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Delirium (also known as acute confusional state (ACS)) is a frequent and potentially preventable source of morbidity and mortality for older hospitalized patients. Advancing age is an independent risk factor for delirium. This chapter reviews the epidemiology, pathophysiology, diagnosis and treatment of delirium. Delirium is associated with a variety of causes, presumed to ultimately affect cerebral cortical processing. Common risk factors include underlying brain diseases, age, and dementia. Chronic medical illness, comorbidity, severity, functional impairment, medication prescription, and polypharmacy can also cause delirium. The Confusion Assessment Method (CAM) is a widely used, reliable, and easy method for ascertaining the presence of delirium. The mediators of ACS are multiple, and additional research is necessary to elucidate whether a "common final pathway" in the brain is present in ACS.