Delirium natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vishal Khurana, M.B.B.S., M.D. [2]; Pratik Bahekar, MBBS [3]

Duration

The duration of delirium is typically affected by the underlying cause. If caused by a fever, the delirious state often subsides as the severity of the fever subsides.

• Ranges from less than a week to more than 2 months.
• Most of the times symptoms resolve by 10to 12 days;
• Up to 15% of patients, typically elderly, symptoms of delirium may last for a month and beyond.

Prognosis==

• Majority of patients have complete recovery
• If untreated delirium may progress to stupor, coma, seizures, or death.
• Delirium in AIDS patients has a poorer prognosis, 27% tends to have complete recovery of cognitive faculties, this may be because of underlying AIDS dementia.
• Delirium in an elderly, can cause many complications, which may include pneumonia and decubitus ulcers, prolonging hospital stays.
• Elderly:

1. Only 4% to 40% may have complete recovery
2. Persistent cognitive deficits are common while recovering from delirium, may be related previously unknown aliments.
3. 22%–76% chance of dying during hospitalization if delirium is developed during respective hospital stay and a very high death rate during the months following discharge.

• Up to 25% of patients with delirium die within 6 months and that their mortality rate in the 3 months after diagnosis is 14 times as high as the mortality rate for patients with affective disorders.
• If delirium develops after orthopedic surgery, risk for postoperative complications increases: longer postoperative recuperation periods, longer hospital stays, and long-term disability.