Delirium in acute neurological care department. Causes, pathogenesis and management

Abstract

Defined as an organic decline, often transient, undulant, mainly of cognitive function, memory, language, delirium is often considered the attribute of patients hospitalized with multiple illnesses. Medical costs, and subsequent psycho-logical implications, prognostic particularities give him a special social importance. Although with multiple recognized etiology, its pathogenesis is partially known, involving relays and neural networks. In the presence of known predisposing factors and under some precipitating influence like acute metabolic or inflammatory disorders (interleukins 1, 6, caspaze), infections, vascular endothelial dysfunction that cause malfunctions of neurotransmitters (GABA, glutamate, acetylcholine, melatonin) occurs, mainly, an attentional matrix disruption (attention modulation is done through the collaboration of the neocortex, thalamus and brainstem’s reticular substance) as well as structural changes of neural networks and their interaction with cerebral default network. Its prevalence is estimated at the time of admission between 11-30% of patients. Early identification of patients at risk and multifactorial and multidisciplinary approach represents efficient solution to prevent delirium consequences. Authors performed a synthetic rundown of the main theoretical aspects of delirium and exemplify by a retrospective study in “Prof. Dr. N. Oblu” Neurological Clinic of Emergencies hospital, Iasi. From 3,707 patients admitted in one year, 32% had impaired language and only 7% have presented confusional syndrome: 58% in ischemic strokes or hemorrhagic (9%), epilepsy (18%), intra-cerebral tumors (1.8%), metabolic encephalopathies (7%), neurodegenerative disorders (22%), infections (3%). Ages prevailed over 60 years and males (64%), low outcome in 15%, 80% had improvement in evolution and 5% died.

Keywords

• delirium
• causes
• management