia. Or, the senior may experience problems with their lungs or hearteither of which can trigger a case of hypoxia.

• #9 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.

• #10 Confusion: Definition, Causes, Symptoms & Prevention

  https://my.clevelandclinic.org/health/symptoms/25206-confusion

  Conditions that can cause confusion include: Alcohol intoxication and alcohol poisoning. Blood sugar level extremes, including very low blood sugar (hypoglycemia) and very high blood sugar (hyperglycemia). Brain bleeds. Brain cancer. Brain lesions (damaged areas in the brain). Dehydration. Delirium. Electrolyte imbalances, like very low sodium (hyponatremia) or very high calcium (hypercalcemia). Endocrine disorders, like hypothyroidism and hyperthyroidism. Extreme body temperatures, including very low body temperature (hypothermia) and very high body temperature (hyperthermia). Head injuries, including concussions and traumatic brain injuries (TBI). Hydrocephalus and normal pressure hydrocephalus. Infections especially encephalitis and meningitis as well as life-threatening, infection-related conditions like sepsis. Lack of blood flow, such as from any kind of stroke, especially ischemic stroke. Lack of oxygen (cerebral hypoxia). Medical and nonmedical drug use, especially with certain drugs like hallucinogens. Mental health conditions or states that involve disrupted or disorganized brain activity, like schizophrenia or psychosis. Migraines. Neurodegenerative diseases like Alzheimers disease or dementia. Organ failure, especially when it affects your kidneys or liver. Seizures, especially right after a seizure, or status epilepticus, which is a medical emergency. Toxins and poisons, like carbon monoxide, heavy metals, certain pesticides or inhalants.

• #11 Acute Confusional States in the Elderly—Diagnosis and Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3371633/

  Disturbances of fluid and electrolyte balance are a main cause of confusion among elderly hospitalized patients, alongside infections and drug effects. […] Dehydration often goes unrecognized in elderly persons who are at home. […] Delirium in the elderly is due to medications in 11% to 30% of cases (mean, 20%).

• #12 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. […] […] Drug-induced delirium is very common amongst the elderly. Drugs can be the sole cause of delirium in some. Common drug causes of delirium include: […] Benzodiazepines. […] Narcotic analgesics. […] First-generation antihistamines. […] Antispasmodics. […] Flouroquinolones. […] Warfarin. […] Captopril. […] Theophylline. […] Isosorbide dinitrate. […] Dipyridamole. […] Furosemide. […] Lithium. […] Tricyclic antidepressants. […] Cimetidine. […] Anti-arrhythmics. […] Statins. […] Digoxin. […] Steroids. […] Beta-blockers. […] Over-the-counter medications – eg, liquid medications containing alcohol or chlorphenamine.

• #13

  https://slam.nhs.uk/sudden-confusion

  Sudden confusion (delirium) can have many different causes. Get medical help immediately if someone suddenly becomes confused (delirious). […] 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 elderly 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 illegal drugs, Carbon monoxide poisoning especially if other people you live with become unwell, A severe asthma attack or other problems with the lungs or heart, Certain types of seizures, caused by epilepsy.

• #14 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. […] 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.

• #15 Delirium | Psychology Today

  https://www.psychologytoday.com/us/conditions/delirium

  Certain pain medications, sleep medications, psychiatric medications (especially those used to treat anxiety or depression), steroids, antihistamines, and medications used to treat Parkinson’s disease are among those that may trigger delirium. […] Yes. Heavy drinkers may be at risk of delirium during periods of withdrawal. This type of delirium, known as delirium tremens, usually starts a few days after drinking is stopped.

• #16 Delirium | MedlinePlus

  https://medlineplus.gov/delirium.html

  Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable. […] 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. […] Treating the conditions that can cause delirium may reduce the risk of getting it.

• #17 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.

• #18 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. […] 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.

• #19 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.

• #20 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Delirium may be the result of an underlying medical condition (e.g., infection or hypoxia), side effect of a medication such as diphenhydramine, promethazine, and dicyclomine, substance intoxication (e.g., opioids or hallucinogenic deliriants), substance withdrawal (e.g., alcohol or sedatives), or from multiple factors affecting one’s overall health (e.g., malnutrition, pain, etc.). […] Delirium arises through the interaction of a number of predisposing and precipitating factors. […] Important predisposing factors include the following: 65 or more years of age, cognitive impairment/dementia, physical morbidity (e.g., biventricular failure, cancer, cerebrovascular disease), psychiatric morbidity (e.g., depression), sensory impairment (i.e., vision and hearing), functional dependence (e.g., requiring assistance for self-care or mobility), dehydration/malnutrition, substance use disorder, especially alcohol use disorder and anticholinergic abuse. […] Any serious, acute biological factor that affects neurotransmitter, neuroendocrine, or neuroinflammatory pathways can precipitate an episode of delirium in a vulnerable brain. […] Certain elements of the clinical environment have also been associated with the risk of developing delirium.

• #21 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  Delirium can have different causes. We may need to do medical tests to help decide what treatment is needed. […] As you get older, you are more likely to have delirium. People who are over 80 years old and have been diagnosed with some type of dementia are particularly at risk. However, delirium can happen in younger people as well, especially if they are critically ill or after surgery. […] Some people with delirium need to come into hospital to manage the condition or what is causing it. They might also be in hospital for another reason and get delirium during their stay. […] The doctors and nurses test for and manage any causes of delirium that can be treated. Examples are: infections, abnormal blood results, constipation (finding it hard to poo), not being able to pee, dehydration, the side effects of different medicines. […] Delirium is always a serious condition. Although many people make a full recovery, some people never get back to how they were completely. This may apply if you: have dementia, have had delirium before, live in a care home (because it is likely that you already have health problems).

• #22 Delirium: Definition, Causes, and What It Feels Like

  https://www.verywellhealth.com/delirium-5223127

  Delirium is common in hospitalized or seriously ill older adults but can also result from infections, surgery, medications, or substance withdrawal. […] While researchers aren’t sure of the exact cause of delirium, it often happens when a person is already sick or recovering from a major illness or surgery. […] Scientists believe it may be linked to changes in brain chemistry, particularly a drop in acetylcholine, a chemical that helps with memory and attention. Other factors, like stress on the body, infections, or medication side effects, can also trigger delirium. […] People with these risk factors are more likely to develop delirium: Hospitalization, especially in the intensive care unit (ICU), Older age, particularly 80 and above, Dehydration and malnutrition, Dementia or Parkinsons disease, Infections, such as meningitis, sepsis, or urinary tract infections (UTIs), Organ failure, including kidney or liver failure, Difficulty seeing or hearing, which can cause confusion, Multiple medications, especially those with mental or emotional side effects, Major surgery with anesthesia, such as open-heart surgery, Hip fractures and other serious injuries, Drug or alcohol intoxication or withdrawal, including delirium tremens, Ventilator use or oxygen deprivation from lung disease, pneumonia, or opioid drugs, Low blood sugar or other metabolic disorders. […] Delirium is particularly common among people over 80. However, anyone can experience delirium, especially if they are using drugs or alcohol, have recently had surgery, or have a chronic or terminal illness.

• #23 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). […] Delirium causes distress due to hallucinations, delusions, exaggerated or labile emotions (anger, anxiety, fear), or incontinence. […] Estimates are difficult, but up to half of delirium at the end of life can be alleviated.

• #24 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.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. […] Delirium may be the first symptom in older adults with a viral disease, such as COVID-19 or influenza. […] Abnormal blood levels of electrolytes, such as calcium, sodium, or magnesium, can interfere with the metabolic activity of nerve cells and lead to 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.

• #25 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.

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

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

  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. […] 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.

• #27 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. […] 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.

• #28 Temporary Confusion & Disorientation (Delirium): Causes & Treatment

  https://www.webmd.com/brain/sudden-confusion-causes

  Sudden confusion, sometimes called delirium or encephalopathy, can be a sign of many health problems. […] Many conditions or health problems can cause sudden confusion, and some are more serious than others: They include: Alcohol or drug abuse, Carbon monoxide poisoning, Very low amounts of sodium or calcium in your body, Diabetes (especially low blood sugar or high blood sugar levels), Infections anywhere in the body (including the brain, lungs, and urinary tract). This is especially common for older people. […] Other things can also make you more likely to have sudden confusion, such as if you: Stay in the hospital, especially after an operation, Have a lot of medical problems, Take a lot of medications, or stop taking a daily medication, Are over age 65, Have dementia, Dont eat or drink enough, Are very overtired, Have problems with sight, hearing, or how well you get around. […] Once doctors can get the cause under control, the confusion usually goes away.

• #29 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.

• #30 Confusion (delirium in the elderly)

  https://emed.ie/Symptoms/Confusion.php

  Delirium is avoidable and treatable not an accepted factor in ageing!! […] Possible pathophysiology: […] Neurotransmitter disturbance ACh dopamine […] Illness related stress overactivity of hypothalamic pituitary-adrenal axis […] Increase cytokine production (effect on cerebral fxn.) […] Reduced activity of plasma esterases (drug metabolising) […] Delirium Risk Factors […] Age 65 […] Physical frailty […] Severe illness / Multiple disease […] Dementia […] Infection/dehydration […] Visual / hearing impairment […] Polypharmacy […] Alcohol […] Renal dysfxn […] Malnutrition […] Delirium Precipitants […] LRTI/ UTI / Catheter […] Constipation […] Dehydration, Hypokalaemia […] Hypercalcaemia, hyper/hypo Na+ […] Stroke, Epilepsy, SDH […] Hypoxia […] Sleep deprivation

• #31 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Delirium may be the result of an underlying medical condition (e.g., infection or hypoxia), side effect of a medication such as diphenhydramine, promethazine, and dicyclomine, substance intoxication (e.g., opioids or hallucinogenic deliriants), substance withdrawal (e.g., alcohol or sedatives), or from multiple factors affecting one’s overall health (e.g., malnutrition, pain, etc.). […] Delirium arises through the interaction of a number of predisposing and precipitating factors. […] Important predisposing factors include the following: 65 or more years of age, cognitive impairment/dementia, physical morbidity (e.g., biventricular failure, cancer, cerebrovascular disease), psychiatric morbidity (e.g., depression), sensory impairment (i.e., vision and hearing), functional dependence (e.g., requiring assistance for self-care or mobility), dehydration/malnutrition, substance use disorder, especially alcohol use disorder and anticholinergic abuse. […] Any serious, acute biological factor that affects neurotransmitter, neuroendocrine, or neuroinflammatory pathways can precipitate an episode of delirium in a vulnerable brain. […] Certain elements of the clinical environment have also been associated with the risk of developing delirium.

• #32 Confusion — AGELESS AGENDA

  https://agelessagenda.com/confusion

  Dehydration, surgery, pain, poor sleep, and constipation are also other risk factors. […] Delirium is more of a quickly occurring type of confusion with loss of attention. […] It is usually reversible and has an underlying cause. […] Having delirium increases the risk of having delirium again when the body is stressed. […] The key and most important treatment for delirium is treating the underlying cause. […] Figuring out the cause is key in treating delirium. […] Yes, surgery is stressful on the body and brain and may lead to delirium afterward. […] There are factors that can increase your risk for delirium such as being over the age of 70, high alcohol use, having dementia, or depression.

• #33 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Delirium may be the result of an underlying medical condition (e.g., infection or hypoxia), side effect of a medication such as diphenhydramine, promethazine, and dicyclomine, substance intoxication (e.g., opioids or hallucinogenic deliriants), substance withdrawal (e.g., alcohol or sedatives), or from multiple factors affecting one’s overall health (e.g., malnutrition, pain, etc.). […] Delirium arises through the interaction of a number of predisposing and precipitating factors. […] Important predisposing factors include the following: 65 or more years of age, cognitive impairment/dementia, physical morbidity (e.g., biventricular failure, cancer, cerebrovascular disease), psychiatric morbidity (e.g., depression), sensory impairment (i.e., vision and hearing), functional dependence (e.g., requiring assistance for self-care or mobility), dehydration/malnutrition, substance use disorder, especially alcohol use disorder and anticholinergic abuse. […] Any serious, acute biological factor that affects neurotransmitter, neuroendocrine, or neuroinflammatory pathways can precipitate an episode of delirium in a vulnerable brain. […] Certain elements of the clinical environment have also been associated with the risk of developing delirium.

• #34 Delirium (sudden confusion) – Dementia UK

  https://www.dementiauk.org/information-and-support/health-advice/delirium/

  Delirium is a state of mental confusion that comes on suddenly. It can have a big impact on the way a person behaves and functions, especially if they have dementia. […] Possible causes of delirium include: an infection such as a urinary tract infection (UTI), dehydration, not eating enough, a stroke or ‘mini stroke’ called a transient ischaemic attack (TIA), low blood sugar in a person with diabetes, pain, head injury, constipation or urine retention, being in hospital or another unfamiliar or distressing environment, surgery, especially hip surgery, older age – although younger people can develop delirium too, some types of medication, especially if the person takes multiple medications, sight or hearing difficulties, being near the end of life. […] Dementia can make people more likely to experience delirium. People who are over 80 and live with dementia are at greater risk, particularly during a hospital stay, when up to 50% of people with dementia develop delirium. […] If a person is experiencing delirium, their doctor should check for underlying causes, such as signs of infection like a high temperature. […] Delirium can’t always be prevented, but there are things you can do to reduce the risk.

• #35 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.

• #36 Delirium | Dementia Australia

  https://www.dementia.org.au/living-dementia/mood-and-behaviour-changes/delirium

  Delirium can come on quickly. […] No-one knows exactly why delirium happens, but it can be brought on by: severe illness, constipation, dehydration, infection, pain, drug effect or withdrawal (alcohol and sedative drugs). […] If the person has experienced delirium in the past, they are more likely to get it again.

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

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

  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. […] 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.

• #38 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. […] 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.

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

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

  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. […] 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.

• #40 Delirium: Definition, Causes, and What It Feels Like

  https://www.verywellhealth.com/delirium-5223127

  Delirium is common in hospitalized or seriously ill older adults but can also result from infections, surgery, medications, or substance withdrawal. […] While researchers aren’t sure of the exact cause of delirium, it often happens when a person is already sick or recovering from a major illness or surgery. […] Scientists believe it may be linked to changes in brain chemistry, particularly a drop in acetylcholine, a chemical that helps with memory and attention. Other factors, like stress on the body, infections, or medication side effects, can also trigger delirium. […] People with these risk factors are more likely to develop delirium: Hospitalization, especially in the intensive care unit (ICU), Older age, particularly 80 and above, Dehydration and malnutrition, Dementia or Parkinsons disease, Infections, such as meningitis, sepsis, or urinary tract infections (UTIs), Organ failure, including kidney or liver failure, Difficulty seeing or hearing, which can cause confusion, Multiple medications, especially those with mental or emotional side effects, Major surgery with anesthesia, such as open-heart surgery, Hip fractures and other serious injuries, Drug or alcohol intoxication or withdrawal, including delirium tremens, Ventilator use or oxygen deprivation from lung disease, pneumonia, or opioid drugs, Low blood sugar or other metabolic disorders. […] Delirium is particularly common among people over 80. However, anyone can experience delirium, especially if they are using drugs or alcohol, have recently had surgery, or have a chronic or terminal illness.

• #41 What Older Adults Need to Know About Opioid Pain Medications, Confusion/Delirium | UAMS Health

  https://uamshealth.com/clinical-resource/what-older-adults-need-to-know-about-opioid-pain-medications-confusion-delirium/

  Confusion/Delirium is a sudden change in your mental status. […] Delirium can result with any opioid pain medication such as Tramadol, codeine, or morphine. […] Unrelieved severe pain can also cause delirium. […] Delirium may have other common underlying reasons such as pneumonia, urinary tract infections, other infections, or an imbalance of sodium, water, and other substances in the blood.

• #42 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.

• #43 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.

• #44 Confusion (delirium in the elderly)

  https://emed.ie/Symptoms/Confusion.php

  Environmental […] absence of clock/watch […] absence of reading glasses […] family member […] Specific precipitant drugs […] Those with anticholinergic activity […] Antihistamine – diphenhydramine […] Antispasmodic – Alverine, hyoscyamine […] Tricyclic antidepressant – Amitriptyline […] Benzodiazepine – Lorazepam […] Analgesic – Codeine […] Antiarrhythmic – Digoxin […] Diuretic – Furosemide […] Bladder stabiliser – Oxybutynin […] Brochodilator – Theophylline […] Immediate while identifying and correcting underlying causes: […] Drug use (above) or drug withdrawal […] Electrolyte and physiologic abnormalities (above) […] Infection (esp. UTI or respiratory infection) […] sensory input (eg, blind, deaf, new surrounds) […] Intracranial problems (stroke, SDH etc) […] Urinary retention / faecal impaction, Myocardial problems.

• #45 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. […] 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. […] Disrupted bloodbrain barrier can allow neurotoxic agents and inflammatory cytokines to enter the brain and may cause delirium.

• #46 Confusion and Delirium: Causes, Symptoms & Treatment

  https://www.ganeshdiagnostic.com/blog/confusion-and-delirium-causes-symptoms-and-treatment

  Even when taken as directed, some medications can increase your chance of developing delirium. […] Drug-induced delirium can be brought on by non-medical drug use, such as using pharmaceutical drugs in a manner other than recommended. […] Losing your body’s ability to distinguish between day and night can significantly increase your risk of getting delirium. […] Delirium may become more likely as a result of several risk factors. […] Delirium causes a generalised disruption in brain function, which can result in a variety of problems. […] There is no particular medicine or therapy for delirium. Instead, healthcare professionals will address the root causes and influencing variables they can see.

• #47 What is Delirium? Common causes, symptoms and treatment

  https://www.agespace.org/health/delirium

  Delirium is a mental condition that is often a symptom of another underlying illness. […] Delirium is caused by one or more underlying health issues. This is particularly true in older people, who are more likely to have multiple health problems. […] Delirium is most common in people who are in hospital, or have recently left hospital. Delirium is also more common in people who already have problems with their memory, including those with dementia. […] Some of the most common causes of delirium are: Dehydration, A chest or urine infection, Recent surgery, Side effects of medicine, Pain, Constipation, Kidney or liver problems, A high fever, Drugs or alcohol withdrawal, Terminal illness, Stroke, Being in a new or unfamiliar location. […] Any illness that leads to inflammation and infection can interfere with brain function, which can cause delirium. Additionally, any condition that reduces the amount of oxygen getting to the brain can lead to delirium. […] Delirium has a much faster onset than dementia, and is usually treatable, whereas dementia is not.

• #48 Delirium (sudden confusion) – Dementia UK

  https://www.dementiauk.org/information-and-support/health-advice/delirium/

  Delirium is a state of mental confusion that comes on suddenly. It can have a big impact on the way a person behaves and functions, especially if they have dementia. […] Possible causes of delirium include: an infection such as a urinary tract infection (UTI), dehydration, not eating enough, a stroke or ‘mini stroke’ called a transient ischaemic attack (TIA), low blood sugar in a person with diabetes, pain, head injury, constipation or urine retention, being in hospital or another unfamiliar or distressing environment, surgery, especially hip surgery, older age – although younger people can develop delirium too, some types of medication, especially if the person takes multiple medications, sight or hearing difficulties, being near the end of life. […] Dementia can make people more likely to experience delirium. People who are over 80 and live with dementia are at greater risk, particularly during a hospital stay, when up to 50% of people with dementia develop delirium. […] If a person is experiencing delirium, their doctor should check for underlying causes, such as signs of infection like a high temperature. […] Delirium can’t always be prevented, but there are things you can do to reduce the risk.

• #49 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.

• #50 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.

• #51 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. […] […] Drug-induced delirium is very common amongst the elderly. Drugs can be the sole cause of delirium in some. Common drug causes of delirium include: […] Benzodiazepines. […] Narcotic analgesics. […] First-generation antihistamines. […] Antispasmodics. […] Flouroquinolones. […] Warfarin. […] Captopril. […] Theophylline. […] Isosorbide dinitrate. […] Dipyridamole. […] Furosemide. […] Lithium. […] Tricyclic antidepressants. […] Cimetidine. […] Anti-arrhythmics. […] Statins. […] Digoxin. […] Steroids. […] Beta-blockers. […] Over-the-counter medications – eg, liquid medications containing alcohol or chlorphenamine.

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

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

  The role of medications may be suggested by a temporal relationship between onset of delirium and start of new medication. However, this is not always the case and practitioners need to be aware of this. Medication lists should be thoroughly reviewed in delirium. The exact mechanism of delirium is unclear but it is postulated that central cholinergic pathway blockade is a major factor. This may explain why anticholinergic medications readily lead to delirious states. It may be that this factor along with the pharmacokinetic changes that occur later in life and comorbidities increase the susceptibility of elderly patients to drug-induced delirium.

• #53 Sudden confusion (delirium) | nidirect

  https://www.nidirect.gov.uk/conditions/sudden-confusion-delirium

  an imbalance of salts and minerals in the blood […] a severely underactive thyroid gland […] thiamine (vitamin B1) deficiency […] a brain tumour […] hypoparathyroidism or hyperparathyroidism (rare hormone disorders) […] Cushing’s disease (a tumour of the pituitary gland) […] an epileptic seizure […] carbon monoxide poisoning.

• #54

  https://zana.com/a/delirium-acute-confusion-common-causes-sudden-confusion.6148

  The most common causes of sudden confusion are: a lack of oxygen in the blood (hypoxia) the cause could be anything from a severe asthma attack to a problem with the lungs or heart […] an infection anywhere in the body, especially in elderly people […] a stroke or TIA („mini stroke”) […] a low blood sugar level (hypoglycaemia) […] diabetic ketoacidosis, a serious complication of diabetes caused by a lack of insulin in the body […] certain medications, including digoxin, diuretics, steroids, and opiates […] alcohol poisoning or alcohol withdrawal […] drug misuse […] Less common causes of sudden confusion are: an infection of the brain or its lining (encephalitis or meningitis) […] an imbalance of salts and minerals in the blood […] a severely underactive thyroid.

• #55 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  In younger people, the cause of delirium is usually a condition that directly affects the brain for example, a brain infection, such as meningitis or encephalitis. […] In older adults, the cause is often a common infection, such as a urinary tract infection, pneumonia, or influenza. […] Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, most often associated with chronic heavy alcohol use, can cause confusion and delirium. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium is more common among older adults. […] 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, pain, retention of urine or severe constipation, sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid, sleep deprivation, stress (any type), mild infection, such as urinary tract infection.

• #56 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).

• #57 Confusion: Definition, Causes, Symptoms & Prevention

  https://my.clevelandclinic.org/health/symptoms/25206-confusion

  Conditions that can cause confusion include: Alcohol intoxication and alcohol poisoning. Blood sugar level extremes, including very low blood sugar (hypoglycemia) and very high blood sugar (hyperglycemia). Brain bleeds. Brain cancer. Brain lesions (damaged areas in the brain). Dehydration. Delirium. Electrolyte imbalances, like very low sodium (hyponatremia) or very high calcium (hypercalcemia). Endocrine disorders, like hypothyroidism and hyperthyroidism. Extreme body temperatures, including very low body temperature (hypothermia) and very high body temperature (hyperthermia). Head injuries, including concussions and traumatic brain injuries (TBI). Hydrocephalus and normal pressure hydrocephalus. Infections especially encephalitis and meningitis as well as life-threatening, infection-related conditions like sepsis. Lack of blood flow, such as from any kind of stroke, especially ischemic stroke. Lack of oxygen (cerebral hypoxia). Medical and nonmedical drug use, especially with certain drugs like hallucinogens. Mental health conditions or states that involve disrupted or disorganized brain activity, like schizophrenia or psychosis. Migraines. Neurodegenerative diseases like Alzheimers disease or dementia. Organ failure, especially when it affects your kidneys or liver. Seizures, especially right after a seizure, or status epilepticus, which is a medical emergency. Toxins and poisons, like carbon monoxide, heavy metals, certain pesticides or inhalants.

• #58 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  In younger people, the cause of delirium is usually a condition that directly affects the brain for example, a brain infection, such as meningitis or encephalitis. […] In older adults, the cause is often a common infection, such as a urinary tract infection, pneumonia, or influenza. […] Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, most often associated with chronic heavy alcohol use, can cause confusion and delirium. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium is more common among older adults. […] 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, pain, retention of urine or severe constipation, sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid, sleep deprivation, stress (any type), mild infection, such as urinary tract infection.

• #59 Confusion: Definition, Causes, Symptoms & Prevention

  https://my.clevelandclinic.org/health/symptoms/25206-confusion

  Conditions that can cause confusion include: Alcohol intoxication and alcohol poisoning. Blood sugar level extremes, including very low blood sugar (hypoglycemia) and very high blood sugar (hyperglycemia). Brain bleeds. Brain cancer. Brain lesions (damaged areas in the brain). Dehydration. Delirium. Electrolyte imbalances, like very low sodium (hyponatremia) or very high calcium (hypercalcemia). Endocrine disorders, like hypothyroidism and hyperthyroidism. Extreme body temperatures, including very low body temperature (hypothermia) and very high body temperature (hyperthermia). Head injuries, including concussions and traumatic brain injuries (TBI). Hydrocephalus and normal pressure hydrocephalus. Infections especially encephalitis and meningitis as well as life-threatening, infection-related conditions like sepsis. Lack of blood flow, such as from any kind of stroke, especially ischemic stroke. Lack of oxygen (cerebral hypoxia). Medical and nonmedical drug use, especially with certain drugs like hallucinogens. Mental health conditions or states that involve disrupted or disorganized brain activity, like schizophrenia or psychosis. Migraines. Neurodegenerative diseases like Alzheimers disease or dementia. Organ failure, especially when it affects your kidneys or liver. Seizures, especially right after a seizure, or status epilepticus, which is a medical emergency. Toxins and poisons, like carbon monoxide, heavy metals, certain pesticides or inhalants.

• #60 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.

• #61

  https://slam.nhs.uk/sudden-confusion

  Sudden confusion (delirium) can have many different causes. Get medical help immediately if someone suddenly becomes confused (delirious). […] 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 elderly 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 illegal drugs, Carbon monoxide poisoning especially if other people you live with become unwell, A severe asthma attack or other problems with the lungs or heart, Certain types of seizures, caused by epilepsy.

• #62 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. […] 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.

• #63 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.

• #64 Delirium – UF Health

  https://ufhealth.org/conditions-and-treatments/delirium

  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.

• #65 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).

• #66 Confusion: Definition, Causes, Symptoms & Prevention

  https://my.clevelandclinic.org/health/symptoms/25206-confusion

  Conditions that can cause confusion include: Alcohol intoxication and alcohol poisoning. Blood sugar level extremes, including very low blood sugar (hypoglycemia) and very high blood sugar (hyperglycemia). Brain bleeds. Brain cancer. Brain lesions (damaged areas in the brain). Dehydration. Delirium. Electrolyte imbalances, like very low sodium (hyponatremia) or very high calcium (hypercalcemia). Endocrine disorders, like hypothyroidism and hyperthyroidism. Extreme body temperatures, including very low body temperature (hypothermia) and very high body temperature (hyperthermia). Head injuries, including concussions and traumatic brain injuries (TBI). Hydrocephalus and normal pressure hydrocephalus. Infections especially encephalitis and meningitis as well as life-threatening, infection-related conditions like sepsis. Lack of blood flow, such as from any kind of stroke, especially ischemic stroke. Lack of oxygen (cerebral hypoxia). Medical and nonmedical drug use, especially with certain drugs like hallucinogens. Mental health conditions or states that involve disrupted or disorganized brain activity, like schizophrenia or psychosis. Migraines. Neurodegenerative diseases like Alzheimers disease or dementia. Organ failure, especially when it affects your kidneys or liver. Seizures, especially right after a seizure, or status epilepticus, which is a medical emergency. Toxins and poisons, like carbon monoxide, heavy metals, certain pesticides or inhalants.

• #67 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  In younger people, the cause of delirium is usually a condition that directly affects the brain for example, a brain infection, such as meningitis or encephalitis. […] In older adults, the cause is often a common infection, such as a urinary tract infection, pneumonia, or influenza. […] Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, most often associated with chronic heavy alcohol use, can cause confusion and delirium. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium is more common among older adults. […] 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, pain, retention of urine or severe constipation, sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid, sleep deprivation, stress (any type), mild infection, such as urinary tract infection.

• #68 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  Delirium can have different causes. We may need to do medical tests to help decide what treatment is needed. […] As you get older, you are more likely to have delirium. People who are over 80 years old and have been diagnosed with some type of dementia are particularly at risk. However, delirium can happen in younger people as well, especially if they are critically ill or after surgery. […] Some people with delirium need to come into hospital to manage the condition or what is causing it. They might also be in hospital for another reason and get delirium during their stay. […] The doctors and nurses test for and manage any causes of delirium that can be treated. Examples are: infections, abnormal blood results, constipation (finding it hard to poo), not being able to pee, dehydration, the side effects of different medicines. […] Delirium is always a serious condition. Although many people make a full recovery, some people never get back to how they were completely. This may apply if you: have dementia, have had delirium before, live in a care home (because it is likely that you already have health problems).

• #69 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  In younger people, the cause of delirium is usually a condition that directly affects the brain for example, a brain infection, such as meningitis or encephalitis. […] In older adults, the cause is often a common infection, such as a urinary tract infection, pneumonia, or influenza. […] Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, most often associated with chronic heavy alcohol use, can cause confusion and delirium. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium is more common among older adults. […] 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, pain, retention of urine or severe constipation, sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid, sleep deprivation, stress (any type), mild infection, such as urinary tract infection.

• #70 What Causes Sudden Confusion in Elderly Adults?

  https://www.griswoldcare.com/blog/what-causes-sudden-confusion-in-elderly-adults/

  Sudden confusion in the elderly, often referred to as delirium, is alarming for both the elderly person and those who love them. […] Assessing confusion in the elderly is necessary to determine whether there is an underlying cause or medical reason for it, especially if elderly confusion comes and goes. […] A common urinary tract infection (UTI) can cause extreme confusion and delirium in an elderly person. […] If an elderly person has a sudden change in behavior, including extreme agitation, hallucinations, and overall disoriented thinking, an untreated UTI is often the cause. […] An infection anywhere in the body can cause these symptoms, so a visit to the doctor is necessary to determine the reason for the sudden confusion. […] A lack of oxygenated blood circulating through the body can cause sudden mental disorientation.

• #71 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.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. […] Delirium may be the first symptom in older adults with a viral disease, such as COVID-19 or influenza. […] Abnormal blood levels of electrolytes, such as calcium, sodium, or magnesium, can interfere with the metabolic activity of nerve cells and lead to 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.

• #72 Confusion: What causes it, and why? Learn more here

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

  Any health problem that affects the brain can cause confusion. […] Virtually any health condition can trigger confusion, especially in people with risk factors. […] Older people have a higher risk of developing delirium a sudden onset of confusion. […] Dementia is one of the most common causes of delirium, or confusion, in older people, but delirium does not mean that a person has dementia. […] Some older people develop new or worsening confusion when they are sick, especially if they have dementia.

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

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

  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. […] 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.

• #74 Abrupt change in mental status | HIGN

  https://hign.org/consultgeri/resources/symptoms/abrupt-change-mental-status

  Delirium, or acute confusion, is a common condition in older adults affecting up to 30% of all patients over age 65 admitted to the hospital. Delirium is characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time. […] Older adults are at increased risk of developing delirium, as are patients with dementia, severe illness, physical frailty, infection or dehydration, polypharmacy, visual impairment, hip fracture, recent surgery, excessive alcohol consumption, and renal impairment. Causes of delirium frequently include underlying medical conditions such as infection and electrolyte imbalances, and drug intoxication and withdrawal. […] The most important action for the management of delirium is identifying and treating the underlying cause of symptoms, such as dehydration, hypoxemia, and hypoglycemia. […] Considering that many older adults have atypical symptoms of delirium, a family members complaint that a patient is not him/herself should never be taken lightly.

• #75 Delirium – Wikipedia

  https://en.wikipedia.org/wiki/Delirium

  Delirium may be the result of an underlying medical condition (e.g., infection or hypoxia), side effect of a medication such as diphenhydramine, promethazine, and dicyclomine, substance intoxication (e.g., opioids or hallucinogenic deliriants), substance withdrawal (e.g., alcohol or sedatives), or from multiple factors affecting one’s overall health (e.g., malnutrition, pain, etc.). […] Delirium arises through the interaction of a number of predisposing and precipitating factors. […] Important predisposing factors include the following: 65 or more years of age, cognitive impairment/dementia, physical morbidity (e.g., biventricular failure, cancer, cerebrovascular disease), psychiatric morbidity (e.g., depression), sensory impairment (i.e., vision and hearing), functional dependence (e.g., requiring assistance for self-care or mobility), dehydration/malnutrition, substance use disorder, especially alcohol use disorder and anticholinergic abuse. […] Any serious, acute biological factor that affects neurotransmitter, neuroendocrine, or neuroinflammatory pathways can precipitate an episode of delirium in a vulnerable brain. […] Certain elements of the clinical environment have also been associated with the risk of developing delirium.

• #76 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. […] 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.

• #77 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. […] 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.

• #78 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  Certain age-related changes make older adults more susceptible to developing delirium. […] Delirium is often the first sign of another, sometimes serious disorder. […] Having delirium also increases the risk that older adults with infection will have to stay in an intensive care unit (ICU), go to a rehabilitation facility after being discharged from the hospital, and/or die. […] Most people with delirium recover fully if the condition causing delirium is rapidly identified and treated. Any delay decreases the chance of a full recovery. Even when delirium is treated, some symptoms may persist for many weeks or months, and improvement may occur slowly. In some people, delirium evolves into chronic brain dysfunction similar to dementia. […] People who are hospitalized and have delirium are more likely to develop complications in the hospital (including death) than those who do not have delirium.

• #79 Why delirium should be treated as a medical emergency

  https://www.interiorhealth.ca/stories/why-delirium-should-be-treated-medical-emergency

  Delirium is marked by a sudden onset of confusion and abrupt changes in behaviour, and should be treated as a medical emergency. […] In older adults, conditions like pneumonia and urinary tract infections can cause confusion. But acute appendicitis, a heart attack, infection and a thyroid storm (thyrotoxicosis) can also cause confusion, and require immediate medical care. […] The reason delirium is a medical emergency is because if you let the insult to the brain go on too long, theres a risk of permanent brain injury, explains Mary Kjorven, a regional clinical nurse specialist in gerontology at IH. […] If we let the cause of the delirium go on too long, we can end up with an impaired brain, and even dementia. […] There are many other causes of delirium including: Unresolved pain, Poor nutrition and/or dehydration, Retention of urine and/or fecal impaction, New illness, Immobility, Sleep deprivation, Change in environment, Medications, Metabolic imbalances.

• #80 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. […] This systematic review concluded that there is insufficient evidence supporting the routine use of antipsychotic agents for the treatment of delirium.

• #81 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.

• #82 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.

• #83 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. […] 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. […] Disrupted bloodbrain barrier can allow neurotoxic agents and inflammatory cytokines to enter the brain and may cause delirium.

• #84 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  Certain age-related changes make older adults more susceptible to developing delirium. […] Delirium is often the first sign of another, sometimes serious disorder. […] Having delirium also increases the risk that older adults with infection will have to stay in an intensive care unit (ICU), go to a rehabilitation facility after being discharged from the hospital, and/or die. […] Most people with delirium recover fully if the condition causing delirium is rapidly identified and treated. Any delay decreases the chance of a full recovery. Even when delirium is treated, some symptoms may persist for many weeks or months, and improvement may occur slowly. In some people, delirium evolves into chronic brain dysfunction similar to dementia. […] People who are hospitalized and have delirium are more likely to develop complications in the hospital (including death) than those who do not have delirium.

• #85 Why delirium should be treated as a medical emergency

  https://www.interiorhealth.ca/stories/why-delirium-should-be-treated-medical-emergency

  Delirium is marked by a sudden onset of confusion and abrupt changes in behaviour, and should be treated as a medical emergency. […] In older adults, conditions like pneumonia and urinary tract infections can cause confusion. But acute appendicitis, a heart attack, infection and a thyroid storm (thyrotoxicosis) can also cause confusion, and require immediate medical care. […] The reason delirium is a medical emergency is because if you let the insult to the brain go on too long, theres a risk of permanent brain injury, explains Mary Kjorven, a regional clinical nurse specialist in gerontology at IH. […] If we let the cause of the delirium go on too long, we can end up with an impaired brain, and even dementia. […] There are many other causes of delirium including: Unresolved pain, Poor nutrition and/or dehydration, Retention of urine and/or fecal impaction, New illness, Immobility, Sleep deprivation, Change in environment, Medications, Metabolic imbalances.

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

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

  Delirium is a sudden and severe change in brain function that causes a person to appear confused or disoriented, or to have difficulties maintaining focus, thinking clearly, and remembering recent events, typically with a fluctuating course. 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). In many cases, the underlying infection or condition is not a brain problem and affects brain function indirectly. […] Sudden withdrawal of a regular prescribed or nonprescribed drug or cessation of regular alcohol use can cause delirium.

• #87 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  Certain age-related changes make older adults more susceptible to developing delirium. […] Delirium is often the first sign of another, sometimes serious disorder. […] Having delirium also increases the risk that older adults with infection will have to stay in an intensive care unit (ICU), go to a rehabilitation facility after being discharged from the hospital, and/or die. […] Most people with delirium recover fully if the condition causing delirium is rapidly identified and treated. Any delay decreases the chance of a full recovery. Even when delirium is treated, some symptoms may persist for many weeks or months, and improvement may occur slowly. In some people, delirium evolves into chronic brain dysfunction similar to dementia. […] People who are hospitalized and have delirium are more likely to develop complications in the hospital (including death) than those who do not have delirium.

• #88 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.

• #89 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.

• #90 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.

• #91 Delirium (sudden confusion) – Overview | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/delirium-sudden-confusion

  Delirium can have different causes. We may need to do medical tests to help decide what treatment is needed. […] As you get older, you are more likely to have delirium. People who are over 80 years old and have been diagnosed with some type of dementia are particularly at risk. However, delirium can happen in younger people as well, especially if they are critically ill or after surgery. […] Some people with delirium need to come into hospital to manage the condition or what is causing it. They might also be in hospital for another reason and get delirium during their stay. […] The doctors and nurses test for and manage any causes of delirium that can be treated. Examples are: infections, abnormal blood results, constipation (finding it hard to poo), not being able to pee, dehydration, the side effects of different medicines. […] Delirium is always a serious condition. Although many people make a full recovery, some people never get back to how they were completely. This may apply if you: have dementia, have had delirium before, live in a care home (because it is likely that you already have health problems).

• #92 Delirium – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

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

  In younger people, the cause of delirium is usually a condition that directly affects the brain for example, a brain infection, such as meningitis or encephalitis. […] In older adults, the cause is often a common infection, such as a urinary tract infection, pneumonia, or influenza. […] Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, most often associated with chronic heavy alcohol use, can cause confusion and delirium. […] Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. […] Delirium is more common among older adults. […] 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, pain, retention of urine or severe constipation, sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid, sleep deprivation, stress (any type), mild infection, such as urinary tract infection.

• #93 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: An imbalance in brain chemicals through use of medications, presence of dementia, and other conditions. […] Almost any physical illness, especially when a person has more than one. […] Changes in the persons surroundings (environment) or too little sensory input because of vision and hearing loss.

• #94 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.

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