Ursachen und Therapie des Delirs

Abstract

Delirium is a potentially life-threating acute disease accompanied by a mortality up to 30 % of all affected patients. It occurs more frequently in older patients ≥ 65 years. Delirium is defined as acute onset of disturbances in attention, awareness and cognition that develops within a short period of time and fluctuates in severity. It can be subdivided in hyperactive, hypoactive and a mixed type. The hypoactive type occurs more frequently in geriatric patients and has the highest mortality of all types. Differential diagnosis of delirium include stroke, central nervous system infection, metabolic diseases, disturbances in electrolytes as well as Wernicke encephalopathy and psychiatric diseases. Treatment should be initiated rapidly and includes non-pharmacological interventions and specific pharmacological treatments. The review summarizes diagnosis and clinical management of patients with delirium.

Das Delir ist eine potenziell lebensbedrohliche Erkrankung, die durch vielfältige Ursachen ab dem 65. Lebensjahr auftreten kann und durch die steigende Alterung der Bevölkerung zunimmt. Bei jüngeren Patienten überwiegt als Ursache der Entzug von Alkohol oder psychotropen Substanzen. Der Beitrag soll die klinischen Zeichen eines Delirs, die Pathophysiologie und Ätiologie, notwendige diagnostische Schritte und die Therapie zusammenfassen.

Schlüsselwörter

Delir - Delir Subtypen - hypoaktives Delir - hyperaktives Delir - postoperatives Delir

Key words

delirium - delirium subtypes - hypoactive delirium - hyperactive delirium - postoperative delirium

• Literatur

• 1 European Delirium Association, American Delirium Society. The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BBMC Med 2014; 12: 141 . doi:10.1186/s12916-014-0141-2
• 2 Davis DH, Barnes LE, Stephan BC. et al. The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS). BMC Geriatr 2014; 14: 87 . doi:10.1186/1471-2318-14-87
• 3 Reynish EL, Hapca SM, De Souza N. et al. Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions. BMC Med 2017; 15: 140 . doi:10.1186/s12916-017-0899-0
• 4 Schenning KJ, Deiner SG. Postoperative Delirium in the Geriatric Patient. Anesthesiol Clin 2015; 33: 505-516 . doi:10.1016/j.anclin.2015.05.007
• 5 Ahmed S, Leurent B, Sampson EL. Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing 2014; 43: 326-333 . doi:10.1093/ageing/afu022
• 6 Maldonado JR. Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure. Int J Geriatr Psychiatry 2017; DOI: 10.1002/gps.4823.
• 7 Hufschmidt A, Shabarin V, Zimmer T. Drug-induced confusional states: the usual suspects?. Acta Neurol Scand 2009; 120: 436-438 . doi:10.1111/j.1600-0404.2009.01174.x
• 8 Peter Nydahl, Gabriele Bartoszek, Andreas Binder. et al. Prevalence for delirium in stroke patients: A prospective controlled study. Brain Behav 2017; 7: e00748 . doi:10.1002/brb3.748
• 9 Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medication in the elderly – PRISCUS list. Dtsch Arztebl Int 2010; 107: 543-551 . doi:10.3238/arztebl.2010.0543
• 10 Morandi A, Di Santo SG, Cherubini A. et al. Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study. Am J Geriatr Psychiatry 2017; 25: 1064-1071 . doi:10.1016/j.jagp.2017.05.003
• 11 Avelino-Silva TJ, Campora F, Curiati JAE. et al. Prognostic effects of delirium motor subtypes in hospitalized older adults: A prospective cohort study. PLoS One 2018; 13: e0191092 . doi:10.1371/journal.pone.0191092
• 12 Garcia NuñezD, Boettger S, Meyer R. et al. Validation and Psychometric Properties of the German Version of the Delirium Motor Subtype Scale (DMSS). Assessment 2017; DOI: 10.1177/1073191117744047.
• 13 Maschke M. et al. Alkoholdelir und Verwirrtheitszustände. Kommission Leitlinien der Deutschen Gesellschaft für Neurologie 2015. AWMF-Registernummer: 030/006
• 14 American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc 2015; 63: 142-150 . doi:10.1111/jgs.13281
• 15 Holbrook AM, Crowther R, Lotter A. et al. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. CMAJ 1999; 160: 649-655
• 16 Mayo-Smith MF, Beecher LH, Fischer TL. et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164: 1405-1412
• 17 Awissi DK, Lebrun G, Fagnan M. et al. Alcohol, nicotine, and iatrogenic withdrawals in the ICU. Crit Care Med 2013; 41: S57-S68 . doi:10.1097/CCM.0b013e3182a16919
• 18 Baumgärtner GR. Clonidine vs. chlordiazepoxide in the management of acute alcohol withdrawal: a preliminary report. Southern Med J 1988; 81: 56-60
• 19 Coursin DB, Coursin DB, Maccioli GA. Dexmedetomidine. Curr Opin Crit Care 2001; 7: 221-226