Delirium natural history, complications and prognosis

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

Duration

• Ranges from less than a week to more than 2 months.
• Most of the times symptoms resolve by 10to 12 days;
• Up to 15% of patients, typically elderly, symptoms of delirium may last for a month and beyond.

Duration

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. However, it has long been suspected that in some cases delirium persists for months and that it may even be associated with permanent decrements in cognitive function. Barrough said in 1583 that if delirium resolves, it may be followed by a "loss of memory and reasoning power." Recent studies bear this out, with cognitively normal patients who suffer an episode of delirium carrying an increased risk of dementia in the years that follow. In many such cases, however, delirium undoubtedly does not have a causal nature, but merely functions as a temporary unmasking with stress, of a previously unsuspected (but well-compensated) state of minimal brain dysfunction (early dementia).

Prognosis

• Majority of patients have complete recovery
• If untreated delirium may progress to stupor, coma, seizures, or death.
• Delirium in AIDS patients has a poorer prognosis, 27% tends to have complete recovery of cognitive faculties, this may be because of underlying AIDS dementia.
• Delirium in an elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
• Elderly:

1. Only 4% to 40% may have complete recovery
2. Persistent cognitive deficits are common while recovering from delirium, may be related previously unknown aliments.
3. 22%–76% chance of dying during hospitalization if delirium is developed during respective hospital stay and a very high death rate during the months following discharge.

• 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.
• If delirium develops after orthopedic surgery, risk for postoperative complications increases: longer postoperative recuperation periods, longer hospital stays, and long-term disability.