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Key Features

Essentials of Diagnosis

  • Acute confusional state

  • Transient global disorder of attention, with clouding of consciousness

  • Usually a result of systemic problems (eg, drugs, hypoxemia)

General Considerations

  • The organic problem may be a primary brain disorder or a secondary manifestation of some general disorder

  • The causes of cognitive disorders are listed in Table 25–11

  • Should be considered a syndrome of acute brain dysfunction analogous to acute kidney injury

  • Terminal delirium occurs commonly at the end of life

    • May be related to multiple medical causes, including organ failure

    • May be unrecognized

Table 25–11.Etiology of delirium and other cognitive disorders.

Demographics

  • Alcohol or substance withdrawal is the most common cause of delirium in the general hospital

Clinical Findings

Symptoms and Signs

  • Onset is usually rapid

  • The mental status fluctuates (impairment is usually least in the morning), with varying inability to concentrate, maintain attention, and sustain purposeful behavior

  • "Sundowning"—mild to moderate delirium at night

    • More common in patients with preexisting dementia

    • May be precipitated by hospitalization, drugs, and sensory deprivation

  • There is a marked deficit of memory and recall

  • Anxiety and irritability are common

  • Orientation problems follow the inability to retain information

  • Perceptual disturbances (often visual hallucinations) and psychomotor restlessness with insomnia are common

  • Physical findings vary according to the cause

Diagnosis

Laboratory ...

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