In this issue, we will discuss the difference between dementia and another state that also causes mental confusion, delirium. While both involve cognitive and behavioral changes, they are different and involve different approaches and treatment.
What is delirium?
Delirium and dementia both are cognitive disorders, involving disturbances in thinking and orientation. While dementia refers to a more permanent and possibly progressive state, delirium is transient and involves a passing phase due to some external cause. In older people, delirium is often a result of sudden changes in medication or medical status.
Delirium often accompanies hospitalization. It also often accompanies patients who are transferred from hospital to a skilled nursing facility. In many cases, delirium is misdiagnosed as dementia, with the patient being erroneously treated as if the mental status deterioration is long-standing.
What are the signs of delirium?
Delirium is accompanied by changes in mental status that often fluctuate during the day. The person’s level of alertness and confusion ebbs and flows. At times, there are periods of lucidity, while at other times confusion reigns. Delirium is often accompanied by aggressive behavior, hallucinations and withdrawal.
Can delirium be treated?
Delirium is managed by a combination of environmental and pharmacological care. In most cases, delirium lifts as the responsible precipitant factor (e.g., anesthesia, infection, etc.) lifts. Pharmacological treatment provides symptomatic relief of behavioral disturbances, such as aggression, that may accompany the delirium.
How do I deal with the behavior problems of delirium?
Providing a supportive and comfortable environment is paramount in treating delirium. Stimuli that are familiar to the patient, such as photographs, favorite items, music, etc., can provide a framework for reducing the confusion that accompanies delirium. In some cases, attending staff as well as family members need to be informed of the issues surrounding delirium and to emphasize that, unlike dementia, it is a passing phase that most often clears after the factors responsible for the confusion are treated.
Pre-existing factors such as dementia or depression can complicate both diagnosis and recovery from delirium.
What should I keep in mind when I see a possible case of delirium?
It is critical to recognize that confusional states and mental status impairment need not be dementia. In older people, one often assumes dementia for any type of confusion. Delirium is common and in most cases reversible. Providing information, support and the proper medical treatment to the patient and family is critical in intervention.
How does this impact on care on people discharged from hospital?
The accurate assessment of mental status is critical in insuring a proper adjustment after a hospital stay. Where confusion is present, do not automatically assume that we are dealing with a serious dementia, like Alzheimer's disease. The stress of the recent hospitalization, as well as the impact of acute medical conditions, medications. etc., can bring about delirium. An accurate history and evaluation by a health care professional helps in determining diagnosis and treatment.