Delirium is a neuropsychiatric complication that can occur in patients with cancer, particularly in those with advanced disease. The prevention of delirium in the patient with cancer has not been systematically examined, but studies in hospitalized elderly patients suggest that early identification of risk factors reduces the occurrence rate of delirium and the duration of episodes.
Delirium has been defined as a disorder of global cerebral dysfunction characterized by disordered awareness, attention, and cognition. In addition, delirium is associated with behavioral manifestations. The text revision of the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) cites the core clinical criteria for diagnosis as follows:
- A disturbance of consciousness with reduced clarity of awareness and attention deficit.
- Other cognitive or perceptual disturbances.
- Acuity of onset (hours to days) and fluctuation over the course of the day.
- The presence of an underlying cause such as a general medical condition (e.g., hypoxia or electrolyte disturbance), medication, a combination of etiologies, or indeterminate etiology.
Other associated noncore clinical criteria features include sleep-wake cycle disturbance, delusions, emotional lability, and disturbance of psychomotor activity. The latter forms the basis of classifying delirium into three different subtypes:[4,5]
- Mixed, with both hypoactive and hyperactive features.
In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.
- Inouye SK, Bogardus ST Jr, Charpentier PA, et al.: A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340 (9): 669-76, 1999. [PUBMED Abstract]
- Lipowski ZJ: Delirium in the elderly patient. N Engl J Med 320 (9): 578-82, 1989. [PUBMED Abstract]
- American Psychiatric Association: Delirium, dementia, and amnestic and other cognitive disorders. In: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th rev. ed. Washington, DC: American Psychiatric Association, 2000, pp 135-80.
- Clinical features, course, and outcome. In: Lipowski ZJ: Delirium: Acute Confusional States. New York, NY: Oxford University Press, 1990, pp 54-70.
- Camus V, Burtin B, Simeone I, et al.: Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium. Int J Geriatr Psychiatry 15 (4): 313-6, 2000. [PUBMED Abstract]