Delirium
Basics
Description
- A temporary neurocognitive complication of illness and/or medication(s) manifested by new confusion and impaired attention
- Requires evaluation to decrease morbidity and mortality
Epidemiology
- Predominant age: older persons
- Predominant sex: male = female
Incidence
- >50% in older ICU patients
- 11–51% in postoperative patients
- 19% after intracranial surgery and 42% after neurovascular surgery
- 10–40% in hospitalized older patients
- 20–22 % in nursing home/post–acute care patients
Prevalence
- 1–2% in outpatients
- 8–17% in older ED patients
Etiology and Pathophysiology
- Multifactorial: believed to result from a decline in physiologic reserves with aging, resulting in a vulnerability to new stressors
- Often interaction between predisposing and precipitating risk factors
Risk Factors
- Predisposing risk factors
- Advanced age, >70 years
- Preexisting cognitive impairment
- Functional impairment
- Dehydration
- History of alcohol abuse
- Malnutrition
- Hearing or vision impairment
- Multiple comorbidities
- Precipitating risk factors
- Severe illness in any organ system
- Medical devices (urinary catheter, restraints)
- Polypharmacy (≥5 medications)
- Specific medications, especially benzodiazepines, opioids, anticholinergics diphenhydramine, high-dose neuroleptics
- Pain
- Any iatrogenic event
- Surgery
- Sleep deprivation
Commonly Associated Conditions
Multiple but most common are the following:
- Medication changes
- Infections (especially lung, urine, and bloodstream, but consider meningitis as well)
- Toxic metabolic (especially low sodium, elevated calcium, renal failure, and hepatic failure)
- Heart attack or stroke
- Alcohol or drug withdrawal
- Preexisting cognitive impairment increases risk.
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Citation
Domino, Frank J., et al., editors. "Delirium." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116168/0/Delirium.
Delirium. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116168/0/Delirium. Accessed November 4, 2024.
Delirium. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116168/0/Delirium
Delirium [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 04]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116168/0/Delirium.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Delirium
ID - 116168
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116168/0/Delirium
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -