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Delirium in elderly: the role of psychiatric expertise in a multi-disciplinary team

Mariana Arnaoudova


INTRODUCTION: Delirium is a neurocognitive disorder frequently observed in elderly patients and can be found in any medical condition. Our experience of consulting elderly patients is that delirium is often unrecognized and respectively under-treated. The aim of our study was to evaluate the association between delirium and some risk factors and to elicit important diagnostic and therapeutic issues that could be of practical application to various specialists, dealing with elderly patients with delirium.

PATIENTS AND METHODS: We studied 35 consecutive delirious patients (age 60-88), consulted or admitted at a gerontopsychiatric clinic. The patients came from different hospital settings of the university hospital. The ICD-10 and DSM-IV criteria for delirium and dementia were used. A psychiatric interview, clinical psychiatric and mental status examination, physical, laboratory examination and head computed tomography (CT) were performed. Cognitive impairment was recorded by Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). Descriptive statistic and correlation analysis were applied.

RESULTS AND DISCUSSION: Dementia was diagnosed in 23 (65.7%) out of all 35 delirious patients. Delirium was associated with factors such as prior cognitive impairment (dementia), advanced age, medical conditions and alcohol abuse. Without significant influence on the development of delirium were gender, marital status and education. Much of the disputable diagnostic issues are associated with the fact that no concrete speciality is dealing with the different aspects of delirium. The risk factors (predisposing and precipitating) provoking delirium should be concerned. The role of psychiatry services should be not restricted only to placement issues and acute treatment.

CONCLUSION: Delirium in elderly is a serious medical problem, requiring precise and appropriate diagnosis and management. The fact that delirium is often multifactorial in origin necessitates a broad intervention strategy. The attention should be on prevention, primary and secondary, mostly by active psychiatric consultation.

Keywords: delirium, elderly, risk factors, diagnosis, management, psychiatric expertise


delirium; elderly; risk factors; diagnosis; management; psychiatric expertise

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O`Keeffe, S.T., J.N. Lavan. Clinical significance of delirium subtypes in older people. Age Ageing, 1999;28:115-119.

Young, J., S. K. Inouye. Delirium in older people. BMJ, 2007;334:842-846.

Brown, T. M., M. F. Boyle. ABC of Psychological medicine: Delirium. BMJ, 2002;325: 644-647.

Harrison`s Online textbook. Chapter 26: Confusion and Delirium. McGraw-Hill Companies. Accessed February 2009.

Witlox, J., L.S.M. Eurelings, J. F. M de Jonghe, K.J. Kalisvaart, W.A. van Gool. Delirium in elderly patients and the risk of post discharge mortality, institutionalization and dementia: a meta-analysis. JAMA, 2010;304:443-51.

Siddiqi, N., A.O. Horne, A.O. House, J.D. Holmes. Occurrence and outcome of delirium in medical in-patients; a systematic literature review. Age Ageing, 2006;35:350-364.

McAvay, G. J., P.H. van Ness, S.T. Bogardus, H. Zhany, D. L. Leslie, L.S. Leo-Summers, et al. Older adults discharged from hospital with delirium: one year outcomes. J Am Geriatr Soc., 2006;54:1245-50.

Bucht, G., Y.Gustafson, O. Sandberg. Epidemiology of delirium.- Dement Geriatr Cogn Disord., 1999;10:315-318.

Fann, J. R. The epidemiology of delirium: a review of studies and methodological issues. Semin in Clin Neuropsychiatry, 2000;5:64-76.

Meagher, D. Delirium: The role of psychiatry. - APT, 2001;7:433-442.

Leentjens, A. F., R.C. van der Mast. Delirium in elderly people: an update. Curr Opin Psychiatry, 2005;18:325-330.

Young J., L. Murthy, M. Westby, A. Akunne, R. O` Mahoney. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ, 2010;341:c3704.

Folstein, M.F., Folstein, S.E., McHugh, P.R. `Minimental state`. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res., 1975;12(3):189-198.

Sunderland, T., Hill, J.L., Mellow, A.M., Lawlor, B.A., Gundersheimer, J., Newhouse, P.A., Grafman, J.H. Clock drawing in Alzheimer`s disease: a novel measure of dementia severity. J Am Geriatr Soc., 1989;37:725-729.

World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva, Switzerland: World Health Organization, 1993;36-40

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA, 1994.

McKhann, G., D. Drachman, M. Folstein, R. Katzman, D.Price, E.M.Stadlan. Clinical diagnosis of Alzheimer`s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer`s Disease. Neurology, 1984;34:939-44.

McKhann G. , D. S. Knopmanc, H. Chertkow, B. T. Hyman, C. R. Jack, C. H. Kawas et al. The diagnosis of dementia due to Alzheimer`s disease: Recommendations from the National Institute on Aging and the Alzheimer`s Association workgroup. Alzheimers Dement., 2011;1-7/

Roman, G.C., T.K. Tatemichi, T. Erkinjuntti, J.L. Cummings, J.C.Masdeu, J.H.Garcia et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology, 1993;43(2):250-60.

Wetterling, T., R.D. Kanitz, K. J. Borgis. Comparison of Different Diagnostic Criteria for Vascular Dementia (ADDTC, DSM-IV, ICD-10, NINDS-AIREN). Stroke, 1996;27:30-36.

J. McCusker, M. G.Cole, P.Voyer, M. Vu, A. Ciampi, J.Monette, N. Champoux, E. Belzile, A.Dyachenko. Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium. J Am Geriatr Soc., 2013;61(4):502-11. doi: 10.1111/jgs.12164. Epub 2013 Mar 21.

M. Kennedy, R. A. Enander, S.P. Tadiri, R. E. Wolfe, N. I. Shapiro, E. R. Marcantonio. Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department. J Am Geriatr Soc., 2014;62(3):462-9. doi: 10.1111/jgs.12692. Epub 2014 Feb 10.

Vidan, M.T., E. Sanches, M. Alonso, B. Montero, J. Ortiz, J. A. Serra. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. J Am Geriatr Soc., 2009;58:2029-36

Cole, M., J. McCusker, N. Dendukuri, L.Han. The Prognostic Significance of Subsyndromal Delirium in Elderly Medical Inpatients. J Am Geriatr Soc., 2003;51:754-60.

Schuurmans MJ, Duursma SA, Shortridge-Baggett LM. Early recognition of delirium: review of the literature. J Clin Nurs., 2001;10;721-9.

Girard, T.D., P.P. Panharipande, S.S. Carson, G.A. Schmidt, P.E. Wright, A.E. Canonico et al. Feasibility, efficacy, and safety of antypsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med., 2010;38:428-37.

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About The Author

Mariana Arnaoudova
Medical University of Varna

Department of psychiatry and medical psychology, St. Marina University Hospital of Varna

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