Download PDF
Semin Neurol 2021; 41(05): 572-587
DOI: 10.1055/s-0041-1733791
Review Article

Evaluation and Management of Delirium

Sophia L. Ryan
1   Department of Neurology, Mount Sinai Medical Center, New York, New York
,
Eyal Y. Kimchi
2   Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Delirium, sometimes referred to as encephalopathy, is an acute confusional state that is both common in hospitalized patients and associated with poor outcomes. For patients, families, and caregivers, delirium can be a traumatic experience. While delirium is one of the most common diagnoses encountered by the consulting neurologist, the majority of the time it will have been previously unrecognized as such by the care team. Neurologic syndromes such as dementia or aphasia can either be misdiagnosed as delirium or may coexist with it, necessitating careful neurologic assessment. Once the diagnosis of delirium has been established, a careful evaluation for predisposing and precipitating factors can help uncover modifiable contributors, which should be addressed as part of a multicomponent, primarily nonpharmacologic intervention. Importantly, delirium management, which begins with comprehensive prevention, should emphasize the humanity of the delirious patient and the challenges of caring for this vulnerable population. When considered, delirium represents an important opportunity for the neurologist to substantially enhance patient care.

Keywords

delirium - encephalopathy - consultation - agitation


Publication History

Article published online:
07 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Chadwick J, Mann M. The Medical Works of Hippocrates. Blackwell; 1950
    Search in Google Scholar
  • 2 Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 2009; 5 (04) 210-220
    CrossrefPubMedSearch in Google Scholar
  • 3 Slooter AJC, Otte WM, Devlin JW. et al. Updated nomenclature of delirium and acute encephalopathy: statement of ten societies. Intensive Care Med 2020; 46 (05) 1020-1022
    CrossrefPubMedSearch in Google Scholar
  • 4 Morandi A, Pandharipande P, Trabucchi M. et al. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med 2008; 34 (10) 1907-1915
    CrossrefPubMedSearch in Google Scholar
  • 5 Neurocognitive disorders. In: Diagnostic and Statistical Manual of Mental Disorders. DSM Library. American Psychiatric Association; 2013.
    CrossrefSearch in Google Scholar
  • 6 Liptzin B, Levkoff SE. An empirical study of delirium subtypes. Br J Psychiatry 1992; 161 (06) 843-845
    CrossrefPubMedSearch in Google Scholar
  • 7 D'Esposito M. Profile of a neurology residency. Arch Neurol 1995; 52 (11) 1123-1126
    CrossrefPubMedSearch in Google Scholar
  • 8 Chang P, Ruff I, Mendelson SJ, Caprio F, Bergman DL, Prabhakaran S. The 2CAN score. Stroke 2018; 49 (12) 2866-2871
    CrossrefPubMedSearch in Google Scholar
  • 9 Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing 2009; 38 (01) 19-26
    CrossrefPubMedSearch in Google Scholar
  • 10 Rockwood K, Cosway S, Stolee P. et al. Increasing the recognition of delirium in elderly patients. J Am Geriatr Soc 1994; 42 (03) 252-256
    CrossrefPubMedSearch in Google Scholar
  • 11 Kales HC, Kamholz BA, Visnic SG, Blow FC. Recorded delirium in a national sample of elderly inpatients: potential implications for recognition. J Geriatr Psychiatry Neurol 2003; 16 (01) 32-38
    CrossrefPubMedSearch in Google Scholar
  • 12 Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014; 383 (9920): 911-922
    CrossrefPubMedSearch in Google Scholar
  • 13 Bolton C, Thilges S, Lane C, Lowe J, Mumby P. Post-traumatic stress disorder following acute delirium. J Clin Psychol Med Settings 2021; 28 (01) 31-39
    CrossrefPubMedSearch in Google Scholar
  • 14 Physical and verbal violence against health care workers. Sentinel Event Alert 2018; (59) 1-9
    PubMedSearch in Google Scholar
  • 15 Inouye SK. The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med 1994; 97 (03) 278-288
    CrossrefPubMedSearch in Google Scholar
  • 16 Ely EW, Shintani A, Truman B. et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291 (14) 1753-1762
    CrossrefPubMedSearch in Google Scholar
  • 17 Watt CL, Momoli F, Ansari MT. et al. The incidence and prevalence of delirium across palliative care settings: a systematic review. Palliat Med 2019; 33 (08) 865-877
    CrossrefPubMedSearch in Google Scholar
  • 18 Shi Q, Presutti R, Selchen D, Saposnik G. Delirium in acute stroke: a systematic review and meta-analysis. Stroke 2012; 43 (03) 645-649
    CrossrefPubMedSearch in Google Scholar
  • 19 Zipser CM, Deuel J, Ernst J. et al. Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients. J Neurol 2019; 266 (12) 3065-3075
    CrossrefPubMedSearch in Google Scholar
  • 20 Zipser CM, Deuel J, Ernst J, Schubert M, von Känel R, Böttger S. The predisposing and precipitating risk factors for delirium in neurosurgery: a prospective cohort study of 949 patients. Acta Neurochir (Wien) 2019; 161 (07) 1307-1315
    CrossrefPubMedSearch in Google Scholar
  • 21 Shim JJ, Leung JM. An update on delirium in the postoperative setting: prevention, diagnosis and management. Best Pract Res Clin Anaesthesiol 2012; 26 (03) 327-343
    CrossrefPubMedSearch in Google Scholar
  • 22 Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr 2007; 19 (02) 197-214
    CrossrefPubMedSearch in Google Scholar
  • 23 Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med 2017; 377 (15) 1456-1466
    CrossrefPubMedSearch in Google Scholar
  • 24 Pendlebury ST, Lovett NG, Smith SC. et al. Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission. BMJ Open 2015; 5 (11) e007808
    CrossrefPubMedSearch in Google Scholar
  • 25 Brown EG, Douglas VC. Moving beyond metabolic encephalopathy: an update on delirium prevention, workup, and management. Semin Neurol 2015; 35 (06) 646-655
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Maldonado JR. Delirium pathophysiology: an updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry 2018; 33 (11) 1428-1457
    CrossrefPubMedSearch in Google Scholar
  • 27 Maclullich AMJ, Ferguson KJ, Miller T, de Rooij SEJA, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 2008; 65 (03) 229-238
    CrossrefPubMedSearch in Google Scholar
  • 28 Hasselmo ME, Sarter M. Modes and models of forebrain cholinergic neuromodulation of cognition. Neuropsychopharmacology 2011; 36 (01) 52-73
    CrossrefPubMedSearch in Google Scholar
  • 29 Hshieh TT, Fong TG, Marcantonio ER, Inouye SK. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 2008; 63 (07) 764-772
    CrossrefPubMedSearch in Google Scholar
  • 30 Ali S, Patel M, Jabeen S. et al. Insight into delirium. Innov Clin Neurosci 2011; 8 (10) 25-34
    PubMedSearch in Google Scholar
  • 31 Yu A, Wu S, Zhang Z. et al. Cholinesterase inhibitors for the treatment of delirium in non-ICU settings. Cochrane Database Syst Rev 2018; 6 (06) CD012494
    PubMedSearch in Google Scholar
  • 32 Nikooie R, Neufeld KJ, Oh ES. et al. Antipsychotics for treating delirium in hospitalized adults: a systematic review. Ann Intern Med 2019; 171 (07) 485-495
    CrossrefPubMedSearch in Google Scholar
  • 33 Oh ES, Needham DM, Nikooie R. et al. Antipsychotics for preventing delirium in hospitalized adults: a systematic review. Ann Intern Med 2019; 171 (07) 474-484
    CrossrefPubMedSearch in Google Scholar
  • 34 van Montfort SJT, van Dellen E, Stam CJ. et al. Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis. Neuroimage Clin 2019; 23: 101809
    CrossrefPubMedSearch in Google Scholar
  • 35 Gofton TE, Young GB. Sepsis-associated encephalopathy. Nat Rev Neurol 2012; 8 (10) 557-566
    CrossrefPubMedSearch in Google Scholar
  • 36 Cerejeira J, Firmino H, Vaz-Serra A, Mukaetova-Ladinska EB. The neuroinflammatory hypothesis of delirium. Acta Neuropathol 2010; 119 (06) 737-754
    CrossrefPubMedSearch in Google Scholar
  • 37 Shioiri A, Kurumaji A, Takeuchi T, Matsuda H, Arai H, Nishikawa T. White matter abnormalities as a risk factor for postoperative delirium revealed by diffusion tensor imaging. Am J Geriatr Psychiatry 2010; 18 (08) 743-753
    CrossrefPubMedSearch in Google Scholar
  • 38 Hatano Y, Narumoto J, Shibata K. et al. White-matter hyperintensities predict delirium after cardiac surgery. Am J Geriatr Psychiatry 2013; 21 (10) 938-945
    CrossrefPubMedSearch in Google Scholar
  • 39 Theisen-Toupal J, Breu AC, Mattison MLP, Arnaout R. Diagnostic yield of head computed tomography for the hospitalized medical patient with delirium. J Hosp Med 2014; 9 (08) 497-501
    CrossrefPubMedSearch in Google Scholar
  • 40 Lai MMY, Wong Tin Niam DM. Intracranial cause of delirium: computed tomography yield and predictive factors. Intern Med J 2012; 42 (04) 422-427
    CrossrefPubMedSearch in Google Scholar
  • 41 Naeije G, Bachir I, Gaspard N, Legros B, Pepersack T. Epileptic activities are common in older people with delirium. Geriatr Gerontol Int 2014; 14 (02) 447-451
    CrossrefPubMedSearch in Google Scholar
  • 42 Sambin S, Gaspard N, Legros B, Depondt C, De Breucker S, Naeije G. Role of epileptic activity in older adults with delirium, a prospective continuous EEG study. Front Neurol 2019; 10: 263
    CrossrefPubMedSearch in Google Scholar
  • 43 Naeije G, Gaspard N, Depondt C, Pepersack T, Legros B. Acute confusional state of unknown cause in the elderly: a study with continuous EEG monitoring. Epilepsy Behav 2012; 23 (03) 330-334
    CrossrefPubMedSearch in Google Scholar
  • 44 Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62 (10) 1743-1748
    CrossrefPubMedSearch in Google Scholar
  • 45 Kimchi EY, Neelagiri A, Whitt W. et al. Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes. Neurology 2019; 93 (13) e1260-e1271
    CrossrefPubMedSearch in Google Scholar
  • 46 Meagher DJ, Leonard M, Donnelly S, Conroy M, Adamis D, Trzepacz PT. A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis. J Psychosom Res 2011; 71 (06) 395-403
    CrossrefPubMedSearch in Google Scholar
  • 47 Avelino-Silva TJ, Campora F, Curiati JAE, Jacob-Filho W. Prognostic effects of delirium motor subtypes in hospitalized older adults: a prospective cohort study. PLoS One 2018; 13 (01) e0191092
    CrossrefPubMedSearch in Google Scholar
  • 48 Kanich W, Brady WJ, Huff JS. et al. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med 2002; 20 (07) 613-617
    CrossrefPubMedSearch in Google Scholar
  • 49 Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med 1990; 113 (12) 941-948
    CrossrefPubMedSearch in Google Scholar
  • 50 Ely EW, Inouye SK, Bernard GR. et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 286 (21) 2703-2710
    CrossrefPubMedSearch in Google Scholar
  • 51 Baten V, Busch H-J, Busche C. et al. Validation of the Brief Confusion Assessment Method for screening delirium in elderly medical patients in a German emergency department. Acad Emerg Med 2018; 25 (11) 1251-1262
    CrossrefPubMedSearch in Google Scholar
  • 52 Steis MR, Evans L, Hirschman KB. et al. Screening for delirium via family caregivers: convergent validity of the Family Confusion Assessment Method (FAM-CAM) and interviewer-rated CAM. J Am Geriatr Soc 2012; 60 (11) 2121-2126
    CrossrefPubMedSearch in Google Scholar
  • 53 Inouye SK, Puelle M, Saczynski J, Steis M. The Family Confusion Assessment Method (FAM-CAM): Instrument and Training Manual. 2012
    Search in Google Scholar
  • 54 Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The Confusion Assessment Method: a systematic review of current usage. J Am Geriatr Soc 2008; 56 (05) 823-830
    CrossrefPubMedSearch in Google Scholar
  • 55 Tamune H, Yasugi D. How can we identify patients with delirium in the emergency department? A review of available screening and diagnostic tools. Am J Emerg Med 2017; 35 (09) 1332-1334
    CrossrefPubMedSearch in Google Scholar
  • 56 Ganguli M, Ratcliff G, Huff FJ. et al. Serial sevens versus world backwards: a comparison of the two measures of attention from the MMSE. J Geriatr Psychiatry Neurol 1990; 3 (04) 203-207
    CrossrefPubMedSearch in Google Scholar
  • 57 Adamis D, Meagher D, Murray O. et al. Evaluating attention in delirium: a comparison of bedside tests of attention. Geriatr Gerontol Int 2016; 16 (09) 1028-1035
    CrossrefPubMedSearch in Google Scholar
  • 58 Pendlebury ST. Delirium screening in older patients. Age Ageing 2018; 47 (05) 635-637
    CrossrefPubMedSearch in Google Scholar
  • 59 Morandi A, Davis D, Bellelli G. et al. The diagnosis of delirium superimposed on dementia: an emerging challenge. J Am Med Dir Assoc 2017; 18 (01) 12-18
    CrossrefPubMedSearch in Google Scholar
  • 60 Patel SB, Poston JT, Pohlman A, Hall JB, Kress JP. Rapidly reversible, sedation-related delirium versus persistent delirium in the intensive care unit. Am J Respir Crit Care Med 2014; 189 (06) 658-665
    CrossrefPubMedSearch in Google Scholar
  • 61 Shi Q, Warren L, Saposnik G, MacDermid JC. Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy. Neuropsychiatr Dis Treat 2013; 9: 1359-1370
    CrossrefPubMedSearch in Google Scholar
  • 62 Mitasova A, Kostalova M, Bednarik J. et al. Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2012; 40 (02) 484-490
    CrossrefPubMedSearch in Google Scholar
  • 63 Inouye SK, Bogardus Jr ST, Charpentier PA. et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999; 340 (09) 669-676
    CrossrefPubMedSearch in Google Scholar
  • 64 Hshieh TT, Yang T, Gartaganis SL, Yue J, Inouye SK. Hospital Elder Life Program: systematic review and meta-analysis of effectiveness. Am J Geriatr Psychiatry 2018; 26 (10) 1015-1033
    CrossrefPubMedSearch in Google Scholar
  • 65 Inouye SK, Baker DI, Fugal P, Bradley EH. HELP Dissemination Project. Dissemination of the hospital elder life program: implementation, adaptation, and successes. J Am Geriatr Soc 2006; 54 (10) 1492-1499
    CrossrefPubMedSearch in Google Scholar
  • 66 Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc 2011; 59 (Suppl. 02) S241-S243
    CrossrefPubMedSearch in Google Scholar
  • 67 Inouye SK, Marcantonio ER, Metzger ED. Doing damage in delirium: the hazards of antipsychotic treatment in elderly persons. Lancet Psychiatry 2014; 1 (04) 312-315
    CrossrefPubMedSearch in Google Scholar
  • 68 Kuehn BM. FDA warns antipsychotic drugs may be risky for elderly. JAMA 2005; 293 (20) 2462-2462
    CrossrefPubMedSearch in Google Scholar
  • 69 Meyer-Massetti C, Cheng CM, Sharpe BA, Meier CR, Guglielmo BJ. The FDA extended warning for intravenous haloperidol and torsades de pointes: how should institutions respond?. J Hosp Med 2010; 5 (04) E8-E16
    CrossrefPubMedSearch in Google Scholar
  • 70 Kallergis EM, Goudis CA, Simantirakis EN, Kochiadakis GE, Vardas PE. Mechanisms, risk factors, and management of acquired long QT syndrome: a comprehensive review. ScientificWorldJournal 2012; 2012: 212178
    CrossrefPubMedSearch in Google Scholar
  • 71 Herzig SJ, Rothberg MB, Guess JR. et al. Antipsychotic use in hospitalized adults: rates, indications, and predictors. J Am Geriatr Soc 2016; 64 (02) 299-305
    CrossrefPubMedSearch in Google Scholar
  • 72 Chen JJ. Treatment of psychotic symptoms in patients with Parkinson disease. Ment Health Clin 2018; 7 (06) 262-270
    CrossrefPubMedSearch in Google Scholar
  • 73 Maldonado JR, Wysong A, van der Starre PJA, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics 2009; 50 (03) 206-217
    CrossrefPubMedSearch in Google Scholar
  • 74 Mathru M. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Yearbook Anesthesiol Pain Management 2010; 2010: 219-220
    CrossrefPubMedSearch in Google Scholar
  • 75 Cui Y, Li G, Cao R, Luan L, Kla KM. The effect of perioperative anesthetics for prevention of postoperative delirium on general anesthesia: a network meta-analysis. J Clin Anesth 2020; 59: 89-98
    CrossrefPubMedSearch in Google Scholar
  • 76 Reel B, Maani CV. Dexmedetomidine. StatPearls Publishing; 2020 . Accessed July 26, 2020 at: http://www.ncbi.nlm.nih.gov/books/NBK513303/
    PubMedSearch in Google Scholar
  • 77 Marra A, Ely EW, Pandharipande PP, Patel MB. The ABCDEF bundle in critical care. Crit Care Clin 2017; 33 (02) 225-243
    CrossrefPubMedSearch in Google Scholar
  • 78 Dale CR, Kannas DA, Fan VS. et al. Improved analgesia, sedation, and delirium protocol associated with decreased duration of delirium and mechanical ventilation. Ann Am Thorac Soc 2014; 11 (03) 367-374
    CrossrefPubMedSearch in Google Scholar
  • 79 Campbell AM, Axon DR, Martin JR, Slack MK, Mollon L, Lee JK. Melatonin for the prevention of postoperative delirium in older adults: a systematic review and meta-analysis. BMC Geriatr 2019; 19 (01) 272
    CrossrefPubMedSearch in Google Scholar
  • 80 Al-Aama T, Brymer C, Gutmanis I, Woolmore-Goodwin SM, Esbaugh J, Dasgupta M. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry 2011; 26 (07) 687-694
    CrossrefPubMedSearch in Google Scholar
  • 81 Choy SW, Yeoh AC, Lee ZZ, Srikanth V, Moran C. Melatonin and the prevention and management of delirium: a scoping study. Front Med (Lausanne) 2018; 4: 242
    CrossrefPubMedSearch in Google Scholar
  • 82 Shehabi Y, Riker RR, Bokesch PM, Wisemandle W, Shintani A, Ely EW. SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Delirium duration and mortality in lightly sedated, mechanically ventilated intensive care patients. Crit Care Med 2010; 38 (12) 2311-2318
    CrossrefPubMedSearch in Google Scholar
  • 83 Pandharipande PP, Girard TD, Jackson JC. et al; BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med 2013; 369 (14) 1306-1316
    CrossrefPubMedSearch in Google Scholar
  • 84 van den Boogaard M, Schoonhoven L, Evers AWM, van der Hoeven JG, van Achterberg T, Pickkers P. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med 2012; 40 (01) 112-118
    CrossrefPubMedSearch in Google Scholar
  • 85 Vasilevskis EE, Chandrasekhar R, Holtze CH. et al. The cost of ICU delirium and coma in the intensive care unit patient. Med Care 2018; 56 (10) 890-897
    CrossrefPubMedSearch in Google Scholar
  • 86 Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008; 168 (01) 27-32
    CrossrefPubMedSearch in Google Scholar
  • 87 Leslie DL, Zhang Y, Holford TR, Bogardus ST, Leo-Summers LS, Inouye SK. Premature death associated with delirium at 1-year follow-up. Arch Intern Med 2005; 165 (14) 1657-1662
    CrossrefPubMedSearch in Google Scholar
  • 88 Saczynski JS, Marcantonio ER, Quach L. et al. Cognitive trajectories after postoperative delirium. N Engl J Med 2012; 367 (01) 30-39
    CrossrefPubMedSearch in Google Scholar
  • 89 Davis DHJ, Muniz Terrera G, Keage H. et al. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 2012; 135 (Pt 9): 2809-2816
    CrossrefPubMedSearch in Google Scholar
  • 90 Davis DHJ, Muniz-Terrera G, Keage HAD. et al; Epidemiological Clinicopathological Studies in Europe (EClipSE) Collaborative Members. Association of delirium with cognitive decline in late life: a neuropathologic study of 3 population-based cohort studies. JAMA Psychiatry 2017; 74 (03) 244-251
    CrossrefPubMedSearch in Google Scholar
  • 91 Kiely DK, Marcantonio ER, Inouye SK. et al. Persistent delirium predicts greater mortality. J Am Geriatr Soc 2009; 57 (01) 55-61
    CrossrefPubMedSearch in Google Scholar
  • 92 McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002; 162 (04) 457-463
    CrossrefPubMedSearch in Google Scholar
  • 93 Dharmarajan K, Swami S, Gou RY, Jones RN, Inouye SK. Pathway from delirium to death: potential in-hospital mediators of excess mortality. J Am Geriatr Soc 2017; 65 (05) 1026-1033
    CrossrefPubMedSearch in Google Scholar
  • 94 Herzig SJ, LaSalvia MT, Naidus E. et al. Antipsychotics and the risk of aspiration pneumonia in individuals hospitalized for nonpsychiatric conditions: a cohort study. J Am Geriatr Soc 2017; 65 (12) 2580-2586
    CrossrefPubMedSearch in Google Scholar
  • 95 By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2019; 67 (04) 674-694
    CrossrefPubMedSearch in Google Scholar
  • 96 Voyer P, Champoux N, Desrosiers J. et al. Assessment of inattention in the context of delirium screening: one size does not fit all!. Int Psychogeriatr 2016; 28 (08) 1293-1301
    CrossrefPubMedSearch in Google Scholar