Delirium natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]

Overview

The duration of delirium may vary from hours to months. After remission , delirium may increase the risk of functional decline, cognitive dysfunction, and institutional placement, and with higher mortality. Delirium in the elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays. Delirium was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after orthopedic surgery. Common complications associated with delirium include increased mortality, cognitive impairment, longer durations of mechanical ventilation, longer lengths of stay in the ICU. Prognosis is dependent on the severity of delirium, and the 1 year mortality rate of patients with delirium is approximately 10%-26%.

The duration of delirium is typically affected by the underlying cause.
If caused by a fever, the delirious state often subsides as the severity of the fever subsides.
Ranges from less than a week to more than 2 months.
Most of the time symptoms resolve by 10 to 12 days.
Up to 15% of patients, typically elderly, delirium may last for a month and beyond.
Delirium associated with substance withdrawal develops when concentrations of the substance in fluid and tissue decrease.

The duration of delirium may vary from hours to months.^[1]
After remission , delirium may increase the risk of functional decline, cognitive dysfunction, and institutional placement, and with higher mortality.^[2]
Delirium in the elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
Up to 25% of patients with delirium die within 6 months and that their mortality rate in the 3 months after diagnosis is 14 times as high as the mortality rate for patients with affective disorders.
After one episode of delirium, the mortality rate was 24%-76% within one year.^[3]
Delirium was associated with longer postoperative recovery periods, longer hospital stays, and long-term disability after orthopedic surgery.^[4]
Common complications associated with delirium include increased mortality, cognitive impairment, longer durations of mechanical ventilation, longer lengths of stay in the ICU.^[5]
Prognosis is dependent on the severity of delirium, and the 1 year mortality rate of patients with delirium is approximately 10%-26%.^[6]

↑ Rudberg, Mark A; Pompei, Peter; Foreman, Marquis D.; Ross, Ruth E.; Cassel, Christine K. (1997). “The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity”. Age and Ageing. 26 (3): 169–174. doi:10.1093/ageing/26.3.169. ISSN 0002-0729.
↑ McNicoll, Lynn; Pisani, Margaret A.; Zhang, Ying; Ely, E. Wesley; Siegel, Mark D.; Inouye, Sharon K. (2003). “Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients”. Journal of the American Geriatrics Society. 51 (5): 591–598. doi:10.1034/j.1600-0579.2003.00201.x. ISSN 0002-8614.
↑ McCusker, Jane; Cole, Martin; Dendukuri, Nandini; Han, Ling; Belzile, Éric (2003). “The course of delirium in older medical inpatients”. Journal of General Internal Medicine. 18 (9): 696–704. doi:10.1046/j.1525-1497.2003.20602.x. ISSN 0884-8734.
↑ “Practice guideline for the treatment of pati… [Am J Psychiatry. 1999] – PubMed – NCBI”.
↑ Salluh, J. I. F.; Wang, H.; Schneider, E. B.; Nagaraja, N.; Yenokyan, G.; Damluji, A.; Serafim, R. B.; Stevens, R. D. (2015). “Outcome of delirium in critically ill patients: systematic review and meta-analysis”. BMJ. 350 (may19 3): h2538–h2538. doi:10.1136/bmj.h2538. ISSN 1756-1833.
↑ McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E (February 2002). “Delirium predicts 12-month mortality”. Arch Intern Med. 162 (4): 457–63. doi:10.1001/archinte.162.4.457. PMID 11863480.