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Delirium in the Oldest of Old

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Advanced Age Geriatric Care

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Abstract

The normal ageing process affecting the brain reduces its capacity and its reserves, thereby making it vulnerable to both internal and external insults. The major manifestation of these insults, either single or usually multiple, is delirium. Delirium significantly increases both morbidity and mortality and is a life-threatening condition. The chapter provides an overview of delirium in the very elderly. The pathophysiology of delirium remains poorly understood. The chapter reviews briefly what is known of the pathophysiology. Several theories have been proposed to explain the initial and subsequent development of delirium. The final common outcome from the many factors or mechanisms seems to be associated with alteration in the neurotransmitter synthesis and function that mediates cognitive and behavioural changes.

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References

  1. Francis J, Kapoor WN. Delirium in hospitalized elderly. J Gen Intern Med. 1990;5:65–79. https://doi.org/10.1007/BF02602312.

    Article  CAS  PubMed  Google Scholar 

  2. Liston EH. Delirium in the aged. Psychiatr Clin North Am. 1982;5:49–66.

    Article  CAS  PubMed  Google Scholar 

  3. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness safer. European Delirium association and American Delirium Society. BMC Med. 2014;12:141. https://doi.org/10.1186/s12916-014-0141-2.

  4. Fong TG, Tuleaev SR, Inouye SK. Delirium in elderly adults: diagnosis prevention and treatment. Nat Rev Neuol. 2009;5(4):210–20.

    Article  Google Scholar 

  5. de Lange E, Verhaak PF, van der Meer K. Prevalence, presentation and prognosis of delirium in older people in the population at home and in long term care. Int J Geriatr Psychiatry. 2013;28(2):127–34.

    Article  PubMed  Google Scholar 

  6. Das Gupta M. Cognitive impairment in hospitalised seniors. Geriatrics. 2016;7:4. https://doi.org/10.3390/geriatrics1010004.

    Article  Google Scholar 

  7. Rigney TS. Delirium in the hospitalized elder and recommendations for practice. Geriatr Nurs. 2006;27(3):51–7.

    Article  Google Scholar 

  8. Cole MG, Ciampi A, Belzile E, Dubuc-Sarrasin M. Subsyndromal delirium in older people: a systematic review of frequency, risk factors, course and outcomes. Int J Geriatr Psychiatry. 2003;28:771–80.

    Article  Google Scholar 

  9. Kukreja D. Gunther Ulf, Popp J. Delirium in the elderly: current problems with increasing geriatric age. Ind J Med Res. 2015;142(6):655–62.

    Article  Google Scholar 

  10. Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, Nava VS, et al. Delirium epidemiology in critical care study group. Delirium Epidemiology in Critical Care Study Group. Delirium in critical care (DECCA) an International Study. Crit Care. 2010;14(6):R210. https://doi.org/10.1186/119333.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Agarwal V, O’Neill PJ, Cotton BA, Pun BT, Haney S, Thompson J, et al. Prevalence and risk factors for development of delirium in burns ICU patients. J Burns Care Res. 2010;31(5):706–15.

    Article  Google Scholar 

  12. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity reliability of the confusion assessment method for ICU. JAMA. 2001;286(21):2703010.

    Article  Google Scholar 

  13. Grover S, Lahariya A, Bagga S, Sharma A. Incidence prevalence and risk factors for delirium in elderly admitted to a coronary care unit. J Geriatric Mental Health. 2014;1(1):45–53.

    Article  Google Scholar 

  14. Demeure MJ, Fan MJ. The elderly surgical patient and postoperative delirium. J Am Coll Surg. 2006;203(5):752–7.

    Article  PubMed  Google Scholar 

  15. Waas S, Webster PJ, Nair BR. Delirium in the elderly. Oman Med J. 2008;23(3):150–7.

    Google Scholar 

  16. Steiner LA. Post-operative delirium. Part: Pathophysiology and risk factors. Eur J Anaesthesiol. 2011;28(9):628–36.

    Article  CAS  PubMed  Google Scholar 

  17. Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol. 2010;119(6):737–54.

    Article  PubMed  Google Scholar 

  18. Maclullich AMJ, Anand A, Davis DH, Jackson T, Barugh AJ, et al. New horizons in the pathogenesis, assessment and management of delirium. Age Ageing. 2013;42:667–74.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Maldonado JP. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013;21(12):1190–222.

    Article  PubMed  Google Scholar 

  20. Maclullich AM, Ferguson KJ, Miller T, de Rooj SE, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008;65:229–38.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cunningham C, Campson S, Lunnin K, Murray CL, Woods JF, Deacon RM, et al. Systemic inflammation induces acute behavioural and cognitive changes and accelerates neurodegenerative disease. Biol Psychiatry. 2009;65:304–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. van Munster BC, Korevar JC, Zwinderman AH, Levi M, Wiersinga WJ, de Rooij SE. Time-course of cytokines during delirium in elderly patients with hip fractures. J Am Geriatr Soc. 2008;56:1704–9.

    Article  PubMed  Google Scholar 

  23. de Rooij SE, van Munster BC, Korevaar JC, Levi M. Cytokines and acute phase response in delirium. J Psychosom Res. 2007;2(5):521–5.

    Article  Google Scholar 

  24. Murray S, Sanderson DJ, Barkus C, Deacon RM, Rawins JN, Bannerman DM, et al. Systemic inflammation induces working memory deficits in the primed brain: relevance for delirium. Neurobiol Aging. 2012;33(3):603–16.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Olsson T, Marklund N, Gustafson Y, Nasinen B. Abnormalities at different levels of the hypothalamic –pituitary adrenocortical axis early after stroke. Stroke. 1992;23(ii):1573–6.

    Article  CAS  PubMed  Google Scholar 

  26. Sanders RD. Hypotheses for the pathophysiology of delirium: role of base; line brain network connectivity and changes in inhibitory tone. Med Hypotheses. 2011;77(1):140–3.

    Article  PubMed  Google Scholar 

  27. Veiga Fernandez F, Cruz JJ. Delirium: etiology and pathophysiology. Rev Esp Geriatr Gerontol. 2004;43(Suppl 3):4–12.

    Google Scholar 

  28. Alagiakrishnan K. Delirium. Medscape http://emedicine.medscape.com/article/288890-overview. Accessed 20 July 2017.

  29. Burns A, Gallagley A, Byrne J. Delirium. J Neurol Neurosurg Psychiatry. 2004;75:362–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Fong TG, Bogardus ST Jr, Daftary A, Auerbach E, Blumenfeld H, Modur S, et al. Cerebral perfusion in older delirious patients using 99mTc HMPA O SPECT. J Gerontol A Biol Sci Med Sci. 2006;61:1294–9.

    Article  PubMed  Google Scholar 

  31. Caplan LR, Kelly M, Kase Hier DB, White JL, Tatamichi T, Mohr J, et al. Infarction of the inferior division of the right middle cerebral artery. Neurology. 1986;56:1015–28.

    Article  Google Scholar 

  32. Dostovic Z, Smajlovic D, Dostovic E, Ibrahimagic OC. Risk factors for delirium in the acute stroke. https://www.intechpen.combooks-…/risk-factors-for-delirium-in–the-acute-stroke. 2012. Accessed 23 July 2017.

    Google Scholar 

  33. Nagaratnam N, Nagaratnam K. Subcortical origins of acute confusional states. Eur J Int Med. 1995;6:55–8.

    Google Scholar 

  34. Bruunsgaard H, Pedersen M, Pedersen BK. Aging and proinflammatory cytokines. Curr Opin Haematol. 2001;8:131–6.

    Article  CAS  Google Scholar 

  35. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. The immunology of delirium. Neueoimmunomodulation. 2014;21(2–3):72–8.

    Article  CAS  PubMed  Google Scholar 

  36. Trzepacz PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry. 2000;5(2):132–48.

    Google Scholar 

  37. Girard TD, Pandharipande PP, Ely WE. Delirium in the intensive care unit. Crit Care. 2008;12(suppl 3):S#. https://doi.org/10.1186/cc6149.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Flacker JM, Lipitz LA. Neural mechanisms of delirium: current hypothesis and evolving concepts. J Gerontol A Biol Sci Med Sci. 1999;54(6):B239–46.

    Article  CAS  PubMed  Google Scholar 

  39. Bogovic TZ, Tonkovic D, Sekulic A, Bandic-Pavlovic D, Baronica R, Bogovic M, et al. Pathophysiology of delirium. Acta Med Croatica. 2012;66(1):61–6.

    CAS  PubMed  Google Scholar 

  40. Seaman JS, Schillerstrom J, Carroll D, Brown TM. Impaired oxidative metabolism precipitates delirium: a study of 101 ICU patients. Psychosomatics. 2006;47:56–61.

    Article  PubMed  Google Scholar 

  41. Egberts A, Fekkes D, Wijnbeld EHA, van der Ploeg MA, van Saase J LCM, Ziere G, et al. Disturbed serotonergic neurotransmission and oxidative stress in elderly patients. Dement Geriatr Cogn Dis Extra. 2015;5(3):450–58.

    Google Scholar 

  42. De Rooij SE, van Munster BC. Melatonin deficiency hypothesis in delirium: synthesis of current evidence. Rejuvenation Res. 2013;16(4):273–8.

    Article  PubMed  Google Scholar 

  43. Figueroa-Ramos MI, Arroyo-Novoal M, Lee KA, Padilla G, Puntillo KA. Sleep and delirium in ICU patients and review of mechanisms and manifestations. Intensive Care Med. 2009;35:781–5.

    Article  PubMed  Google Scholar 

  44. De Jonghe A, Korevaar JC, van Munster BC, de Rooij SE. Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia: are there implications for delirium? A systematic review. Int J Geriatr Psychiatry. 2010;25(12):1201–8.

    Article  PubMed  Google Scholar 

  45. Bellapart J, Boots R. Potential use of melatonin in sleep and delirium in the critically ill. Br J Anaesth. 2012;108(4):572–80.

    Article  CAS  PubMed  Google Scholar 

  46. Liptzin B, Levkoff SE. A empirical study of delirium subtypes. Br J Psychiatry. 1992;6:843–5.

    Article  Google Scholar 

  47. Jain G, Chakrabarti S, Kulhara P. Symptoms of delirium: an explanatory factor for analytic study among referred patients. Gen Hosp Psychiatry. 2011;33(4):377–88.

    Article  PubMed  Google Scholar 

  48. Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: an overview. Ann Intensive Care. 2012;2:49. https://doi.org/10.1186/2110-5820-2-49.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Hall W, Zador D. The alcohol withdrawal syndrome. Lancet. 1997;349(9069):1897–900.

    Article  CAS  Google Scholar 

  50. Shi O, Warren L, Saposnik G, Macdermid JC. Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy. Neuropsychiatr Dis Treat. 2013;9:1359–70.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Inouye SK, Bogardus ST Jr, Charpentier PA, Leo Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–76.

    Article  CAS  PubMed  Google Scholar 

  52. Siddiqi N, Harrson JK, Clegg A, Teale EA, Young J, Taylor T, et al. Interventions to prevent delirium in hospitalised patients, not including those on intensive care units. http://www.cochrane.org/CD005563/DEMENTIA_interventions-prevent-…hospitalised-patients-not–including-those-intensive-care-units. Accessed 1 Aug 2017.

  53. (www.hospitalelderlifeprogram.org (http://www.hospitalelderlifeprogram.org))

  54. Inouye SK, Bogardus ST Jr, Baker DI, Leo-Summers L, Cooney M Jr. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalised patients. J Am Geriatr Soc. 2000;48:1679–170.

    Article  Google Scholar 

  55. Vidan MT, Sanchez E, Alonso M, Montero B, Oritz J, Serra JA. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalisation of elderly patients. J Am Geriatr Soc. 2009;57:01292036.

    Article  Google Scholar 

  56. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49:516–22.

    Article  CAS  PubMed  Google Scholar 

  57. Kalisvaart KJ, de Jonghe JF, Bogaards MJ, Vreewijk R, Egberts TC, Burger BJ, et al. Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc. 2005;53:1658–66.

    Article  PubMed  Google Scholar 

  58. Prakanrattana U, Prapaitrakool S. Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care. 2007;35:714–9.

    CAS  PubMed  Google Scholar 

  59. Mayo Clinic. Delirium. www.mayclinic.org/disease-cnditions/deiroium.basics/tratment/con_20033982.

  60. Holroyd-Leduc JM, Khandwala F, Sink KM. How can delirium best be prevented and managed in older patients in hospital? Can Med Assoc J. 2010;182(5):465–70.

    Article  Google Scholar 

  61. Chan PKY. Clarifying the confusion about confusion: current practices in managing geriatric delirium. BCMJ. 2011;53:409–15.

    Google Scholar 

  62. Taylor DM. Antipsychotics and QT prolongation. Acta Psychiar Scand. 2003;107:85–95.

    Article  CAS  Google Scholar 

  63. Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007;(2):CD005594.

    Google Scholar 

  64. Roberts B, Rickard CM, Rajbhandari D, Turner G, Clarke J, Hill D, et al. Multicentre study of delirium in ICU patients using a simple screening tool. Aust Crit Care. 2005;18(1):6,11–4.

    Article  Google Scholar 

  65. Bruno JJ, Warren ML. Intensive care unit delirium. Crit Care Nurs Clin North Am. 2010;22(2):161–78.

    Article  PubMed  Google Scholar 

  66. Delvin JW, Brummel NE, Al-Qadheeb NS. Optimising the recognition of delirium in the intensive care unit. Best Pract Res Clin Anaesthesiol. 2012;26(3):385–93.

    Article  Google Scholar 

  67. Van Eijk MM, Slooter AJ. Delirium in intensive care unit patients. Semin Cardiothorac Vasc Anesth. 2010;14(2):141–7.

    Article  PubMed  Google Scholar 

  68. Miller RR 3rd, Ely EW. Delirium and cognitive dysfunction in the intensive care unit. Semin Respir Crit Care Med. 2006;27(3):210–20.

    Article  PubMed  Google Scholar 

  69. Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005;11(4):360–8.

    PubMed  Google Scholar 

  70. Grover S, Kate N. Assessment scales for delirium: a review. World J Psychiatry. 2012;2(4):58–70.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Gusmao-Flores D, Salluh JL, Chalhub RA, Quarantini LC. The confusion assessment method fot the intensive care unit(CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16(4):R115. https://doi.org/10.1186/cc11.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Burkhart CS, Birkner-Binder D, Steiner LA. Delirium in the intensive care unit. Ther Umsch. 2010;67(2):75–8.

    Article  PubMed  Google Scholar 

  73. Quimet S, Kavansgh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med. 2007;33(1):66–73.

    Article  Google Scholar 

  74. Morandi A, Jackson JC. Delirium in the intensive care unit: a review. Neurol Clin. 2011;29(4):749–63.

    Article  PubMed  Google Scholar 

  75. Ely EY, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–9.

    Article  CAS  PubMed  Google Scholar 

  76. Agrawal IJ, Devlin JW, Peelen LM, Slooter AJ. A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40–7.

    Article  Google Scholar 

  77. Zaal IJ, Devlin JW, Peelen LM. Slooter AJ.A systematic review of risk factors for delirium in the ICU. Crit Care Med. 2015;43(1):40–7.

    Article  PubMed  Google Scholar 

  78. Sharma A, Malhotra S, Grover S, Jindal SK. Incidence, prevalence, risk factor and outcome of delirium in intensive care unit: a study from India. Gen Hosp Psychiatry. 2012;34(6):639–46.

    Article  PubMed  Google Scholar 

  79. Bryczkowski SB, Lopreiato MC, Yonclas PP, Sacca JJ, Mosenthal AC. Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit. J Trauma Acute Care Surg. 2014;77(6):944–51.

    Article  PubMed  Google Scholar 

  80. Meagher DJ, Trzepacz PT. Motoric subtypes of delirium. Semin Clin Neuropsychiatry. 2000;5:75–85.

    CAS  PubMed  Google Scholar 

  81. Serafim RB, Soaes M, Bozza FA, Silva LE, Dal-Pizzol F, et al. Outcomes of subsyndomal delirium in ICU: a systematic review and meta-analysis. Crit Care. 2017;21(1):179. https://doi.org/10.1186/s13054-017-1765-3.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi AA, et al. He course of subsyndromal delirium in older long-term care residents. Am J Geriatr Psychiatry. 2013;21(3):289–96.

    Article  PubMed  Google Scholar 

  83. Ouimet S, Riker R, Bergeron N, Cossette M, Kavanagh B, Skrobik Y. Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med. 2007;33(6):1007–13.

    Article  PubMed  Google Scholar 

  84. Pandaharipande PP, Patel MB, Barr J. Management of pain, agitation and delirium in critically ill patients. Pol Arch Med Wewn. 2014;124(3):114–23.

    Google Scholar 

  85. von Haken, Gruss M, Plaschke K, Scholz M, Engelhardt R, Brobeil A, et al. Delirium in the intensive care unit. Anaesthetist. 2010;59(3):235–47.

    Article  CAS  Google Scholar 

  86. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A method for detection of delirium. Ann Intern Med. 1990;113:941–8.

    Article  CAS  PubMed  Google Scholar 

  87. Trzepaez PJ, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the Delirium Rating Scale-Revised-98. Comparison with the Dementia Rating Scale and Cognitive test for Delirium. J Neuropsyhiatry Clin Sci. 2001;13:229–42.

    Google Scholar 

  88. Dostovic Z, Smajlovic D, Sinanovic O, Vidovic H. Duration of delirium in the acute stage of stroke. Acta Clin Croat. 2009;48(1):13–7.

    PubMed  Google Scholar 

  89. McManus J, Pathansali R, Hassan H, Ouldred E, Cooper D, Stewrat R, et al. The evaluation of delirium post-stroke. Int J Geriatr Psychiatry. 2009;24(11):1251–6.

    Article  Google Scholar 

  90. McManus J, Pathansali R, Stewart R, Macdonald A, Jackson S. Delirium post-stroke. Age Aging. 2007;36(6):613–8.

    Article  Google Scholar 

  91. Martin JJ. Confusion agitation and delirium. Front Neurol Neurosci. 2012;30:46–9.

    Article  PubMed  Google Scholar 

  92. Oldenbenving AW, de Kort PL, Jansen BP, Roks G, Kappilla LT. Delirium in acute stroke: a review. Int J Stroke. 2007;2:270–5.

    Article  Google Scholar 

  93. Dahl MH, Ronning OM, Thommissen B. Delirium in acute stroke-prevalence and risk factors. Acta Neurol Scand. 2010;122(s190):39–43.

    Article  Google Scholar 

  94. Siddiqi N, House AO, Holmes TD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Aging. 2006;35:350–64.

    Article  Google Scholar 

  95. Sheng AZ, Shen Q, Cordato D, Zhang YY, Yan Chan OR. Delirium within 3 days of stroke in a cohort of elderly patients. J Am Geriatr Soc. 2006;54(8):1192–8.

    Article  PubMed  Google Scholar 

  96. Dostovic Z, Dostovic E, Smajlovic D, Ibrahimagic OC, Avdic L, Becirovic E. Predictors for post-stroke delirium outcome. Mater Sociomed. 2016;28(5):382–6.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Mesulam MM, Waxman SG, Geschwind N, Sabin T. Acute confusional state: with right-sided cerebral artery infarctions. J Neurol Neurosurg Psychiatry. 1976;39:84–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Caplan LR, Kelly M, Kase CS, Hier DB, White JL, Tatemichi TK, et al. Infarction of the right middle cerebral artery. Neurology. 1986;36:1015–20.

    Article  CAS  PubMed  Google Scholar 

  99. Devinsky O, Bear D, Volpe BT. Confusional states following posterior cerebral artery infarction. Arch Neurol. 1988;45:601–6.

    Article  Google Scholar 

  100. Nicolai A, Lazzarino LG. Acute confusional states secondary to infarctions in the territory of the osterior cerebral artery in elderly patients. Italian J Neurol Sci. 1994;15(2):91–6.

    Article  CAS  Google Scholar 

  101. Milandre L, Brosset C, Botti G, Khalil R. A study of 82 cerebral infarction in the area of the posterior cerebral arteries. Rev Neurol. 1994;150:133–41.

    CAS  PubMed  Google Scholar 

  102. Tatemichi TK, Desmond DW, Prohovnik I, Cross DT, Gropen TI, Mohr JP, et al. Confusion and memory loss from capsular genu infarction: a thalamocortical disconnection syndrome? Neurology. 1992;42:1966–79.

    Article  CAS  PubMed  Google Scholar 

  103. Santamaria J, Blesa R, Tolsa ES. Confusional syndrome in thalamic stoke. Neurology. 1984;34:168.

    Article  Google Scholar 

  104. Caeiro L, Ferro JM, Albuquerque R, Figueira ML. Delirium in the first days of acute stroke. J Neurol. 2004;251(2):17–8.

    Article  Google Scholar 

  105. Naidech AM, Polnaszek KL, Berman MD, Voss JL. Haematoma locations predicting delirium symptoms after intracerebral haemorrhage. Neurocrit Care. 2016;24(3):397–403.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Shi Q, Persutti R, Selchen D, Saposnik G. Delirium in acute stroke. Stroke. 2012;42:645–9.

    Article  Google Scholar 

  107. Melkar S, Laurila JV, Vataje R, Oksala N, Jokinen H, Pohjasvaara T, et al. Post-stroke delirium in reaction to dementia and long term mortality. Int J Geriatr Psychiatry. 2012;27(4):401–8.

    Google Scholar 

  108. Morandi A, Davis D, Bellelli G, Arora RC, Caplan GA, Kamholz B, et al. The diagnosis of delirium superimposed on dementia: an emerging challenge. J Am Med Dir Assoc. 2017;18(1):12–8.

    Article  PubMed  Google Scholar 

  109. Gore RL, Vardy ER, O’Brien JT. Delirium and dementia with Lewy bodies: distinct diagnosis or part of same spectrum. J Neurol Neurosurg Psychiatry. 2015;86(1):50–9.

    Article  PubMed  Google Scholar 

  110. Walker MP, Ayre GA, Cummings JL, Wesnes K, McKeith IG, O’Brien JT, et al. Quantifying fluctuation with dementia with Lewy bodies, Alzheimer’ dementia, vascular dementia. Neurology. 2000;54:1616–162.

    Article  CAS  PubMed  Google Scholar 

  111. Grubeck-Loebenstein B, Della Bella S, Iorio AM, Michel JP, Pawelec G, Solana R. Immunosenescence and vaccine failure in the elderly. Aging Clin Exp Res. 2009;21(13):201–9.

    Article  CAS  PubMed  Google Scholar 

  112. Burkle A, Casell G, Franceschi C, Mariani E, Sansoni P, Sansoni A, et al. Pathophysiology of ageing, longevity and age related disease. Immunity Aging. 2007;4:4. https://doi.org/10.1186/1742-4933-4-4.

    Article  CAS  Google Scholar 

  113. Campisi J. The biology of replicative senescence. Eur J Cancer. 1997;33(5):703–9.

    Article  CAS  PubMed  Google Scholar 

  114. Vasto S, Colonna-Romano G, Larbi A, Wikby A, Caruso C, Pawelec G. Role of persistent CMV infection in in figuring T cell immunity in the elderly. Immun Ageing. 2007;4:2. https://doi.org/10.1186/1742-4933-42.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Gruver AL, Hudson LL, Sempowski GD. Immunosenescence of ageing. J Pathol. 2007;211(2):144–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Alberts B, Johnson A, Lewis J, Raff M, Robrts K, Walter P. Helper T cells and lymphocyte activation. In: Molecular biology of the cell. 4th ed. New York: Garland Science; 2002.

    Google Scholar 

  117. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalised elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996;275(11):852.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Kujan Nagaratnam

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  1. Kujan Nagaratnam
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Corresponding author

Correspondence to Kujan Nagaratnam .

Editor information

Editors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Nages Nagaratnam

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Kujan Nagaratnam

  3. Rehabilitation and Aged Care Service, Blacktown-Mt Druitt Hospital, Blacktown, NSW, Australia

    Gary Cheuk

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    The following are true of delirium, EXCEPT:

    1. A.

      In delirium the attention is reduced.

    2. B.

      The hypoactive form occurs infrequently and often mistaken for depression or dementia.

    3. C.

      The clinical manifestations can vary according to the precipitating cause.

    4. D.

      Acute delirium is a common complication of medical illnesses.

  2. 2.

    The following are true of delirium, EXCEPT:

    1. A.

      The term subsyndromal has been used to describe an intermediate stage between delirium and normal cognition.

    2. B.

      Delirium can occur in pre-existing dementia and has been referred to as delirium superimposed on dementia.

    3. C.

      Delirium and Lewy body dementia differ largely in their clinical manifestations.

    4. D.

      Specific stroke types may likely to bring on delirium.

  3. 3.

    The following are true in the management of delirium, EXCEPT:

    1. A.

      Potential side effects of antipsychotics (typical and atypical) include prolongation of the QTc interval.

    2. B.

      Antipsychotics should be used short term until the delirium subsides.

    3. C.

      Haloperidol in low dosage was in no way different to the atypical antipsychotics, olanzapine and risperidone in efficacy.

    4. D.

      There is conclusive evidence to support pharmacological intervention for the prevention and management of delirium.

MCQ Answers

  1. 1.

    B

  2. 2.

    C

  3. 3.

    D

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Nagaratnam, K. (2019). Delirium in the Oldest of Old. In: Nagaratnam, N., Nagaratnam, K., Cheuk, G. (eds) Advanced Age Geriatric Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96998-5_32

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  • DOI: https://doi.org/10.1007/978-3-319-96998-5_32

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