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Development of delirium unraveled

Today is World Delirium Awareness Day, an international effort to raise awareness of the dangers of delirium among patients, healthcare professionals, administrators and policy-makers.

Certain medicines, a dysfunctional immune system, and a disturbed signal transmission in the brain contribute to the development of delirium. These are the findings for which Dr. Angelique Egberts received her PhD last week.  

One in three elderly people who are admitted to hospital suffer delirium. Delirium is an acute state of confusion that has a significant effect on the recovery of older hospital patients. Patients with infections or patients who required anesthesia often develop delirium. This often leads to a longer hospital stay, increases the risk of developing dementia, and increases the likelihood of premature death. Moreover, it has been shown that these patients are less able to fend for themselves after hospitalization. A quarter of the patients suffering delirium die within a year of experiencing delirium.

Imbalanced immune system
We already knew that the effects are severe, but little was known about the development of delirium. Angelique Egberts felt that this needed to change. She examined the blood of 86 elderly patients who had been admitted to Erasmus MC's Geriatric department. Half of the patients examined had experienced delirium, the other half had not. She found various substances in the blood of the delirium patients, including elevated white blood cell counts, which indicated an imbalanced immune system. She also found reduced amounts of the substances needed for adequate signal transmission in the brain. It therefore appears that a dysfunctional immune system and a disturbed signal transmission in the brain contribute to the development of delirium.

After examining the records of 905 patients, Egberts also discovered an association between the development of delirium and the use of anticholinergic medications (based on the Anticholinergic Risk Scale (ARS)). These drugs block certain molecular processes in the body and are used to treat depression and urge incontinence. Additional research will be needed to determine whether delirium can be prevented if patients do not take these drugs during their hospital stay. "It is also important that physicians and patients become more aware of the adverse effects of delirium. The longer the duration of delirium, the more severe the subsequent effects are."

Date published: 14 March 2018.

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