Skip to main content

Transient Cognitive Disorders (Delirium, Acute Confusional Sates) in the Elderly

  • Chapter
Psychosomatic Medicine and Liaison Psychiatry

Abstract

Cognitive disorders are on the rise. Their growing importance as a medical and psychiatric problem reflects the continued increase in the number of the elderly worldwide.1,2 In the United States, there are 25.5 million persons aged 65 years and older. Dementia and delirium, the main cognitive disorders, are most common among the elderly. Recent medical editorials speak of dementia as a “quiet epidemic” and “one of the greatest problems facing modern society.”3 4 The elderly, and especially the demented, are uniquely prone to transient cognitive disorders, usually referred to in the literature as delirium or acute confusional states.5 As the prevalence of dementia is expected to rise in the coming years because of the aging of the populaion, so the incidence of delirium is likely to follow suit. While dementia has attracted growing attention.6, 7 delirium in the elderly continues to be neglected.8, 9 A recent report of the Royal College of Physicians emphasizes that insufficient attention has been paid to this common and important mental disorder, one whose onset in an elderly patient usually heralds physical illness and hence calls for immediate medical evaluation.8 Furthermore, delirium is still often mistaken for an irreversible dementia. The present overview may help prevent such grave diagnostic errors in the future and stimulate sorely needed research on transient cognitive disorders.

Delirium and intoxication may be considered transient effects, from temporary causes, of that condition of sensorium which, more deeply fixed and longer continued, obtains the name and produces all the aspects of mental derangement. Henry Holland, Medical Notes and Reflections.

1939

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Siegel JS: Demogrpahic background for international gerontological studies.J Gerontol36: 93–102, 1981.

    PubMed  CAS  Google Scholar 

  2. McFarland DD: The aged in the 21st century: A demographer’s view, in Jarvik LF (ed):Aging into the 21st Century. New York, Gardner Press, 1978.

    Google Scholar 

  3. Dementia: The quiet epidemic (edtl).Br Med J1: 1–2, 1978.

    Article  Google Scholar 

  4. Alzheimer’s disease (edtl).Br Med J2: 1374–1375, 1980.

    Google Scholar 

  5. Jolley D: Acute confusional states in the elderly, in Coakley D (ed):Acute Geriatric MedicineLondon, Croon Helm, 1981.

    Google Scholar 

  6. Schneck MK, Reisberg B, Ferris SH: An overview of current concepts of Alzheimer’s disease.Am J Psychiatry139: 165–173, 1982.

    PubMed  CAS  Google Scholar 

  7. Wells CE: Chronic brain disease: an overview.Am J Psychiatry135: 1–12, 1978.

    PubMed  CAS  Google Scholar 

  8. Organic mental impairment in the elderly.J R Coll Physicians Lond15: 141–167, 1981.

    Google Scholar 

  9. Senility reconsidered.JAMA244: 259–264, 1980.

    Google Scholar 

  10. Hood P: On senile delirium.Practitioner5: 279–289, 1870.

    Google Scholar 

  11. Picket W: Senile dementia: a clinical study of two hundred cases with particular regard to types of the disease.J Nerv Ment Dis31: 81–88, 1904.

    Article  Google Scholar 

  12. Robinson GW: Acute confusional states of old age.South Med J32: 479–485, 1939.

    Article  Google Scholar 

  13. Psychogeriatrics. World Health Organization Technical Report 507. Geneva, WHO, 1972.

    Google Scholar 

  14. Berrios GE: Delirium and confusion in the 19th century: A conceptual history.Br J Psychiatry139: 439–449, 1981.

    Article  PubMed  CAS  Google Scholar 

  15. Wolanin MO, Philips LRF:Confusion. St. Louis, CV Mosby Co, 1981.

    Google Scholar 

  16. Lishman WA:Organic Psychiatry. Oxford, England, Blackwell, 1978.

    Google Scholar 

  17. Lipowski ZJ:Delirium: Acute Brain Failure in Man. Springfield, III, Charles C Thomas, 1980.

    Google Scholar 

  18. Campbell RJ:Psychiatric Dictionary, ed. 5 New York, Oxford University Press, 1981.

    Google Scholar 

  19. Adams RD, Victor M:Principles of Neurology, ed. 2 New York, McGraw-Hill, 1981.

    Google Scholar 

  20. Lipowski ZJ: Delirium, clouding of consciousness and confusion.J Nerv Ment Dis145: 227–55, 1967.

    Article  PubMed  CAS  Google Scholar 

  21. Lipowski ZJ: A new look at organic brain syndromes.Am J Psychiatry137: 674–678, 1980.

    PubMed  CAS  Google Scholar 

  22. Hodkinson HM:Common Symptoms of Disease in the Elderly. Oxford, England, Blackwell, 1976.

    Google Scholar 

  23. Brocklehurst JC: Psychogeriatric care as a specialized discipline in medicine.Bull NY Acad Med53: 702–709, 1977.

    CAS  Google Scholar 

  24. Doty EJ: The incidence and treatment of delirious reactions in later life.Geriatrics1: 21–26, 1946.

    PubMed  CAS  Google Scholar 

  25. Willi J: Delir, daemmerzustand und Verwirrtheit bei koerperlich kranken, in Bleuler M, Willi J, Buehler HR (eds):Akute Psychische Begleiterscheinungen Koerperlicher Krankheiten, Stuttgart, Thieme Verlag, 1966.

    Google Scholar 

  26. Hodkinson HM: Mental impairment in the elderly.J R Coll Physicians Lond7: 305–317, 1973.

    PubMed  CAS  Google Scholar 

  27. Bedford PD: General medical aspects of confusional states in elderly people.Br Med J2: 185–188, 1959.

    Article  PubMed  CAS  Google Scholar 

  28. Simon A, Cahan RB: The acute brain syndrome in geriatric patients.Psychiatr Res Rep16: 8–21, 1963.

    Google Scholar 

  29. Bergmann K, Eastham EJ: Psychogeriatric ascertainment and assessment for treatment in an acute medical ward setting.Age Ageing3: 174–188, 1974.

    Article  PubMed  CAS  Google Scholar 

  30. Seymour DG, Henschke PJ, Cape RDT, et al: Acute confusional states and dementia in the elderly: the role of dehydration/volume depletion, physical illness and age.Age Ageing9: 137–146, 1980.

    Article  PubMed  CAS  Google Scholar 

  31. National Center for Health Statistics:Vital and Health Statistics, series 13, number 64: Utilization of Short Stay Hospitals, Washington, DC, NCHS, 1982.

    Google Scholar 

  32. Seymour DG, Pringle R: Post-operative complications in the elderly surgical patient.Gerontology29: 262–270, 1983.

    Article  PubMed  CAS  Google Scholar 

  33. Millar HR: Psychiatric morbidity in elderly surgical patients.BR J Psychiatry138: 17–20, 1981.

    Article  PubMed  CAS  Google Scholar 

  34. Lipowski ZJ: Delirium (acute confusional states), in Albert ML (ed:):The Clinical Neurology of Aging. New York, Oxford University Press, 1984.

    Google Scholar 

  35. Lipowski ZJ: Delirium updated.Compr Psychiatry21: 190–196, 1980.

    Article  PubMed  CAS  Google Scholar 

  36. Kennedy A: Psychological factors in confusional states in the elderly:Gerontol Clin1: 71–82, 1959.

    Article  Google Scholar 

  37. Kral VA: Confusional states: description and management, in Howells JG (ed):Modern Perspectives in the Psychiatry of Old Age. New York, Brunner/Mazel, 1975.

    Google Scholar 

  38. Roth M: Some diagnostic and aetiological aspects of confusional states in the elderly.Gerontol Clin1: 83–95, 1959.

    Article  Google Scholar 

  39. Levin M: Delirious disorientation: the law of the unfamiliar mistaken for the familiar.J Ment Sci91: 447–450, 1945.

    PubMed  CAS  Google Scholar 

  40. Willanger R, Klee A: Metamorphopsia and other visual disturbances with latency occurring in patients with diffuse cerebral lesions.Acta Neurol Scand42: 1–18, 1966.

    Article  Google Scholar 

  41. Aggernaes A, Myschetzky A: Experienced reality in somatic patients more than 65 years old.Acta Psychiatr Scand54: 225–237, 1976.

    Article  PubMed  CAS  Google Scholar 

  42. Frieske DA, Wilson WP, Formal qualities of hallucinations: a comparative study of the visual hallucinations in patients with schizophrenic, organic and affective psychoses, in Hoch PH, Zubin J (eds):Psychopathology of Schizophrenia. New York, Grune & Stratton, 1966.

    Google Scholar 

  43. Hernandez-Peon R: Physiological mechanisms in attention, in Russell RWFrontiers of Physiological Psychology. New York, Academic Press, 1966.

    Google Scholar 

  44. Quincy J:Lexicon Physicomedicum. London, Bell, Taylor, Osborn, 1719, p 103.

    Google Scholar 

  45. Strejilevitch SM: La turbulence nocturne du viellard psychotique.Encephale51: 238–262, 1962.

    Google Scholar 

  46. Aurelianus C:On Acute Diseases and on Chronic Diseases. Edited by Drabkin IE. Chicago, University of Chicago Press, 1950.

    Google Scholar 

  47. Chedru F, Geschwind N: Disorders of higher cortical functions in acute confusional states.Cortex8: 395–411, 1972.

    PubMed  CAS  Google Scholar 

  48. Chedru F, Geschwind N: Writing disturbances in acute confusional states.Neuropsvchologia10: 343–353, 1972.

    Article  CAS  Google Scholar 

  49. Simon A, Lowenthal MF, Epstein LJ:Crisis and Intervention. San Francisco, Jossey-Bass, 1970.

    Google Scholar 

  50. Kral VA: Stress and mental disorders of the senium.Med Sev J Can18: 363–370, 1962.

    CAS  Google Scholar 

  51. Flint FJ, Richards SM: Organic basis of confusional states in the elderly.Br Med J2: 1537–1539, 1956.

    Article  PubMed  CAS  Google Scholar 

  52. Kay DWK, Roth M: Physical accompaniments of mental disorder in old age.Lancet2: 740–745, 1955.

    Article  Google Scholar 

  53. Purdie FR, Honigman TB, Rosen P: Acute organic brain syndrome: a review of 100 cases.Ann Emerg Med10: 455–461, 1981.

    Article  PubMed  CAS  Google Scholar 

  54. Fish F, Williamson J: A delirium unit in an acute geriatric hospital.Gerontol Clin6: 71–80, 1964.

    Article  CAS  Google Scholar 

  55. Roth M: The psychiatric disorders of later life.Psychiatr Ann6: 417–445, 1976.

    Google Scholar 

  56. Roth M: The natural history of mental disorder in old age.J Ment Sci101: 281–301, 1955.

    PubMed  CAS  Google Scholar 

  57. Whitehead T: Confusing the causes of confusion.Nurs Mirror151: 38–39, 1980.

    PubMed  CAS  Google Scholar 

  58. Dunn T, Arie T: Mental disturbance in the ill old person.Br Med J2: 413–416, 1973.

    Article  Google Scholar 

  59. Samorajski T, Hartford J: Brain physiology of aging, in Busse EW, Blazer DG (eds):Handbook of Geriatric Psychiatry. New York, Van Nostrand Reinhold Co, 1980.

    Google Scholar 

  60. Brady H: Neuroanatomy and neuropathology of aging, in Busse EW, Blazer DG (eds):Handbook of Geriatric Psychiatry. New York, Van Nostrand Reinhold Co, 1980.

    Google Scholar 

  61. Hishikawa Y, Lijima J, Shimizu T, et al: A dissociated sleep state “stage 1-REM” and its relation to delirium in Baldy-Moulinier M (ed):Actualités en Médecine Expérimentale.

    Google Scholar 

  62. Gibson GE, Peterson C, Jenden DJ: Brain acetylcholine synthesis declines with senescence.Science213: 674–676, 1981.

    Article  PubMed  CAS  Google Scholar 

  63. Blass JP, Plum F: Metabolic encephalopathies, in Katzman R, Terry RD (eds):The Neurology of Aging. Philadelphia, FA Davis, 1983.

    Google Scholar 

  64. Obrist WD: Cerebral circulatory changes in normal aging and dementia, in Hoffmeister F, Müller C (eds):Brain Function in Old Age. Berlin, Springer-Verlag, 1979.

    Google Scholar 

  65. Farkas T, Ferris SH, Wolf AP, et al:18F-2-Deoxy-2-fluoro-D-glucose as a tracer in the positron emission tomographic study of senile dementia.Am J Psychiatry139: 352–353, 1982.

    PubMed  CAS  Google Scholar 

  66. Sokoloff L: Effects of normal aging on cerebral circulation and energy metabolism, in Brain Function in Hoffmeister F, Müller C. (eds):Brain Function in Old Age. Berlin, Springer-Verlag, 1979.

    Google Scholar 

  67. Vestal RE: Drug use in the elderly: A review of problems and special considerations.Drugs16: 358, 1978.

    Article  PubMed  CAS  Google Scholar 

  68. Blazer DG, Federspeil CF, Ray WA, et al: The risk of anticholinergic toxicity in the elderly: a study of prescribing practices in two populations.J Gerontol38: 31–35, 1983.

    PubMed  Google Scholar 

  69. Liston EH: Delirium in the aged.Psychiatr Clin North Am5: 49–66, 1982.

    PubMed  CAS  Google Scholar 

  70. Hart B: Delirious states.Br Med J2: 745–749, 1936.

    Article  PubMed  CAS  Google Scholar 

  71. Engel GL, Romano J: Delirium, a syndrome of cerebral insufficiency.J Chron Dis9: 260–277, 1959.

    Article  PubMed  CAS  Google Scholar 

  72. Itil T, Fink M: Anticholinergic drug-induced delirium: Experimental modification, quantitiative EEG and behavioral correlations.J Nerv Ment Dis143: 492–507, 1966.

    Article  PubMed  CAS  Google Scholar 

  73. Hawley RJ, Major LF, Schulman EA, et al: CSF levels of norepinephrine during alcohol withdrawal.Arch Neurol38: 289–292, 1981.

    PubMed  CAS  Google Scholar 

  74. Allahyari H, Deisenhammer E, Weiser G: EEG examination during delirium tremens.Psychiatr Clin (Basel)9: 21–31, 1976.

    CAS  Google Scholar 

  75. Vernadakis A, Timiras PS (eds):Hormones in Development and Aging. New York, SP Medical & Scientific Books, 1982.

    Google Scholar 

  76. Carpenter WT, Gruen PH: Cortisol’s effects on human mental functioning.J Clin Psychopharmacol2: 91–101. 1982.

    Article  PubMed  CAS  Google Scholar 

  77. Faucheux BA, Bourliere F, Baulon A, et al: The effects of psychosocial stress on urinary excretion of adrenaline and noradrenaline in 51- to 55- and 71- to 74-year-old men.Gerontology27: 313–325, 1981.

    Article  PubMed  CAS  Google Scholar 

  78. Carlsson C, Hagerdal M, Kaasi AE, et al: A catecholamine-mediated increase in cerebral oxygen uptake during immobilisation stress in rats.Brain Res119: 223–231, 1977.

    Article  PubMed  CAS  Google Scholar 

  79. Lipowski ZJ. Sensory and information inputs overload: behavioral effects.Compr Psychiatry16: 199–221, 1975.

    Article  PubMed  CAS  Google Scholar 

  80. Mazziotta JC, Phelps ME, Carson RE, et al: Tomographic mapping of human cerebral metabolism: sensory deprivation.Ann Neurol12: 435–444, 1982.

    Article  PubMed  CAS  Google Scholar 

  81. Cameron DE: Studies in senile nocturnal delirium.Psychiatr Q15: 47–53, 1941.

    Article  Google Scholar 

  82. Feinberg I, Koresko RL, Schaffner IR: Sleep electroencephalographic and eye-movement patterns in patients with chronic brain syndrome.J Psychiatr Res3: 11–26, 1965.

    Article  Google Scholar 

  83. Bondareff W, Mountjoy CQ, Roth M: Loss of neurons of origin of the adrenergic projection to cerebral cortex (nucleus locus ceruleus) in senile dementia.Neurology (NY)32: 164–168, 1982.

    CAS  Google Scholar 

  84. Dement WC, Miles LE, Carskadon MA: “White paper” on sleep and aging.J Am Geriatr Soc30: 25–50, 1982.

    PubMed  CAS  Google Scholar 

  85. Kahn RL, Miller NE: Assessment of altered brain function in the aged, in Storandt M, Siegler HC, Elias MF (eds):The Clinical Psychology of Aging. New York, Plenum. 1978.

    Google Scholar 

  86. Anthony JC, La Resche L, Niaz U, et al: Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients.Psychol Med12: 397–408, 1982.

    Article  PubMed  CAS  Google Scholar 

  87. Obrecht R, Okhomina FOA, Scott DR: Value of EEG in acute confusional states.J Neurol Neurosurg Psychiatry42: 75–77, 1979.

    Article  PubMed  CAS  Google Scholar 

  88. Obrist WD: Electroencephalographic changes in normal aging and dementia, in Hoffmeister F, Müller C (eds):Brain Function in Old Age. Berlin, Springer-Verlag, 1979.

    Google Scholar 

  89. Lipowski ZJ: Differentiating delirium from dementia in the elderly.Clin Gerontologist1: 3–10, 1982.

    Article  Google Scholar 

  90. Libow LS: Pseudosenility: acute and reversible organic brain syndrome.J Am Geriatr Soc21: 112–120, 1973.

    PubMed  CAS  Google Scholar 

  91. Glassman M: Misdiagnosis of senile dementia: Denial of care to the elderly.Social Work25: 288–292, 1980.

    PubMed  CAS  Google Scholar 

  92. Goldney R: Pseudodelirium.Med J Aust1: 630, 1979.

    PubMed  CAS  Google Scholar 

  93. Wells CE: Pseudodementia.Am J Psychiatry136: 895–900, 1979.

    PubMed  CAS  Google Scholar 

  94. McAllister TW, Ferrel RB, Price TRP, et al: The dexamethasone suppression test in two patients with severe depressive psudodementia.Am J Psychiatry139: 479–481, 1982.

    PubMed  CAS  Google Scholar 

  95. Bayne JRD: Management of confusion in elderly persons.Can Med Assoc J118: 139–141, 1978.

    PubMed  CAS  Google Scholar 

  96. Chisholm SE, Deniston OL, Igvisan RM, et al: Prevalence of confusion in elderly hospitalized patientsJ Gerontol Nurs8: 87–96, 1982.

    PubMed  CAS  Google Scholar 

  97. Lipowski ZJ: The need to integrate liaison psychiatry and geropsychiatry.Am J Psychiatry140: 1003–1005, 1983.

    PubMed  CAS  Google Scholar 

  98. Waxman HM, Carner EA, Dubin W, et al: Geriatric psychiatry in the emergency department: Characteristics of geriatric and non-geriatric admissions.J Am Geriatr Soc30: 427–432, 1982.

    PubMed  CAS  Google Scholar 

  99. Levitan SJ, Kornfeld DS: Clinical and cost benefits of liaison psychiatry.Am J Psychiatry138: 790–793, 1981.

    PubMed  CAS  Google Scholar 

  100. Warshaw GA, Moore JT, Friedman SW, et al: Functional disability in the hospitalized elderly.JAMA248: 847–850, 1982.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 1983 American Psychiatric Association

About this chapter

Cite this chapter

Lipowski, Z.J. (1983). Transient Cognitive Disorders (Delirium, Acute Confusional Sates) in the Elderly. In: Psychosomatic Medicine and Liaison Psychiatry. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-2509-3_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-2509-3_16

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-9517-4

  • Online ISBN: 978-1-4613-2509-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics