Delirium Bibliography

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

You may base your search on as many search terms as you like. A search term can be a keyword, an author's name, all or part of an article's title, or any word or phrase that you might expect to find in an article's abstract. You may then indicate whether you would like to limit the search to one or more options.

The results are prioritized so that entries including all search terms will be listed first, but you can indicate whether to then sort by title (the default), by author, by journal name or by publication year.

You may further restrict to a topic category. Note: If you do not enter any search terms, the results will include all of the entries for the selected topic category.

More information about each entry on this page is available by moving the mouse over the green information symbols.

Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 3105

  • Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. 2001 Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Elie M. Archives of internal medicine, 161:8 (1099-105)
    • Title

      Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients.

    • Authors
      Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Elie M
    • Year
      2001
    • Journal
      Archives of internal medicine
    • URL
    • Abstract
      Use of anticholinergic (ACH) medications is a biologically plausible and potentially modifiable risk factor of delirium, but research findings are conflicting regarding its association with delirium.
    • PubMed ID
  • Establishing a case-finding and referral system for at-risk older individuals in the emergency department setting: the SIGNET model. 2001 Mion LC, Palmer RM, Anetzberger GJ, Meldon SW. Journal of the American Geriatrics Society, 49:10 (1379-86)
    • Title

      Establishing a case-finding and referral system for at-risk older individuals in the emergency department setting: the SIGNET model.

    • Authors
      Mion LC, Palmer RM, Anetzberger GJ, Meldon SW
    • Year
      2001
    • Journal
      Journal of the American Geriatrics Society
    • URL
    • Abstract
      Older emergency department (ED) patients have complex medical, social, and physical problems. We established a program at four ED sites to improve case finding of at-risk older adults and provide comprehensive assessment in the ED setting with formal linkage to community agencies. The objectives of the program are to (1) improve case finding of at-risk older ED patients, (2) improve care planning and referral for those returning home, and (3) create a coordinated network of existing medical and community services. The four sites are a 1,000-bed teaching center, a 700-bed county teaching hospital, a 400-bed community hospital, and a health maintenance organization (HMO) ED site. Ten community agencies also participated in the study: four agencies associated with the hospital/HMO sites, two nonprofit private agencies, and four public agencies. Case finding is done using a simple screening assessment completed by the primary or triage nurse. A geriatric clinical nurse specialist (GCNS) further assesses those considered at risk. Patients with unmet medical, social, or health needs are referred to their primary physicians or to outpatient geriatric evaluation and management centers and to community agencies. After 18 months, the program has been successfully implemented at all four sites. Primary nurses screened over 70% (n = 28,437) of all older ED patients, GCNSs conducted 3,757 comprehensive assessments, participating agency referrals increased sixfold, and few patients refused the GCNS assessment or subsequent referral services. Thus, case finding and community linkage programs for at-risk older adults are feasible in the ED setting.
    • PubMed ID
  • Relationship between aggressive behaviors and depression among nursing home residents with dementia. 2001 Menon AS, Gruber-Baldini AL, Hebel JR, Kaup B, Loreck D, Itkin Zimmerman S, Burton L, German P, Magaziner J. International journal of geriatric psychiatry, 16:2 (139-46)
    • Title

      Relationship between aggressive behaviors and depression among nursing home residents with dementia.

    • Authors
      Menon AS, Gruber-Baldini AL, Hebel JR, Kaup B, Loreck D, Itkin Zimmerman S, Burton L, German P, Magaziner J
    • Year
      2001
    • Journal
      International journal of geriatric psychiatry
    • URL
    • Abstract
      Verbal and physical aggression are common behavior problems among nursing home residents with dementia. Depression among nursing home residents is also a common but underdiagnosed disorder.
    • PubMed ID
  • Functional decline in independent elders after minor traumatic injury. 2001 Shapiro MJ, Partridge RA, Jenouri I, Micalone M, Gifford D. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 8:1 (78-81)
    • Title

      Functional decline in independent elders after minor traumatic injury.

    • Authors
      Shapiro MJ, Partridge RA, Jenouri I, Micalone M, Gifford D
    • Year
      2001
    • Journal
      Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
    • URL
    • Abstract
      To describe injury types, patterns, and health status in independently functioning elder patients presenting to the emergency department (ED) after a minor traumatic injury; and 2) to assess short-term functional decline in this population at three-month follow-up.
    • PubMed ID
  • The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program. 2000 Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM. Journal of the American Geriatrics Society, 48:12 (1697-706)
    • Title

      The Hospital Elder Life Program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital Elder Life Program.

    • Authors
      Inouye SK, Bogardus ST, Baker DI, Leo-Summers L, Cooney LM
    • Year
      2000
    • Journal
      Journal of the American Geriatrics Society
    • URL
    • Abstract
      To describe the Hospital Elder Life Program, a new model of care designed to prevent functional and cognitive decline of older persons during hospitalization. PROGRAM STRUCTURE AND PROCESS: All patients aged > or =70 years on specified units are screened on admission for six risk factors (cognitive impairment, sleep deprivation, immobility, dehydration, vision or hearing impairment). Targeted interventions for these risk factors are implemented by an interdisciplinary team-including a geriatric nurse specialist, Elder Life Specialists, trained volunteers, and geriatricians--who work closely with primary nurses. Other experts provide consultation at twice-weekly interdisciplinary rounds.
    • PubMed ID
  • Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies. 2000 Inouye SK. Annals of medicine, 32:4 (257-63)
    • Title

      Prevention of delirium in hospitalized older patients: risk factors and targeted intervention strategies.

    • Authors
      Inouye SK
    • Year
      2000
    • Journal
      Annals of medicine
    • URL
    • Abstract
      Delirium is a common, costly, and potentially devastating condition for hospitalized older patients. Delirium is a multifactorial syndrome, involving the inter-relationship between patient vulnerability, or predisposing factors at admission, and noxious insults or precipitating factors during hospitalization. Through a series of studies, we first identified significant predisposing factors for delirium, including vision impairment, severe illness, cognitive impairment, and dehydration. Subsequently, significant precipitating factors were identified, including physical restraint use, malnutrition, adding more than three drugs, bladder catheter use, and any iatrogenic event. Through targeting preventive strategies towards six identified risk factors in a controlled clinical trial, we were successful in the primary prevention of delirium. In 852 subjects, the incidence of delirium was significantly reduced in the intervention group compared with usual care (9.9% vs 15.0%, matched odds ratio: 0.60; 95% confidence interval: 0.39-0.92). The total number of days and episodes of delirium were also significantly reduced in the intervention group. Based on this work, evidence-based recommendations for delirium prevention are proposed. While not all cases of delirium will be preventable with this approach, unifying medical and epidemiological approaches to delirium represents a key advance essential to reducing the high morbidity and mortality associated with delirium in the older population.
    • PubMed ID
  • Goals in geriatric assessment: are we measuring the right outcomes? 2000 Bradley EH, Bogardus ST, van Doorn C, Williams CS, Cherlin E, Inouye SK. The Gerontologist, 40:2 (191-6)
    • Title

      Goals in geriatric assessment: are we measuring the right outcomes?

    • Authors
      Bradley EH, Bogardus ST, van Doorn C, Williams CS, Cherlin E, Inouye SK
    • Year
      2000
    • Journal
      The Gerontologist
    • URL
    • Abstract
      Previous evaluative studies of outpatient geriatric assessment have focused on a limited set of outcomes related to functioning, health services utilization, and costs. The purpose of this study was to identify important goals for care as described by patients and family caregivers being cared for in this setting. Using a cross-section of 226 consecutive sets of patients and their primary family caregivers, physicians, and case managers, goals of care for individual patients were coded from open-ended interview responses. The most common categories of goals expressed by family caregivers were obtaining education and referrals (57.5%) and improving social and family relationships (53.0%). The process of establishing and meeting such goals should be explicitly included in the design of future evaluations of outpatient geriatric assessment.
    • PubMed ID
  • Serotonin and amino acids: partners in delirium pathophysiology? 2000 van der Mast RC, Fekkes D. Seminars in clinical neuropsychiatry, 5:2 (125-31)
    • Title

      Serotonin and amino acids: partners in delirium pathophysiology?

    • Authors
      van der Mast RC, Fekkes D
    • Year
      2000
    • Journal
      Seminars in clinical neuropsychiatry
    • URL
    • Abstract
      Delirium may be the result of dysfunction of multiple interacting neurotransmitter systems. Changes in the levels of various amino acids being precursors of cerebral neurotransmitters may affect their function and, thus, contribute to the development of delirium. Serotonin is one of the neurotransmitters that may play an important role in medical and surgical delirium. Normal serotonin synthesis and release in the human brain is, among others, dependent on the availability of its precursor tryptophan (Trp) from blood. The essential amino acid Trp competes with the other large neutral amino acids (LNAA) tyrosine, phenylalanine, valine, leucine, and isoleucine for transport across the blood-brain barrier. This competition determines its uptake into the brain, represented by the ratio of the plasma level of Trp to the sum of the other LNAA. The plasma ratio of Trp/LNAA, plasma level of Trp, and serotonin in plasma and platelets have been used as indirect peripheral measures for central serotonergic functioning. Both increased and decreased serotonergic activity have been associated with delirium. Serotonin agonists can induce psychosis, both elevated Trp availability and increased cerebral serotonin have been associated with hepatic encephalopathy, and excess serotonergic brain activity has been related to the development of the serotonin syndrome of which delirium is a main symptom. On the other hand, alcohol withdrawal delirium, delirium in levodopa-treated Parkinson patients, and postoperative delirium have been related to reduce cerebral Trp availability from plasma suggesting diminished serotonergic function. Rick factors for delirium such as severe illness, surgery, and trauma can induce immune activation and a physical stress response comprising increased activity of the limbic-hypothalamic-pituitary-adrenocortical axis, the occurrence of a low T3 syndrome, and, possibly, changes in the permeability of the blood-brain barrier. There are indications that these changes have their effect on plasma amino acid concentrations, e.g., Trp, and multiple cerebral neurotransmitters, including serotonin. This stress response may be different depending on the stage of illness being acute or chronic. It will require further study to determine the complex influence of the stress response and immune activation on plasma amino acids, neurotransmitter function and the development of delirium, especially in the more vulnerable older patients.
    • PubMed ID
  • Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. 2000 Trzepacz PT. Seminars in clinical neuropsychiatry, 5:2 (132-48)
    • Title

      Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine.

    • Authors
      Trzepacz PT
    • Year
      2000
    • Journal
      Seminars in clinical neuropsychiatry
    • URL
    • Abstract
      This article reviews the literature relevant to improving our understanding of the neural underpinnings of delirium. That the characteristic symptoms of delirium occur as a result of a wide diversity of causes supports the concept of a "final common pathway. " What constitutes this may involve certain brain regions or circuits and certain neurotransmitters. Neuroanatomical data derived from neuroimaging and lesion reports suggest the importance of pathways in prefrontal cortex, thalamus, fusiform cortex, posterior parietal cortex, and basal ganglia. Neurotransmitters most implicated in delirium that could be candidates to mediate the characteristic symptoms of delirium, as well as the electroencephalogram changes, are acetylcholine and dopamine. Acetylcholine deficiency and dopamine excess---absolute and/or relative to each other---appear to be critical in the final common pathway. These neurotransmitters affect each other, depending on the receptor subtype, and their receptor distribution among layers of cortex in areas such as prefrontal cortex and temporal lobe suggests that cholinergic and dopaminergic neurons could interact with each other during delirium. Electroconvulsive therapy is described as a special situation in which excess dopamine and delirium may have a therapeutic effect on depression recovery, in contrast with the usual association of delirium with negative effects.
    • PubMed ID
  • The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. 2000 Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. International journal of geriatric psychiatry, 15:11 (1021-7)
    • Title

      The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly.

    • Authors
      Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A
    • Year
      2000
    • Journal
      International journal of geriatric psychiatry
    • URL
    • Abstract
      The Mini-Cog, a composite of three-item recall and clock drawing, was developed as a brief test for discriminating demented from non-demented persons in a community sample of culturally, linguistically, and educationally heterogeneous older adults.
    • PubMed ID
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