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Delir in der Neurologie

Diagnose, Behandlung und Prognose

Delirium in patients with neurological diseases

Diagnosis, management and prognosis

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Zusammenfassung

Das Delir ist ein häufiges, akutes neuropsychiatrisches Syndrom. Es ist gekennzeichnet durch gleichzeitig bestehende Störungen des Bewusstseins und der Aufmerksamkeit, der Wahrnehmung, des Denkens, des Gedächtnisses, der Psychomotorik, der Emotionalität und des Schlaf-Wach-Rhythmus. Das Delir durch Alkohol- oder Medikamentenentzug ist nicht Gegenstand dieser Übersichtsarbeit. Für ein Delir gibt es typische Risikofaktoren und Auslöser, die in der gemeinsamen Endstrecke, einer globalen Hirnfunktionsstörung, enden. Die wichtigsten Risikofaktoren sind höheres Alter, kognitive Defizite oder Demenz, sensorische Defizite, Multimorbidität und Polypharmazie. Ein Delir ist immer Ausdruck einer oder mehrerer zugrunde liegender Pathologien, die es zu identifizieren gilt. In der Neurologie spielen sowohl primäre Auslöser des Delirs wie z. B. ein Schlaganfall oder ein epileptischer Anfall eine Rolle. Bei multimorbiden Pateinten sind aber auch sekundäre Auslöser wie metabolische Faktoren oder Medikamentennebenwirkungen von besonderer Bedeutung. Wichtig in der Prophylaxe des Delirs sind nichtmedikamentöse Maßnahmen, durch welche die Prognose verbessert werden kann. Das Delir ist mit einer erhöhten Mortalität assoziiert. Nach einem Delir kann es bei den Patienten längerfristig zu einer Entwicklung kognitiver Defizite und funktioneller Einschränkungen kommen.

Summary

Delirium is a common acute neuropsychiatric syndrome. It is characterized by concurrent disturbances of consciousness and attention, perception, reasoning, memory, emotionality, the sleep-wake cycle as well as psychomotor symptoms. Delirium caused by alcohol or medication withdrawal is not the subject of the current review. Specific predisposing and precipitating factors have been identified in delirium which converge in a common final pathway of global brain dysfunction. The major predisposing factors are older age, cognitive impairment or dementia, sensory deficits, multimorbidity and polypharmacy. Delirium is always caused by one or more underlying pathologies which need to be identified. In neurology both primary triggers of delirium, such as stroke or epileptic seizures and also secondary triggers, such as metabolic factors or medication side effects play a major role. Nonpharmacological interventions are important in the prevention of delirium and lead to an improvement in prognosis. Delirium is associated with increased mortality and in the long term the development of cognitive deficits and functional impairment.

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Danksagung

Die Autorinnen möchten sich bei Dr. Claudia Kohl und Prof. Lars Keller für die kritische Durchsicht des Manuskripts bedanken.

Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Hüfner und B. Sperner-Unterweger geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Hüfner, K., Sperner-Unterweger, B. Delir in der Neurologie. Nervenarzt 85, 427–436 (2014). https://doi.org/10.1007/s00115-013-3934-1

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