Delirium, also called as the acute confusional state, is a medical condition that results in confusion and other disruptions in thinking and behavior, including changes in perception, attention, mood and activity level. While in dementia, there is a progressive decline in memory and at least one other cognitive area in an alert person. These cognitive areas include attention, orientation, judgment, abstract thinking and personality.
In dementia, changes in memory and intellect are slowly evident over months or years while delirium is a more abrupt confusion, emerging over days or weeks, and represents a sudden change from the person’s previous course of dementia.
A patient with delirium.
Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized even by healthcare professionals because many symptoms are shared by the two disorders.
Sudden changes in behavior, such as increased agitation or confusion in the late evening, may be labeled as “sundowning” and dismissed as the unfortunate natural progression of one’s dementia.
Delirium
Dementia
Onset
Sudden, with a definite beginning point
Slow and gradual, with an uncertain beginning point
Duration
Days to weeks, although it may be longer
Usually permanent
Cause
Almost always another condition (eg, infection, dehydration, use or withdrawal of certain drugs)
Usually a chronic brain disorder (eg, Alzheimer disease, Lewy body dementia, vascular dementia)
Course
Usually reversible
Slowly progressive
Effect at night
Almost always worse
Often worse
Attention
Greatly impaired
Unimpaired until dementia has become severe
Level of consciousness
Variably impaired
Unimpaired until dementia has become severe
Orientation to time and place
Varies
Impaired
Use of language
Slow, often incoherent, and inappropriate
Sometimes difficulty finding the right word
Memory
Varies
Lost, especially for recent events
Need for medical attention
Immediate
Required but less urgently
The hallmark separating delirium from underlying dementia is inattention, wherein the individual simply cannot focus on one idea or task.
What to do if you suspect delirium?
Inform your GP about this, delirium may be the first and perhaps only clue of medical illness or adverse medication reaction in the Alzheimer’s individual. Secondly, create a safe and soothing environment to help improve the course of delirium: keep the room softly lit at night, turn off the television and remove other sources of excess noise and stimulation. The reassuring presence of a family member, friend, or a professional often prevents the need to medicate. And lastly, tread lightly with medications.
Image Creits: cfahorg, medscape, classfmonline, telegraph
