Maclullich Alasdair M J, Anand Atul, Davis Daniel H J, Jackson Thomas, Barugh Amanda J, Hall Roanna J, Ferguson Karen J, Meagher David J, Cunningham Colm
Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK.
Age Ageing. 2013 Nov;42(6):667-74. doi: 10.1093/ageing/aft148. Epub 2013 Sep 25.
Delirium is one of the foremost unmet medical needs in healthcare. It affects one in eight hospitalised patients and is associated with multiple adverse outcomes including increased length of stay, new institutionalisation, and considerable patient distress. Recent studies also show that delirium strongly predicts future new-onset dementia, as well as accelerating existing dementia. The importance of delirium is now increasingly being recognised, with a growing research base, new professional international organisations, increased interest from policymakers, and greater prominence of delirium in educational and audit programmes. Nevertheless, the field faces several complex research and clinical challenges. In this article we focus on selected areas of recent progress and/or uncertainty in delirium research and practice. (i)
recent studies in animal models using peripheral inflammatory stimuli have begun to suggest mechanisms underlying the delirium syndrome as well as its link with dementia. A growing body of blood and cerebrospinal fluid studies in humans have implicated inflammatory and stress mediators. (ii)
delirium prevention is effective in the context of research studies, but there are several unresolved issues, including what components should be included, the role of prophylactic drugs, and the overlap with general best care for hospitalised older people. (iii)
though there are several instruments for delirium screening and assessment, detection rates remain dismal. There are no clear solutions but routine screening embedded into clinical practice, and the development of new rapid screening instruments, offer potential. (iv)
studies are difficult given the heterogeneity of delirium and currently expert and comprehensive clinical care remains the main recommendation. Future studies may address the role of drugs for specific elements of delirium. In summary, though facing many challenges, the field continues to make progress, with several promising lines of enquiry and an expanding base of interest among researchers, clinicians and policymakers.
谵妄是医疗保健领域中尚未满足的首要医疗需求之一。它影响着八分之一的住院患者，并与多种不良后果相关，包括住院时间延长、新的机构收容以及患者的极大痛苦。最近的研究还表明，谵妄是未来新发痴呆症的强烈预测因素，同时会加速现有痴呆症的发展。谵妄的重要性现在越来越受到认可，研究基础不断扩大，新的专业国际组织不断涌现，政策制定者的兴趣增加，谵妄在教育和审计项目中的地位更加突出。尽管如此，该领域仍面临一些复杂的研究和临床挑战。在本文中，我们关注谵妄研究和实践中近期取得进展和/或存在不确定性的特定领域。（i）
最近在动物模型中使用外周炎症刺激的研究开始揭示谵妄综合征的潜在机制及其与痴呆症的联系。越来越多针对人类血液和脑脊液的研究表明炎症和应激介质与之相关。（ii）
在研究背景下，谵妄预防是有效的，但仍有几个未解决的问题包括应包含哪些组成部分、预防性药物的作用以及与住院老年人一般最佳护理的重叠问题。（iii）
尽管有多种用于谵妄筛查和评估的工具，但检出率仍然很低。目前尚无明确解决方案，但将常规筛查纳入临床实践以及开发新的快速筛查工具具有潜力。（iv）
鉴于谵妄的异质性，相关研究困难，目前主要建议是专家和全面的临床护理。未来的研究可能会探讨药物在谵妄特定方面的作用。总之，尽管面临诸多挑战，该领域仍在不断取得进展，有几条有前景的研究方向，研究人员、临床医生和政策制定者的兴趣基础也在不断扩大。
