THE DILEMMA OF DELIRIUM - CLINICAL AND RESEARCH CONTROVERSIES REGARDING DIAGNOSIS AND EVALUATION OF DELIRIUM IN HOSPITALIZED ELDERLY MEDICAL PATIENTS
THE DILEMMA OF DELIRIUM - CLINICAL AND RESEARCH CONTROVERSIES REGARDING DIAGNOSIS AND EVALUATION OF DELIRIUM IN HOSPITALIZED ELDERLY MEDICAL PATIENTS
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DOI：
10.1016/0002-9343(94)90011-6
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发表时间：
1994-09-01
影响因子：
5.9
通讯作者：
INOUYE, SK
中科院分区：
文献类型：
--
作者：
INOUYE, SK
谵妄的发生率从14%到56%，相关死亡率从10%到65%，每年的医疗保健支出从10亿美元到20亿美元不等，对住院的老年患者来说是一个常见而严重的问题。谵妄常常被照顾老年病人的医生所识别或误诊。认知测试很少作为老年住院患者入院评估的一部分。由于诊断标准和工具仍在发展之中，因此很难作出具体诊断。谵妄的病因是复杂和多因素的，诱发（主机脆弱性）和促发因素都必须考虑。在缺乏客观疗效数据的情况下，推荐的谵妄评价方法是经验性的。评估的基础包括仔细的病史、体格检查和药物清单的回顾，因为药物是谵妄最常见的可逆原因。需要进行研究，以建立一种具有成本效益的方法，并澄清进一步测试的作用，如脑脊液检查，脑成像和脑电图。本文旨在提高临床医生的认识，以及刺激研究，以解决这一重要的，被忽视的问题，老年住院患者。
Delirium, with occurrence rates from 14% to 56%, associated mortality rates from 10% to 65%, and excess annual health care expenditures from $1 to $2 billion, poses a common and serious problem for hospitalized elderly patients. Delirium is often unrecognized or misdiagnosed by physicians caring for elderly patients. Cognitive testing is rarely done as part of the admission evaluation of elderly hospitalized patients. Specific diagnosis has been difficult, since diagnostic criteria and instruments are still being developed. The etiology of delirium is complex and multifactorial, and both predisposing (host vulnerability) and precipitating factors must be considered. The recommended approach to the evaluation of delirium is empiric, in the absence of objective efficacy data. The cornerstone of evaluation includes a careful history, physical examination, and review of the medication list-since medications are the most common reversible cause of delirium. Research is needed to establish a cost-effective approach and to clarify the role of further testing, such as cerebrospinal fluid examination, brain imaging, and electroencephalography. This article is intended to heighten the awareness of clinicians as well as to stimulate research to address this important, neglected problem for elderly hospitalized patients.