title: Precipitating factors of delirium: stress response to multiple triggers among patients with and without dementia.
abstract: OBJECTIVE
  Delirium is common and serious acute syndrome among older people precipitated by multiple external factors such as acute illnesses, trauma, surgery, and drugs. The aim of this study was to find possible stressors and causative triggers for acute delirium and compare patients with or without dementia in this respect.
  
  
  METHODS
  193 delirious patients from two separate delirium studies including settings of nursing homes and geriatric wards were thoroughly assessed for precipitating factors of delirium. Patients with and without dementia were compared for their clinical status, symptoms and signs, prognosis, and the profile of precipitating factors of delirium.
  
  
  RESULTS
  The patients with dementia (n=98) and without dementia (n=95) did not differ in their demographic factors, mean number of drugs, or their psychiatric symptoms. The patients with dementia had higher number of comorbidities, poorer cognition, and they were more often restrained than those without dementia. The mean number of precipitators for delirium was 2.6 among those without dementia and 2.0 among those with dementia (p=0.0019). Infections, metabolic conditions, trauma, and surgery were more common precipitating factors for delirium in those without than those with dementia. There was no difference in mortality between the groups.
  
  
  CONCLUSIONS
  Most patients had multiple precipitating factors for delirium irrespective of prior dementia. Those with dementia and decreased cognitive reserves needed lower number of etiologies to develop delirium. The profile of causative agents differed among patients with and without dementia.
authors.affiliation: Department of Social Services and Health Care, Geriatric Psychiatric Clinic, Finland; Department of Social Services and Health Care, Laakso Hospital, Finland; Helsinki University Hospital, Unit of General Practice and University of Helsinki, Department of General Practice and Primary Health Care, Finland. Electronic address: eeva.holtta@hel.fi.
authors.forename: E H
authors.initials: EH
authors.lastname: Hölttä
authors.affiliation: University of Helsinki and Helsinki University Hospital, Geriatric Clinic, Finland.
authors.forename: J V
authors.initials: JV
authors.lastname: Laurila
authors.affiliation: Department of Social Services and Health Care, Laakso Hospital, Finland; Helsinki University Hospital, Unit of General Practice and University of Helsinki, Department of General Practice and Primary Health Care, Finland.
authors.forename: M L
authors.initials: ML
authors.lastname: Laakkonen
authors.affiliation: University of Helsinki and Helsinki University Hospital, Geriatric Clinic, Finland; University of Oulu, Institute of Health Sciences/Geriatrics, Finland.
authors.forename: T E
authors.initials: TE
authors.lastname: Strandberg
authors.affiliation: University of Helsinki and Helsinki University Hospital, Geriatric Clinic, Finland.
authors.forename: R S
authors.initials: RS
authors.lastname: Tilvis
authors.affiliation: Helsinki University Hospital, Unit of General Practice and University of Helsinki, Department of General Practice and Primary Health Care, Finland.
authors.forename: K H
authors.initials: KH
authors.lastname: Pitkala
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003693:Delirium / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003704:Dementia / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D015985:Precipitating Factors; D011379:Prognosis; D013312:Stress, Physiological / Q000502:physiology*
keywords: Causative agent; Delirium; Dementia; Precipitating factor; Prognosis