Dementia and delirium may be particularly difficult to distinguish, and a person may have both. In fact, delirium frequently occurs in people with dementia. But having episodes of delirium does not always mean a person has dementia. So a dementia assessment should not be done during a delirium episode because the results could be misleading.
Dementia is the progressive decline of memory and other thinking skills due to the gradual dysfunction and loss of brain cells. The most common cause of dementia is Alzheimer's disease. If a relative, friend or someone in your care shows any signs or symptoms of delirium, see a doctor.
Your input about the person's symptoms, typical thinking and everyday abilities will be important for a proper diagnosis and for finding the underlying cause. If you notice signs and symptoms of delirium in a person in a hospital or nursing home, report your concerns to the nursing staff or doctor rather than assuming that those problems have been observed.
Older people recovering in the hospital or living in a long-term care facility are particularly at risk of delirium. Delirium occurs when the normal sending and receiving of signals in the brain become impaired.
This impairment is most likely caused by a combination of factors that make the brain vulnerable and trigger a malfunction in brain activity. Delirium may have a single cause or more than one cause, such as a combination of a medical condition and drug toxicity. Sometimes no cause can be identified. Possible causes include:. Any condition that results in a hospital stay, especially in intensive care or after surgery, increases the risk of delirium, as does being a resident in a nursing home.
Delirium is more common in older adults. Delirium may last only a few hours or as long as several weeks or months. If issues contributing to delirium are addressed, the recovery time is often shorter.
The degree of recovery depends to some extent on the health and mental status before the onset of delirium. People with dementia, for example, may experience a significant overall decline in memory and thinking skills. People in better health are more likely to fully recover. Pressure sores often result from pressure combined with pulling on the skin, friction, These problems may have serious consequences in older people. Thus, older people can benefit from treatment managed by an interdisciplinary team Interdisciplinary care Providing medical care to older people can be complicated.
People often have many different health care practitioners at different locations. Travel and transportation issues become more difficult To help prevent delirium in an older person during a hospital stay, family members can ask hospital staff members to help—by doing the following:. Family members can visit and talk with the person and thus help keep the person oriented. People with delirium may be frightened, and the familiar voice of a family member can have a calming effect.
Delirium usually begins suddenly and progresses over hours or days. The actions of people with delirium vary but roughly resemble those of a person who is becoming progressively more intoxicated.
People with delirium cannot concentrate, so they have trouble processing new information and cannot recall recent events. Thus, they do not understand what is happening around them. They become disoriented.
Sudden confusion about time and often about place where they are may be an early sign of delirium. If delirium is severe, people may not know who they or other people are. Thinking is confused, and people with delirium ramble, sometimes becoming incoherent. Their level of awareness consciousness may fluctuate. That is, people may be overly alert one moment and drowsy and sluggish the next.
Other symptoms also often change within minutes and tend to worsen during the evening a phenomenon called sundowning. People with delirium often sleep restlessly or reverse their sleep-wake cycle, sleeping during the day and staying awake at night. People may have bizarre, frightening visual hallucinations, seeing things or people that are not there. Some people develop paranoia unwarranted feelings of being persecuted or have delusions false beliefs usually involving a misinterpretation of perceptions or experiences.
Personality and mood may change. Some people become so quiet and withdrawn that no one notices that they are delirious.
Others become irritable, agitated, and restless and may pace. People who develop delirium after taking sedatives are likely to become very drowsy and withdrawn. Those who have taken amphetamines or who have stopped taking sedatives may become aggressive and hyperactive. Some people alternate between the two types of behavior. Delirium can last hours, days, or even longer, depending on the severity and the cause.
If the cause of delirium is not quickly identified and treated, people may become increasingly drowsy and unresponsive, requiring vigorous stimulation to be aroused a condition called stupor Stupor and Coma Stupor is unresponsiveness from which a person can be aroused only by vigorous, physical stimulation. Coma is unresponsiveness from which a person cannot be aroused and in which the person's Stupor may lead to coma or death.
Doctors suspect delirium based on symptoms, particularly when people cannot pay attention and when their ability to pay attention fluctuates from one moment to the next.
However, mild delirium may be difficult to recognize. Doctors may not recognize delirium in hospitalized people. Most people thought to have delirium are hospitalized to evaluate them and protect them from injuring themselves or others. Diagnostic procedures can be done quickly and safely in the hospital, and any disorders detected can be treated quickly.
Because delirium may be caused by a serious disorder which could be rapidly fatal , doctors try to identify the cause as quickly as possible. Treating the cause, once identified, can often reverse the delirium. Doctors first try to distinguish delirium from other disorders that affect mental function. Friends, family members, or other observers are asked for information because people with delirium are usually unable to answer.
Questions include the following:. What drugs including alcohol and illicit drugs, especially if the person is younger and dietary supplements including medicinal herbs the person uses. Information may also come from medical records, the police, emergency medical personnel, or evidence such as pill bottles and certain documents.
Documents such as a checkbook, recent letters, or notification of unpaid bills or missed appointments can indicate a change in mental function. If delirium is accompanied by agitation and hallucinations, delusions, or paranoia, it must be distinguished from a psychosis due to a psychiatric disorder, such as manic-depressive illness Bipolar Disorder In bipolar disorder formerly called manic-depressive illness , episodes of depression alternate with episodes of mania or a less severe form of mania called hypomania.
Mania is characterized People with a psychosis due to a psychiatric disorder do not have confusion or memory loss, and the level of consciousness does not change. Psychotic behavior that begins during old age usually indicates delirium or dementia.
During the physical examination, doctors check for signs of disorders that can cause delirium, such as infections and dehydration. A neurologic examination Neurologic Examination When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system.
People who may have delirium are given a mental status test Mental Status When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the nervous system. First, they are asked questions to determine whether the main problem is being unable to pay attention. For example, they are read a short list and asked to repeat it.
Doctors must determine whether people take in register what is read to them. People with delirium cannot. The mental status test also includes other questions and tasks, such as testing short-term and long-term memory, naming objects, writing sentences, and copying shapes. People with delirium may be too confused, agitated, or withdrawn to respond to this test.
Samples of blood and urine are usually taken and analyzed to check for disorders that doctors think may be causing delirium. For example, abnormalities in electrolyte and blood sugar levels and liver and kidney disorders are common causes of delirium.
So doctors usually do blood tests to measure electrolyte and blood sugar levels and to evaluate how well the liver and kidneys are functioning. If doctors suspect a thyroid disorder, tests may be done to evaluate how well the thyroid gland is functioning. Or if doctors suspect that certain drugs may be the cause, they may do tests to measure drug levels in the blood. These tests can help determine whether drug levels are high enough to have harmful effects and whether a person took an overdose.
Cultures Culture of Microorganisms Infectious diseases are caused by microorganisms, such as bacteria, viruses, fungi, and parasites. Doctors suspect an infection based on the person's symptoms, physical examination results, A chest x-ray may be done to determine whether pneumonia may be the cause of delirium, especially in older people who are breathing fast, whether or not they have a fever or cough.
Sometimes a test that records the brain's electrical activity electroencephalography Electroencephalography Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography EEG is a simple, painless procedure in which Electrocardiography ECG , pulse oximetry using a sensor that measures oxygen levels in the blood , and a chest x-ray may be used to evaluate how well the heart and lungs are functioning.
In people with a fever or headache, a spinal tap Spinal Tap Spinal fluid is a liquid that surrounds your brain and spinal cord. Spinal fluid helps cushion your brain if you hit your head or fall. Spinal fluid moves freely around your brain and spinal Such analysis helps doctors rule out infection of or bleeding around the brain and spinal cord as possible causes.
Most people who have delirium are hospitalized. However, when the cause of delirium can be corrected readily for example, when the cause is low blood sugar , people are observed for a short time in the emergency department and can then return home. Once the cause is identified, it is promptly corrected or treated. For example, doctors treat infections with antibiotics, dehydration with fluids and electrolytes given intravenously, and delirium due to stopping alcohol with benzodiazepines as well as measures to help people not start drinking alcohol again.
Prompt treatment of the disorder causing delirium usually prevents permanent brain damage and may result in a complete recovery. The environment is kept as quiet and calm as possible. It should be well-lit to enable people to recognize what and who is in their room and where they are. Placing clocks, calendars, and family photographs in the room can help with orientation. At every opportunity, staff and family members should reassure people and remind them of the time and place.
Procedures should be explained before and as they are done. People who need glasses or hearing aids should have access to them. People who have delirium are prone to many problems, including dehydration Dehydration Dehydration is a deficiency of water in the body.
Although many people have no symptoms before a fall Preventing such problems requires meticulous care. Thus, people, particularly older people, may benefit from treatment managed by an interdisciplinary team Interdisciplinary care Providing medical care to older people can be complicated. People who are extremely agitated or who have hallucinations may injure themselves or their caregivers.
The following measures can help prevent such injuries:. Devices, such as intravenous lines, bladder catheters, or padded restraints, are not used if possible because they can further confuse and upset the person, increasing the risk of injury. However, sometimes during hospitalization, padded restraints must be used—for example, to keep the person from pulling out intravenous lines and to prevent falls.
Restraints are applied carefully by a staff member trained in their use, released at frequent intervals, and stopped as soon as possible because they can upset the person and worsen agitation.
Drugs are used to manage agitation only after all other measures have been ineffective. Two types of drugs are usually used to control agitation, but neither is ideal:. Antipsychotic drugs Antipsychotic drugs Schizophrenia is a mental disorder characterized by loss of contact with reality psychosis , hallucinations usually, hearing voices , firmly held false beliefs delusions , abnormal thinking However, they may prolong or worsen agitation, and some have anticholinergic effects Anticholinergic: What Does It Mean?
Newer antipsychotics, such as risperidone , olanzapine , and quetiapine have fewer side effects than older antipsychotics, such as haloperidol. But if used for a long time, the newer drugs may cause weight gain and abnormal fat lipid levels hyperlipidemia Dyslipidemia Dyslipidemia is a high level of lipids cholesterol, triglycerides, or both or a low high-density lipoprotein HDL cholesterol level. Lifestyle, genetics, disorders such as low thyroid hormone Urination and thirst are In older people with psychosis and dementia, these drugs may increase the risk of stroke, and death.
It is not intended to, and does not, mount to advice which you should rely on. It is not in any way an alternative to specific advice. You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet.
If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay. If you think you are experiencing any medical condition you should seek immediate medical attention from a doctor or other professional healthcare provider.
Delirium is a state of mental confusion that starts suddenly and is caused by a physical condition of some sort. It is also called an 'acute confusional state'. John, a retired teacher, was admitted to hospital after he broke his leg. A few days after his surgery his physiotherapist noticed that he seemed reluctant to work with her.
A specialist nurse noticed that he did not know where he was or why he was there, and that he could not pay attention to their conversation. Medical problems, surgery and medications can all cause delirium. It often starts suddenly and usually lifts when the condition causing it gets better. It can be frightening — not only for the person who is unwell, but also for those around him or her. It is usually worse at night. There is often more than one cause — but sometimes the cause is never found.
You are more likely to have an episode of delirium if you are older, or have problems with your sight or hearing. About 2 in every 10 hospital patients have a period of delirium. It is even more likely if someone has to be looked after on an Intensive Care Unit. Delirium is more common if you are:. If someone becomes confused they need to see a doctor urgently. They will often be too confused to describe what has happened to them, so it's important that the doctor can talk to someone who knows the person well and, hopefully, knows what has been happening recently.
Once a physical cause has been identified, it needs to be treated. For example, a chest infection will be treated with antibiotics. Even when someone is confused, there are simple steps that can be taken to help them feel safer and less agitated. These include:. Some people become so distressed that medication may be needed to calm them down. Unfortunately, sedative medications may do this but also make the delirium worse. So, sedatives should only be prescribed if a confused person:.
Any sedative medication should be given at the lowest possible dose, for the shortest possible time.
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