MEDREH-09 · Delirium in Medical Rehabilitation

Delirium in Medical Rehabilitation. Topics: Diagnosis, Subtypes, Prevention, and Management. Part of the Medical Rehabilitation series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: But opioids primarily act on mu-opioid receptors, which manage pain and reward. They do not govern global cortical attention the way GABA does. Therefore, a patient in opioid withdrawal has what we call a clear sensorium. — Correct: The clinical point is right and the receptor explanation is not. Opioid withdrawal usually does leave the sensorium clear, so delirium during opioid withdrawal should prompt a search for another or additional cause; delirium there appears only in scattered case reports. But mu-opioid receptors are not sealed off from attention, and no verified receptor mechanism explains the clear sensorium. Alcohol and benzodiazepine withdrawal remain the classic withdrawal causes of delirium. This correction is filed from the chapter's attributed quote block and the banked ruling; the live recording was not re-transcribed and no audio cutover was performed. (2) In the audio: Delirium can literally install new onset dementia in a previously healthy, robust person. — Correct: Delirium is associated with faster later cognitive decline and with new dementia diagnoses: in 560 adults over 70 followed for 72 months after elective surgery, delirium tracked with steeper decline. The authors of that cohort explicitly could not separate a direct causal effect from the baseline vulnerability that made delirium likely. Observational evidence does not establish that an episode installs dementia or destroys neurons irreversibly, and prevention does not guarantee preserved cognition. This correction is filed from the chapter's attributed quote block and the banked ruling; the live recording was not re-transcribed and no audio cutover was performed. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MEDREH-09.