New horizons in the pathogenesis, assessment and management of delirium.
New horizons in the pathogenesis, assessment and management of delirium.
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DOI：
10.1093/ageing/aft148
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发表时间：
2013-11
期刊：
影响因子：
6.7
通讯作者：
Cunningham C
中科院分区：
文献类型：
--
作者：
Maclullich AM;Anand A;Davis DH;Jackson T;Barugh AJ;Hall RJ;Ferguson KJ;Meagher DJ;Cunningham C
谵妄是医疗保健中最重要的未满足的医疗需求之一。它影响八分之一的住院患者，并与多种不良后果相关，包括住院时间延长、新的机构和相当大的患者痛苦。最近的研究还表明，谵妄强烈地预示着未来新发痴呆，以及加速现有痴呆。谵妄的重要性现在越来越被认识到，研究基础不断扩大，新的专业国际组织，政策制定者的兴趣增加，谵妄在教育和审计计划中的地位更加突出。然而，该领域面临着一些复杂的研究和临床挑战。在这篇文章中，我们重点关注谵妄研究和实践中最近进展和/或不确定性的选定领域。(1)发病机制：最近在动物模型中使用外周炎症刺激的研究已经开始提示谵妄综合征的机制及其与痴呆的联系。越来越多的人体血液和脑脊液研究涉及炎症和应激介质。（二）预防：在研究的背景下，预防谵妄是有效的，但有几个尚未解决的问题，包括应包括哪些组成部分，预防性药物的作用，以及与住院老年人的一般最佳护理重叠。（三）评估：虽然有几种仪器用于谵妄的筛查和评估，但检出率仍然很低。目前还没有明确的解决方案，但将常规筛查纳入临床实践，以及开发新的快速筛查工具，提供了潜力。（iv）管理：由于谵妄的异质性，研究是困难的，目前专家和全面的临床护理仍然是主要的建议。未来的研究可能会探讨药物对谵妄特定因素的作用。总之，尽管面临许多挑战，但该领域仍在继续取得进展，有几条有希望的研究路线，研究人员、临床医生和政策制定者的兴趣基础也在不断扩大。
Delirium is one of the foremost unmet medical needs in healthcare. It affects one in eight hospitalised patients and is associated with multiple adverse outcomes including increased length of stay, new institutionalisation, and considerable patient distress. Recent studies also show that delirium strongly predicts future new-onset dementia, as well as accelerating existing dementia. The importance of delirium is now increasingly being recognised, with a growing research base, new professional international organisations, increased interest from policymakers, and greater prominence of delirium in educational and audit programmes. Nevertheless, the field faces several complex research and clinical challenges. In this article we focus on selected areas of recent progress and/or uncertainty in delirium research and practice. (i) Pathogenesis: recent studies in animal models using peripheral inflammatory stimuli have begun to suggest mechanisms underlying the delirium syndrome as well as its link with dementia. A growing body of blood and cerebrospinal fluid studies in humans have implicated inflammatory and stress mediators. (ii) Prevention: delirium prevention is effective in the context of research studies, but there are several unresolved issues, including what components should be included, the role of prophylactic drugs, and the overlap with general best care for hospitalised older people. (iii) Assessment: though there are several instruments for delirium screening and assessment, detection rates remain dismal. There are no clear solutions but routine screening embedded into clinical practice, and the development of new rapid screening instruments, offer potential. (iv) Management: studies are difficult given the heterogeneity of delirium and currently expert and comprehensive clinical care remains the main recommendation. Future studies may address the role of drugs for specific elements of delirium. In summary, though facing many challenges, the field continues to make progress, with several promising lines of enquiry and an expanding base of interest among researchers, clinicians and policymakers.
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影响因子：
15.1
作者：
Chen, Jing;Buchanan, Jessica B.;Johnson, Rodney W.
通讯作者：
Johnson, Rodney W.
影响因子：
4.7
作者：
Breitbart, W;Rosenfeld, B;Passik, S
通讯作者：
Passik, S
影响因子：
8.8
作者：
Devlin, John W.;Roberts, Russel J.;Garpestad, Erik
通讯作者：
Garpestad, Erik
影响因子：
3.4
作者：
Breitbart, W;Gibson, C;Tremblay, A
通讯作者：
Tremblay, A
影响因子：
105.7
作者：
Goldberg, Sarah E.;Bradshaw, Lucy E.;Harwood, Rowan H.
通讯作者：
Harwood, Rowan H.