Zusammenfassung
Ein Delir geht beim geriatrischen Patienten mit auch dauerhaften funktionellen und kognitiven Funktionseinschränkungen einher. Häufig wird das delirante Syndrom allerdings von den Behandelnden nicht erkannt oder fehlinterpretiert. Dies ist besonders bei der hypoaktiven Form des Delirs der Fall. Screening-/Assessment-Instrumente helfen bei der Identifizierung von Patienten mit Delir. Der Delirentstehung wird ein multifaktorielles Modell, bestehend aus prädisponierenden Faktoren und auslösenden Noxen, zugrunde gelegt. Die Vermeidung delirauslösender Noxen ist ein wichtiger Ansatz in dessen Prävention. Wird ein Delir vermutet, sollten die Diagnostik und Therapie der zugrunde liegenden Ursache im Vordergrund stehen. Nichtmedikamentöse Therapiestrategien, wie z. B. milieutherapeutische Ansätze, spielen in der Delirtherapie eine wichtige Rolle. Dagegen ist die medikamentöse Therapie rein symptomatisch und sollte nur bei ausgewählten Patienten eingesetzt werden.
Abstract
Delirium in older patients is also associated with persistent functional and cognitive impairment. Nevertheless, it frequently remains unrecognized or misinterpreted by treating physicians and this is particularly true in cases of hypoactive delirium. Screening and assessment instruments are helpful in the identification of patients with delirium. A multifactorial model of a combination of predisposing and precipitating factors best explains the etiology of delirium and avoidance is crucial for its prevention. Whenever delirium is suspected, immediate diagnosis and therapy of the precipitating condition are of primary importance. Non-pharmacological interventions, for example environmental modifications, play an important role in managing behavioral symptoms of delirium. Pharmacological interventions are merely symptomatic and should be limited to patients with severe symptoms when non-pharmacological means fail.
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Interessenkonflikt. K. Singler und T. Frühwald geben an, dass kein Interessenkonflikt besteht. Der Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Singler, K., Frühwald, T. Delir. Internist 55, 775–781 (2014). https://doi.org/10.1007/s00108-014-3464-3
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DOI: https://doi.org/10.1007/s00108-014-3464-3