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New horizons in the pathogenesis, assessment and management of delirium

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dc.contributor.author MacLullich, Alasdair M.
dc.contributor.author Anand, Atul
dc.contributor.author Davis, Daniel H.J.
dc.contributor.author Jackson, Thomas
dc.contributor.author Barugh, Amanda J.
dc.contributor.author Hall, Roanna J.
dc.contributor.author Ferguson, Karen J.
dc.contributor.author Meagher, David
dc.contributor.author Cunningham, Colm
dc.date.accessioned 2018-10-26T14:45:56Z
dc.date.available 2018-10-26T14:45:56Z
dc.date.issued 2013
dc.identifier.uri http://hdl.handle.net/10344/7262
dc.description peer-reviewed en_US
dc.description.abstract 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) Pathogenesis: 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) Prevention: 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) Assessment: 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) Management: 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. en_US
dc.language.iso eng en_US
dc.publisher Oxford University Press en_US
dc.relation.ispartofseries Age and Ageing;42 pp. 667-674
dc.subject delirium en_US
dc.subject older people en_US
dc.subject delirium pathogenesis en_US
dc.subject delirium assessment en_US
dc.subject delirium management en_US
dc.title New horizons in the pathogenesis, assessment and management of delirium en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.date.updated 2018-10-26T14:38:15Z
dc.description.version PUBLISHED
dc.identifier.doi 10.1093/ageing/aft148
dc.contributor.sponsor UK and the British Geriatrics Society en_US
dc.contributor.sponsor The Dunhill Medical Trust en_US
dc.contributor.sponsor Wellcome Trust Senior Research Fellowship en_US
dc.relation.projectid RTF17/0111 en_US
dc.relation.projectid 342 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 1555645
dc.internal.copyrightchecked Yes
dc.identifier.journaltitle Age and ageing
dc.description.status peer-reviewed


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