Delirium Initiative – Brigham and Women’s Hospital

Introduction

Team

TAMMY HSHIEH, MD

GINGER POLICH, MD

JORDAN ROSEN, MD

SEJAL SHAH, MD

SHOSHANA STREITER, MD

ADRIENNE TAYLOR, MD

SAMIR TULEBAEV, MD

Epidemiology

Delirium Risk Factors

PREDISPOSING RISK FACTORS

PRECIPITATING RISK FACTORS

Diagnosis

Delirium Phenomenology

Subacute Delirium

Acute Delirium

DSM-5 Criteria

A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).
The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.
There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

Specify whether:

Specify if:

Specify if:

Hyperactive – The individual has a hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care.
Hypoactive – The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor.
Mixed level of activity

Confusion Assessment Method (CAM)

CAM is positive if a patient has criteria 1 and 2 and either 3 or 4

Role of Imaging and EEG

Biomarkers

DIFFERENTIAL DIAGNOSIS

Delirium vs. Dementia

Prevention

Management

Outcomes

Future work