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Delirium (PDQ®)

Health Professional Version
Last Modified: 07/30/2014

Incidence and Prevalence

Occurrence rates range from 28% to 48% in patients with advanced cancer on admission to hospital or hospice,[1-3] and approximately 85% to 90% of these patients will experience delirium in the hours to days before death.[3-6] The term acute confusional state has also been used to describe this syndrome; in the last days of life, the condition sometimes referred to as terminal restlessness probably represents a terminal delirium.[7]

Although delirium clearly has a recognized association with the dying phase, many episodes of delirium are reversible; therapeutic intervention can result in delirium reversal, or at least improvement, in 30% to 75% of episodes.[3,5,8-11] Variability in reported occurrence rates and clinical outcomes most likely reflects sampling from different clinical settings or different stages in the clinical trajectory of cancer, in addition to inconsistency in diagnostic terminology.[12]

References
  1. Minagawa H, Uchitomi Y, Yamawaki S, et al.: Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer 78 (5): 1131-7, 1996.  [PUBMED Abstract]

  2. Pereira J, Hanson J, Bruera E: The frequency and clinical course of cognitive impairment in patients with terminal cancer. Cancer 79 (4): 835-42, 1997.  [PUBMED Abstract]

  3. Lawlor PG, Gagnon B, Mancini IL, et al.: Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med 160 (6): 786-94, 2000.  [PUBMED Abstract]

  4. Massie MJ, Holland J, Glass E: Delirium in terminally ill cancer patients. Am J Psychiatry 140 (8): 1048-50, 1983.  [PUBMED Abstract]

  5. Bruera E, Miller L, McCallion J, et al.: Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage 7 (4): 192-5, 1992.  [PUBMED Abstract]

  6. Breitbart W, Alici Y: Agitation and delirium at the end of life: "We couldn't manage him". JAMA 300 (24): 2898-910, E1, 2008.  [PUBMED Abstract]

  7. Travis SS, Conway J, Daly M, et al.: Terminal restlessness in the nursing facility: assessment, palliation, and symptom management. Geriatr Nurs 22 (6): 308-12, 2001 Nov-Dec.  [PUBMED Abstract]

  8. Gagnon P, Allard P, Mâsse B, et al.: Delirium in terminal cancer: a prospective study using daily screening, early diagnosis, and continuous monitoring. J Pain Symptom Manage 19 (6): 412-26, 2000.  [PUBMED Abstract]

  9. Maddocks I, Somogyi A, Abbott F, et al.: Attenuation of morphine-induced delirium in palliative care by substitution with infusion of oxycodone. J Pain Symptom Manage 12 (3): 182-9, 1996.  [PUBMED Abstract]

  10. Tuma R, DeAngelis LM: Altered mental status in patients with cancer. Arch Neurol 57 (12): 1727-31, 2000.  [PUBMED Abstract]

  11. Breitbart W, Gibson C, Tremblay A: The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 43 (3): 183-94, 2002 May-Jun.  [PUBMED Abstract]

  12. Lawlor PG: The panorama of opioid-related cognitive dysfunction in patients with cancer: a critical literature appraisal. Cancer 94 (6): 1836-53, 2002.  [PUBMED Abstract]