New horizons in the pathogenesis, assessment and management of delirium.
Delirium is one of the foremost unmet medical needs in healthcare. It affects one in eight hospitalised patients and is associated with multiple adverse outcomes including increased length of stay, new institutionalisation, and considerable patient distress. Recent studies also show that delirium strongly predicts future new-onset dementia, as well as accelerating existing dementia. The importance of delirium is now increasingly being recognised, with a growing research base, new professional international organisations, increased interest from policymakers, and greater prominence of delirium in educational and audit programmes. Nevertheless, the field faces several complex research and clinical challenges. In this article we focus on selected areas of recent progress and/or uncertainty in delirium research and practice. (i)


METHODS
recent studies in animal models using peripheral inflammatory stimuli have begun to suggest mechanisms underlying the delirium syndrome as well as its link with dementia. A growing body of blood and cerebrospinal fluid studies in humans have implicated inflammatory and stress mediators. (ii)


CONCLUSIONS
delirium prevention is effective in the context of research studies, but there are several unresolved issues, including what components should be included, the role of prophylactic drugs, and the overlap with general best care for hospitalised older people. (iii)


RESULTS
though there are several instruments for delirium screening and assessment, detection rates remain dismal. There are no clear solutions but routine screening embedded into clinical practice, and the development of new rapid screening instruments, offer potential. (iv)


RESULTS
studies are difficult given the heterogeneity of delirium and currently expert and comprehensive clinical care remains the main recommendation. Future studies may address the role of drugs for specific elements of delirium. In summary, though facing many challenges, the field continues to make progress, with several promising lines of enquiry and an expanding base of interest among researchers, clinicians and policymakers.
Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
Alasdair M J
AM
Maclullich
Atul
A
Anand
Daniel H J
DH
Davis
Thomas
T
Jackson
Amanda J
AJ
Barugh
Roanna J
RJ
Hall
Karen J
KJ
Ferguson
David J
DJ
Meagher
Colm
C
Cunningham
D000367:Age Factors; D000375:Aging; D000818:Animals; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D003693:Delirium / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
delirium; delirium assessment; delirium management; delirium pathogenesis; older people