Delirium as a term for acute cerebral dysfunction falls short when perceived as a binary phenomenon with the only options of present or completely absent. This approach will arbitrarily generate a cutoff on a continuous or ordinal range of dysfunction. For either conservative or interventional measures, early detection of delirium-even at predelirium or subsyndromal levels-is of great importance. Similar to pain, delirium presents in degrees better represented on an ordinal scale (eg, 0-10) than represented simply as yes or no. As with pain, evolving delirium should alert physicians to look for underlying possible causes and opens the possibility of treatment before reaching a critical value. With respect to outcomes, the severity as well as the length of delirium symptoms matters.2 Additionally, patients with subsyndromal delirium are at an increased risk of adverse outcomes.
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