Recently, the dopaminergic pathway has been a common target for pharmaceutical trials for delirium treatment and prevention. The depressed cholinergic activity pathway is supported by the observation that anticholinergic medications precipitate delirium, and dopaminergic excess based on the possible therapeutic effect on delirium of haloperidol, a potent dopamine antagonist. Disturbances in these pathways lead to decreased cholinergic activity and dopaminergic excess, contributing to delirium. More recently, a functional network comprised of several interconnected brain structures has been implicated in delirium. Among the neurological pathways hypothesized to precipitate delirium, one involves the prefrontal cortex, anterior cingulate, and basal ganglia, and another involves the parietal lobes, superior colliculus, and thalamic pulvinar nucleus. While delirium is a multifactorial phenomenon, with several proposed pathophysiological mechanisms, mechanistic research has been slow in part due a lack of well-established animal models and an absence of easily obtainable biomarkers.

Due to its short- and long-term consequences and costs, delirium has been identified as a research priority by the American Geriatrics Society (AGS) and National Institute on Aging, and a quality-of-care predictor of survival in the Assessing Care of Vulnerable Elders Study (ACOVE). Delirium is also costly, accounting for up to $152 billion in annual US health care expenditures. In hospitalized patients, delirium leads to prolonged length of stay, increased hospital costs, long-term cognitive impairments, prolonged institutionalization, and early death. While predisposing factors such as advanced age, medical comorbidities, and baseline cognitive impairment can predispose patients to delirium, many modifiable precipitating factors also contribute to delirium, including uncontrolled pain, dehydration, and polypharmacy. A sequela of illness, hospitalization, or post-surgical states, delirium complicates up to 11% of emergency department visits, 33% of hospitalizations, and 70% of intensive care unit stays among older adults. We conclude by highlighting areas for future research.ĭelirium, an acute, severe neuropsychiatric syndrome characterized by waxing and waning levels of consciousness and periods of inattention and confusion, has gained attention over the past 20 years as a major health problem. This review aims to provide an in-depth overview on this topic, focusing specifically on (1) delirium and (2) poor sleep in older adults (3) the sleep-delirium connection (4) tools to evaluate delirium and sleep and (5) prevention and management of poor sleep and delirium. Interest is growing in the delirium-sleep/wake relationship, in particular their shared characteristics and mechanisms, bidirectional effects, and impact on outcomes in older adults. This knowledge has motivated efforts to better understand and to prevent delirium, highlighting poor sleep, and more specifically sleep/wake disruption, as a common and potentially modifiable risk factor for delirium. This attention has been driven, in part, by the rise in the older adult population, combined with an explosion in research highlighting numerous adverse consequences of delirium, including long-term cognitive, physical and mental health impairments, and early death. Over the past two decades, delirium, in particular in older adults (≥ 65 years old) hospitalized in intensive care units (ICUs), has gained substantial attention as a common and major health problem.

Martin oversleeps in agena risk