Confusion, agitation and delirium

Abstract

Delirium is one of the most serious and common complications that up to one third of older patients admitted to hospital develop. It is characterized by a disturbance of consciousness, decreased attention, and disorganized thinking that develops over a short period of time, and fluctuates during the course of the day. Delirium post-stroke prevalence ranges from 13 to 48% in general hospitals, and from 10.1 to 28% in Stroke Units. The Confusion Assessment Method and the Delirium Rating Scale are used as delirium screening tools. The cause of delirium is likely to be multifactorial. In stroke, reduced perfusion of the brain with hypoxia, which deranges neurotransmission, may be the cause. Delirium is more frequent after intracerebral hemorrhage and infarction in specific brain areas. Delirium without other signs of stroke has been reported more often after right-sided than after left-sided lesions. Age, cognitive decline, and multiple coexisting conditions are the most consistent and important risk factors for delirium post-stroke. Haloperidol is currently used as the drug of choice, if sedation is needed.