Delirium is a syndrome of disturbed consciousness, attention, and cognition or perception, which develops acutely, fluctuates during the course of the day, and is attributable to a physical disorder. <sup>6 American Psychiatric Association   Diagnostic and Statistical Manual of Mental Disorders Washington: American Psychiatric Press (1994). 

Cliccare qui per andare alla sezione Riferimenti</sup> This syndrome is the focus of increasing attention because of its enormous impact on human suffering as well as on patient care costs. <sup>45 Lipowski Z.J. Delirium in the elderly patient N Engl J Med 1989 ;  320 : 578

Cliccare qui per andare alla sezione Riferimenti, 71 Thomas R.I., Cameron D.J., Fahs M.C. A prospective study of delirium and prolonged hospital stay Arch Gen Psychiatry 1988 ;  45 : 937

Cliccare qui per andare alla sezione Riferimenti</sup> In the elderly, delirium is common, particularly in hospitalized patients. <sup>30 Inouye S.K. The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients Am J Med 1994 ;  97 : 278  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> It has a high rate of associated morbidity and mortality, <sup>20 Francis J., Kapoor W.N. Prognosis after hospital discharge of older medical patients with delirium J Am Geriatr Soc 1992 ;  40 : 601

Cliccare qui per andare alla sezione Riferimenti, 37 Jitapunkul S., Pillay I., Ebrahim S. Delirium in newly admitted elderly patients: A prospective study Q J Med 1992 ;  83 : 307

Cliccare qui per andare alla sezione Riferimenti, 59 Rabins P.V., Folstein M.F. Delirium and dementia: Diagnostic criteria and fatality rates Br J Psychiatry 1982 ;  140 : 149  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and significantly extends the length of hospital stay. <sup>71 Thomas R.I., Cameron D.J., Fahs M.C. A prospective study of delirium and prolonged hospital stay Arch Gen Psychiatry 1988 ;  45 : 937

Cliccare qui per andare alla sezione Riferimenti</sup> Its presence predicts posthospitalization cognitive decline and loss of independent community living. <sup>20 Francis J., Kapoor W.N. Prognosis after hospital discharge of older medical patients with delirium J Am Geriatr Soc 1992 ;  40 : 601

Cliccare qui per andare alla sezione Riferimenti, 37 Jitapunkul S., Pillay I., Ebrahim S. Delirium in newly admitted elderly patients: A prospective study Q J Med 1992 ;  83 : 307

Cliccare qui per andare alla sezione Riferimenti, 40 Koponen H., Stenback U., Mattila E. , e al. Delirium among elderly persons admitted to a psychiatric hospital: Clinical course during the acute stage and one-year follow-up Acta Psychiatr Scand 1989 ;  79 : 579  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> It has been estimated that delirium is responsible for excess annual health care expenditures of $1 to $2 billion. <sup>30 Inouye S.K. The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients Am J Med 1994 ;  97 : 278  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> For all these reasons, delirium is emerging as a central focus for health care cost containment.

Delirium is a medically serious condition. In elderly patients, the presence of delirium may be the only clue to an underlying life-threatening disorder such as myocardial infarction or pneumonia. <sup>46 Lipowski Z.J.   Delirium: Acute Confusional States New York: Oxford (1990). 

Cliccare qui per andare alla sezione Riferimenti</sup> Delirious patients are unable to monitor even basic self-care activities such as fluid intake and output, and thus are at risk of developing secondary conditions such as dehydration. In addition, in the midst of confusion and psychotic thinking, delirious patients may do dangerous things such as performing self-extubation, pulling out central and peripheral lines, wandering out into traffic, standing for hours in the snow in bare feet, falling down stairs, and jumping down laundry chutes.

Delirium is a treatable condition, even in the elderly patient with dementia. Early recognition of the syndrome, aggressive treatment of the underlying cause(s), and appropriate management of attendant behavioral problems all result in decreased morbidity and mortality, shorter lengths of hospitalization, and reduced costs of care. Each of these topics is addressed in the discussion to follow.