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Transcript of Delirium
Global cognitive impairment
Change in psychomotor activity
Disordered sleep-wake cycle
Features of Delirium:
Delirium vs Dementia
Chronic (6 mths)
Not delirium or other psychiatric disease
40% of delirium cases develop some form of chronic brain syndrome
>3 of 4 ICU survivors with delirium leave ICU with long-term cognitive impairment that equates to mild/moderate dementia.
Traumatic brain injury
Any cognitive dysfunction
NS depressant withdrawal
ncontrolled use (intox)
oxious stimuli (Ouch!)
ight, sleep, circadian
40% demented in hospital become delirious
Decreased ACh producing cell volume
Decrease cerebral oxidative metabolism
> 5 medications
Shock, hypoperfusion, hypotension:
Severe illness + decrease supply + increased demand
Ion gradients fail
Cortical spreading depression
Abnormal NT synthesis
Failure to eliminate neurotoxic by-products
Probability of transitioning to delirium increases linearly from 45% to 68% between scores of 10 and 18.
disturbance interferes with:
inhibits aggregation of amyloid into microaggregates/tangles
High DA, NE, GLU
High & Low 5HT, H1-2, GABA
Treatment of underlying medical problems
Rebalance neurotransmitter derangement
Assess delirium risk factors within 24 hours
Aid sensory impairment
Alpha-2 agonists (dexmedetomidine, clonidine)
3% vs 50% propofal vs 50% midazolam
Anti-psychotics (haloperidol, risperidone, quetiapine)
Serotonin receptor antagonist (Zofran)
Anti-glutamate agents (Valproate)
Dopamine agonists (HYPO active)
ACh-esterase inhibitor (rivastigmine)