Delirium, also known as a profound confused state, is a clinical illness that most commonly affects the elderly. It is marked by a shift in awareness and cognition, as well as a decreased capacity to retain, preserve, or redirect attention. It evolves within a short amount of time and varies over the day.
This article provides insight into etiology, epidemiology, treatment and management options for Delirium.
What is Delirium?
Delirium is a type of abrupt brain failure that occurs somewhere between normal consciousness and stupor or coma. The word delirium is derived from the Latin word delirare, which means "to be out of one's furrow or track." It is a common syndrome marked by disorientation, impaired focus, and cognitive impairment. The essence of delirium lies in disturbances in awareness.
Etiology of Delirium
Delirium can be caused by a number of things, including a head injury or an infection. Older age (above 70 years), dementia (often not diagnosed clinically), functional impairments, male gender, poor eyesight and hearing, and moderate cognitive deficits are the most prevalent predisposing variables. An elevated risk has been linked to Alcohol Use Disorder.
Precipitating factors include increased brain exposure to toxins and a hypercholinergic-hyperdopaminergic condition are all caused by inflammation, hypoxia, and oxidative stress. Inflammation puts the body in a vulnerable state, impairing brain function and increasing blood-brain barrier permeability. Predisposition to circulating deliriogenic drugs, endogenous chemicals, and proinflammatory cytokines can all induce or exacerbate delirium.
Endogenous dopamine is released in response to oxidative stress, which is considered to be the fundamental source of perceptive alterations found in delirium. Melatonin deficiency, which disrupts the sleep-wake cycle, and excess norepinephrine and glutamate are further neurotransmitter imbalances linked to delirium.
However, drug overdose or withdrawal is the most common cause of delirium. Many instances of delirium are caused by pharmaceutical toxicity. This could explain why delirium is so common in older people who have undergone surgery.
How does it affect people?
Delirium includes impairments in memory and attention, as well as disordered thinking, in addition to a change in the level of awareness. Delusions and hallucinations are fairly common. In addition, aberrant psychomotor activity such as excessive thrashing and sleep disturbances, are common features of the illness. A delirious person is essentially incapable of doing mental tasks.
Delirium can strike anyone at any age. The elderly are more vulnerable, possibly as a result of typical aging-related brain changes that result in a reduction in "brain reserve." Children, on the other hand, are at a higher risk of delirium, probably because their brains have not yet fully formed. Other risk factors for delirium, in addition to old age, include tobacco use, dementia and depression.
The prevalence of delirium varies greatly depending on the age of the population that is analysed. However, delirium affects between 10% and 51% of patients who have undergone surgery; those who have had heart surgery appear to be at an especially high risk. The occurrence of delirium is also a terrible omen for the patient's prognosis. Delirium is linked to cognitive deterioration, longer hospital admissions, more health issues, and an increased risk of death; 25% of elderly individuals with delirium die within 6 months.
How has science evolved to help patients?
Scientific research has been resourceful to forecast the likelihood of delirium in clinical settings with a high incidence of deliria, such as critical care and postoperative units, to enhance forecast and the risk assessment of elective surgery. The delirium prediction model, PRE-DELIRIC, has been validated in seven countries and is based on nine clinical and demographic variables at the time of admission. Preoperative neuropsychiatric variables, such as depressive symptoms, cognitive skills, and neuroimaging results, along with intraoperative parameters, are being studied to see whether they may be used to predict postoperative delirium risk.
Treatment & Management Options
Delirium is a serious medical condition that requires identifying and treating the underlying cause. Except when delirium is caused by a terminal illness or serious brain trauma, most cases of delirium are recoverable. Medication, environmental adjustments, and family support are all part of the treatment.
Neuroleptics are the most commonly prescribed drugs (Fricchione et al., 2008; Lee et al., 2004). These are also prescribed for schizophrenia. Benzodiazepines (such as those used to treat anxiety disorders) are used to treat delirium caused by alcohol or drug withdrawal (Trzepacz et al., 2002).
Furthermore, environmental modifications that aid patients' orientation, such as sufficient lighting, clear signs, and well-accessible calendars and clocks, can be beneficial. When working with patients, it is also critical that staff personnel introduce themselves, clarify their function, and provide reorienting prompts as needed (O'Mahoney et al., 2011). Even months after an episode of delirium, certain individuals, particularly the elderly, may still have difficulty with orientation, sleep, and other issues.
Delirium is a major cause of death and illness in inpatient elderly individuals and often suggests serious disease in pediatric patients. Prevention and treatment, professional caregiver education, and a methodical approach to management can all help to improve the syndrome's prognosis. Clinicians should be aware that delirium patients have knowledge of their situation, despite their varying sense of reality.
Unwired India is a neurotech-startup that aims at integrating state-of-the-art research and developments in STEM, for catalyzing the transition of Neuroscience to Neurotechnology. We develop avant-garde non-invasive neurostimulation products used to solve some of the world’s most critical global issues and challenges. Our mission is to take cutting-edge brain research directly into the lives and homes of people, thereby fostering a unique culture of sustainable neuroscience and scientific literacy in India.
Founded in 2020, we are the pioneers of Nootropics and non-invasive Neurotechnology devices in the country, and offer so much more than high-quality, delicious Brain Nutrition products for daily cognitive support; a full-service health and fitness startup that has become an important part of the local community, here in New Delhi, India.
We develop non-GMO, all-natural nootropic (smart-drug) formulations, Himalayan herb blends, and specialized amino-nutraceutical interventions and supplements for enhanced brain function, cognition, neuroinflammation, and neurodegeneration.
The Hope Project (THP) is a neuro-disorder awareness initiative within the organizational framework of Unwired India. The initiative aims at creating and scaling awareness against the stigma, fear, and apprehensions associated with Neurological disorders.
Aims: To promote and develop awareness across global masses and to emphasize the importance of early detection, in addition to fostering a healthy lifestyle- which is important in the management and treatment of these ailments.
WORK WITH US.
Register at http://www.unwiredindia.com/team/
A friendly reminder: We've done our research, but you should too! Check our sources against your own and always exercise sound judgment.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070893 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070893 https://www.statpearls.com/ArticleLibrary/viewarticle/20325 https://jnnp.bmj.com/content/75/3/362' https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/ Image Credits: https://www.pexels.com by cottonbro and Thirdman
About the Author
Content Writer for The Hope Project (Delhi, India)
Ishika Jain is a student of Psychology honors from the University of Delhi, armed with hands-on knowledge in research, public health, and health tech. She has worked in the field of global mental health, community research, and intervention, assisting in science communication and research writing. She has a keen interest in Neuropsychology, with a blend of neuroscience, philosophy, and interpersonal contact.