Hameed Fatimah, Sanborn Victoria, Nester Caroline, Daiello Lori A
Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI; Rhode Island Hospital Alzheimer's Disease and Memory Disorders Center.
Rhode Island Hospital Alzheimer's Disease and Memory Disorders Center; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.
R I Med J (2013). 2025 May 1;108(5):26-31.
Delirium is prevalent in healthcare settings, leaving susceptible older adults at risk for persistent cognitive impairment, prolonged care needs, morbidity, and mortality. In older adult patients, delirium often arises from acute medical illnesses, infections, medications, and comorbidities, with age and underlying dementia increasing susceptibility. Its complex pathophysiology involves systemic inflammation, neurotransmitter dysregulation, disrupted brain metabolism, and physiological cycle disturbances. While delirium causes acute cognitive impairments, patients are often left with persistent dysfunction. Moreover, patients with pre-existing cognitive impairment are at higher risk for developing dementia or accelerated cognitive decline in the wake of a delirium episode. Delirium also worsens long-term quality of life, increasing risk for functional disability and need for institutional care. Prevention and management strategies focus on prophylaxis, early intervention, multicomponent programs, and pharmacological interventions, while ongoing research seeks to identify biomarkers and improve delirium detection and long-term management.
谵妄在医疗环境中很常见，使易受影响的老年人面临持续认知障碍、长期护理需求增加、发病和死亡的风险。在老年患者中，谵妄通常由急性疾病、感染、药物和合并症引起，年龄和潜在的痴呆症会增加易感性。其复杂的病理生理学涉及全身炎症、神经递质失调、脑代谢紊乱和生理周期紊乱。虽然谵妄会导致急性认知障碍，但患者往往会留下持续的功能障碍。此外，已有认知障碍的患者在谵妄发作后患痴呆症或认知加速衰退的风险更高。谵妄还会恶化长期生活质量，增加功能残疾的风险和对机构护理的需求。预防和管理策略侧重于预防、早期干预、多组分方案和药物干预，而正在进行的研究旨在识别生物标志物并改善谵妄的检测和长期管理。
