Bisson Dana E, Clancy Burgess Shannon C, Gamache Michelle E, Dunn Maureen P, Valeras Aimee B, Lindpaintner Lyn S
Concord Hospital, Concord, New Hampshire, USA.
J Am Geriatr Soc. 2025 Apr;73(4):1008-1016. doi: 10.1111/jgs.19254. Epub 2024 Nov 29.
Delirium is a complex neurocognitive disorder characterized by an acute disturbance in attention, awareness, and perception. It is a dangerous syndrome that is independently associated with higher rates of morbidity and mortality, inpatient complications, and is a predictor of long-term cognitive dysfunction. Although delirium can occur in persons of all ages, the prevalence among and impact on older adults is particularly significant. Current gold standard approaches for delirium include treating medical precipitants and physiological perturbations and optimizing the environment using multicomponent nonpharmacological interventions. Although these approaches are proven effective in preventing delirium, evidence has not shown them to significantly improve delirium once it occurs. The need for a safe, effective, and specific treatment for the phenotype of delirium itself is an urgent priority worldwide. The intervention described in this article, Attention and Awareness Through Movement technique followed by Movement To Capacity (AATM/MTC), targets cortical dysfunction through sustained sequential touch, cranial nerve stimulation, and muscular movement. It raises the tantalizing possibility that a specific method to reduce inattention and normalize arousal levels may not only be feasible but also safe and inexpensive. For these reasons, preliminary observations are described in the hope of stimulating interest in further exploration of this novel approach to delirium therapy.
谵妄是一种复杂的神经认知障碍,其特征为注意力、意识和感知的急性紊乱。它是一种危险的综合征,与较高的发病率、死亡率、住院并发症独立相关,并且是长期认知功能障碍的一个预测指标。虽然谵妄可发生于所有年龄段的人群,但在老年人中的患病率及其影响尤为显著。目前针对谵妄的金标准方法包括治疗医学诱因和生理紊乱,以及使用多组分非药物干预措施优化环境。尽管这些方法已被证明在预防谵妄方面有效,但证据表明,一旦谵妄发生,它们并不能显著改善谵妄症状。全球迫切需要一种针对谵妄本身表型的安全、有效且特异性的治疗方法。本文所述的干预措施,即通过运动实现注意力和意识训练技术,随后进行能力运动训练(AATM/MTC),通过持续的顺序触摸、颅神经刺激和肌肉运动来针对皮质功能障碍。这引发了一种诱人的可能性,即一种减少注意力不集中和使觉醒水平正常化的特定方法不仅可行,而且安全且廉价。基于这些原因,本文描述了初步观察结果,以期激发人们对进一步探索这种治疗谵妄的新方法的兴趣。