Delirium.

Area of Science:

• Gerontology
• Neurology
• Psychiatry

Background:

• Delirium is an acute confusional state impacting attention and cognition, often superimposed on underlying medical conditions.
• It arises from a complex interplay of predisposing factors (e.g., cognitive impairment) and precipitating factors (e.g., infections).
• Existing neurobiological theories involve neuroinflammation, vascular dysfunction, metabolic changes, neurotransmitter imbalances, and impaired neural connectivity.

Purpose of the Study:

• To review the current understanding of delirium's etiology, diagnosis, and management.
• To highlight the limitations of current pharmacological treatments and the need for improved strategies.
• To emphasize the challenges in implementing effective delirium detection, treatment, and prevention globally.

Main Methods:

• Literature review of delirium pathophysiology, diagnosis, and treatment.
• Analysis of diagnostic criteria, including the DSM-5 and alternative screening tools.
• Evaluation of current management strategies, focusing on multidomain interventions.

Main Results:

• Delirium pathogenesis is multifactorial, involving several neurobiological pathways.
• Pharmacological treatments, such as antipsychotics, have shown limited efficacy.
• Multidomain interventions, addressing precipitating factors and supportive care, represent the current best practice.

Conclusions:

• Effective delirium management requires a comprehensive approach targeting underlying causes and supportive care.
• Significant gaps in understanding delirium's pathophysiology hinder the development of targeted treatments.
• Global healthcare organizations face challenges in implementing evidence-based delirium care strategies.