Moraga Arturo Vilches, Rodriguez-Pascual Carlos
Hospital do Meixoeiro, Complejo Universitario de Vigo, Pontevedra, Spain.
Curr Opin Psychiatry. 2007 May;20(3):262-7. doi: 10.1097/YCO.0b013e3280ec52e5.
Delirium remains one of the most common complicating diagnoses in ailing elderly patients and a leading cause of morbidity, decreased quality of life, prolonged hospital stay, institutionalization and mortality. Despite its clinical importance and health-related costs, it often remains unrecognized or misdiagnosed. We evaluate currently available tools for the screening and diagnosis of delirium, their relevance and suitability for use in various clinical settings, as well as interobserver consistency amongst doctors and other nonclinician interviewers.
Extensive clinical trial evidence has been published recently concerning advances on the three fundamental elements of delirium assessment in elderly people: identification, severity assessment and reporting of existing predisposing and precipitating factors.
Despite advances on the pathophysiology and recognition of delirium, its detection relies on individual clinical expertise, a high index of suspicion and repeated cognitive testing of high-risk patients. Delirium diagnosis remains a clearly underresearched area; particularly, more work is required to adapt cognitive screening tools for use by nonclinicians, to develop cost-effective biochemical and molecular diagnostic techniques and to assess the effects of divulging updated consensus guidelines.
谵妄仍然是患病老年患者最常见的复杂诊断之一，也是发病、生活质量下降、住院时间延长、入住养老院和死亡的主要原因。尽管其具有临床重要性且涉及相关医疗费用，但往往仍未被识别或误诊。我们评估目前可用于谵妄筛查和诊断的工具、它们在各种临床环境中的相关性和适用性，以及医生和其他非临床访谈者之间的观察者间一致性。
最近发表了大量临床试验证据，涉及老年人谵妄评估三个基本要素的进展：识别、严重程度评估以及报告现有的易患因素和促发因素。
尽管在谵妄的病理生理学和识别方面取得了进展，但其检测仍依赖于个人临床专业知识、高度的怀疑指数以及对高危患者进行反复的认知测试。谵妄诊断仍然是一个明显研究不足的领域；特别是，需要开展更多工作，以使认知筛查工具适用于非临床医生，开发具有成本效益的生化和分子诊断技术，并评估公布最新共识指南的影响。
