Altered mental status risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
Risk Factors
The etiology of delirium (and other forms of acute brain dysfunction) involves a complex interplay between patient vulnerability (or predisposing) factors and precipitating factors. Patients who are highly vulnerable (e.g. 92 year old with severe dementia, poor functional status, and multiple comorbidities) will require a relatively benign insult to develop delirium. For these patients, a relatively benign insult such as a simple urinary tract infection or small dose of narcotic medication can precipitate delirium. Because elderly patients are more likely to have multiple vulnerability factors, they are more susceptible to becoming delirious compared with their younger counterparts. Nursing home patients are particularly vulnerable. For patients who are less vulnerable (e.g. 67 year old with no dementia, little comorbidity burden, and who is still functionally independent), higher doses of noxious stimuli such as severe sepsis are required to develop delirium. Consequently, when a patient with little or no vulnerability factors presents to the ED with delirium, stupor, or coma, the clinician should have more concern for an underlying life threatening illness. To develop stupor of coma, even higher doses of noxious stimuli are required.