뇌졸중 후 섬망의 진단과 치료
Diagnosis and Treatment of Post-Stroke Delirium
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초록
Delirium is an acute disturbance of consciousness and cognition with fluctuating course over a short period of time. Recognition of delirium in post-stroke patients is important because of its association with a longer stay in the hospital, a poor functional outcome, an increased risk of deteriorated cognition, and a higher mortality rate. It is occasionally under-recognized due to the fluctuating course and the neurological deficits that are caused by the stroke. Disturbance of several neurotransmitter systems including not only acetylcholine and dopamine but also serotonin, noradrenaline and gamma amino butyric acid have been implicated for the possible pathophysiology of delirium. Numerous potential precipitating and predisposing factors have been proposed such as comorbid condition, age, acute medical insults and environmental issues. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological approaches for risk factors are the most effective strategy for prevention of delirium. Preventive interventions such as frequent reorientation, early and recurrent mobilization, pain management, adequate nutrition and hydration, reducing sensory impairments, and ensuring proper sleep patterns have all been shown to reduce the incidence of delirium, regardless of the care environment. Pharmacologic interventions and physical restraints should be reserved for patients who are a threat to their own safety or the safety of others. This review describes epidemiology, pathophysiology, risk factors, diagnostic methods, and management of delirium in post-stroke patients.
Abstract
Delirium is an acute disturbance of consciousness and cognition with fluctuating course over a short period of time. Recognition of delirium in post-stroke patients is important because of its association with a longer stay in the hospital, a poor functional outcome, an increased risk of deteriorated cognition, and a higher mortality rate. It is occasionally under-recognized due to the fluctuating course and the neurological deficits that are caused by the stroke. Disturbance of several neurotransmitter systems including not only acetylcholine and dopamine but also serotonin, noradrenaline and gamma amino butyric acid have been implicated for the possible pathophysiology of delirium. Numerous potential precipitating and predisposing factors have been proposed such as comorbid condition, age, acute medical insults and environmental issues. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological approaches for risk factors are the most effective strategy for prevention of delirium. Preventive interventions such as frequent reorientation, early and recurrent mobilization, pain management, adequate nutrition and hydration, reducing sensory impairments, and ensuring proper sleep patterns have all been shown to reduce the incidence of delirium, regardless of the care environment. Pharmacologic interventions and physical restraints should be reserved for patients who are a threat to their own safety or the safety of others. This review describes epidemiology, pathophysiology, risk factors, diagnostic methods, and management of delirium in post-stroke patients.
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