Recognition Most Crucial Issue in Delirium Management

I am writing this editorial shortly after returning from the 2nd Canadian Colloquium on Dementia (CCD2), held from October 16-18 in Montreal. This was one of the finest meetings I have ever attended, and if you are interested in cognitive disorders you should reserve time to attend the next meeting, planned for 2005 in Ottawa.

Several of the topics in this issue of Geriatrics & Aging also were addressed at the Colloquium. The crucial issue of recognizing delirium (and dementia and depression) is addressed here by Rola Moghabghab and her colleagues, as they describe the process of implementing nursing best practice guidelines for the recognition of these disorders.

Although there are proven strategies for handling these concerns, recognition is crucial in order for these to be implemented. Several of the speakers at the CCD2 also commented on the issue of what happens after delirium. Dr. Jane McCusker addresses this topic more systematically in her article on the long-term prognosis of delirium.

The theme of under-recognition of delirium and its consequences is addressed more comprehensively by Drs. James L. Rudolph and Edward R. Marcantonio, followed by articles that examine delirium in more specific settings. Dr. Yoanna Skrobik discusses the recognition and management of delirium in the critical care setting, while Dr. Lars S. Rasmussen reviews the detection and prevention of postoperative cognitive dysfunction in older adults. Although the incidence of postoperative delirium is quite variable, it can reach as high as 50% in certain circumstances (older patients with hip fractures), and is a considerable concern whenever it does occur. In fact, I am writing this editorial immediately after seeing a patient in clinic who says, with confirmation from her daughter, that her memory has never returned to normal since her coronary artery bypass surgery six years ago.

We also have our usual varied collection of columns in this issue. Dr. Joseph H. Friedman reviews the incredibly common issue of drug-induced parkinsonism in older adults, while Dr. Osman O. Al-Radi discusses the pathophysiology of mitral regurgitation and its implications for surgical management. Our senior editor, Dr. Shabbir Alibhai, and his colleagues Drs. Foster and Oughton have reviewed the literature on the role of calcium and vitamin D3 supplementation for the primary prevention of fractures.

Enjoy this issue, and I hope to see you in Ottawa for the 3rd Canadian Colloquium on Dementia.