Le syndrome confusionnel chez le patient âgé ayant des troubles neurocognitifs

Delirium is common in geriatric populations, especially in cases of underlying neurocognitive disorders, or acute organic failure. The clinical presentation can be varied, ranging from hypovigilance to psychomotor agitation. There are tools, such as the Confusion Assessment Method, to assist diagnosis. The etiological assessment is central in management. Because delirium is multifactorial, and because its constitutive elements concur with those of the frailty syndrome, the identification of risk factors is essential to enable a preventive approach. There is a need to search for triggering factors, with particular attention to iatrogenic risk. Symptom management is primarily based on the elimination or the management of triggering factors. However, it can take some time to complete the etiological review and initiate treatment, and invasive procedures can be required, potentially hampered by psychomotor agitation associated with the delirium. In these situations, it is essential to implement a symptom-based non-medication approach. Nevertheless, in case of danger for the patient, the use of symptom-control drug therapies can sometimes be necessary. The professional guidelines recommend, on a case-by-case basis, the use of short half-life benzodiazepines in case of anxiety disorders, and neuroleptics in case of productive disorders, but without proposing any particular therapeutic strategy. This article, based on a review of the literature, proposes a therapeutic strategy according to the patient's symptoms.