Pharmacological approach to delirium in hospitalised older adults

Abstract

Acute confusional syndrome (ACS) as a common neuropsychiatric disorder in hospitalised older adults. He pointed out that its onset was sudden and fluctuating, affecting functions such as consciousness, attention and thought. He explained that dysfunction in cholinergic neurotransmission and increased dopaminergic activity were the main pathophysiological mechanisms involved. He described the three clinical subtypes of ACS and emphasised the diagnostic difficulty of the hypoactive type, due to its more silent nature. Regarding treatment, he examined the use of haloperidol and benzodiazepines. He emphasised that haloperidol was widely used because of its action on dopamine receptors, although the evidence for its effectiveness was contradictory. He also mentioned the associated adverse effects, such as drowsiness and cardiac alterations. Regarding benzodiazepines, he indicated that they were useful in specific cases such as delirium due to withdrawal, but with significant risks. Finally, he concluded that the therapeutic choice should be adapted to the type of delirium, the patient's condition and the clinical context, prioritising an individualised and safe approach.