Delirium
Delirium is a serious change in mental abilities. It results in confused thinking and a lack of awareness of someone's surroundings. The disorder usually comes on fast — within hours or a few days.
Delirium can often be traced to one or more factors. Factors may include a severe or long illness or an imbalance in the body, such as low sodium. The disorder also may be caused by certain medicines, infection, surgery, or alcohol or drug use or withdrawal.
Symptoms of delirium are sometimes confused with symptoms of dementia. Health care providers may rely on input from a family member or caregiver to diagnose the disorder. Types of delirium
Experts have identified three types:
Hyperactive delirium. This may be the easiest type to recognize. People with this type may be restless and pace the room. They also may be anxious, have rapid mood swings or see things that aren't there. People with this type often resist care.
Hypoactive delirium. People with this type may be inactive or have reduced activity. They tend to be sluggish or drowsy. They might seem to be in a daze. They don't interact with family or others.
Mixed delirium. Symptoms involve both types of delirium. The person may quickly switch back and forth from being restless and sluggish.
Delirium and Dementia: Delirium and dementia may be hard to tell apart, and a person may have both. Someone with dementia has a gradual decline of memory and other thinking skills due to damage or loss of brain cells. The most common cause of dementia is Alzheimer's disease, which comes on slowly over months or years.
Delirium often occurs in people with dementia. However, episodes of delirium don't always mean a person has dementia. Tests for dementia shouldn't be done during a delirium episode because the results could be misleading.
Some differences between the symptoms of delirium and dementia include:
Onset. The onset of delirium occurs within a short time — within a day or two. Dementia usually begins with minor symptoms that get worse over time.
Attention. The ability to stay focused or maintain focus is impaired with delirium. A person in the early stages of dementia remains generally alert. Someone with dementia often isn't sluggish or agitated.
Rapid changes in symptoms. Delirium symptoms can come and go several times during the day. While people with dementia have better and worse times of day, their memory and thinking skills typically stay at a constant level.
Symptoms
Symptoms of delirium usually begin over a few hours or a few days. They typically occur with a medical problem. Symptoms often come and go during the day. There may be periods of no symptoms. Symptoms tend to be worse at night when it's dark and things look less familiar. They also tend to be worse in settings that aren't familiar, such as in a hospital.
Primary symptoms include the following.
Reduced awareness of surroundings
This may result in:
Trouble focusing on a topic or changing topics
Getting stuck on an idea rather than responding to questions
Being easily distracted
Being withdrawn, with little or no activity or little response to surroundings
Poor thinking skills
This may appear as:
Poor memory, such as forgetting recent events
Not knowing where they are or who they are
Trouble with speech or recalling words
Rambling or nonsense speech
Trouble understanding speech
Trouble reading or writing
Behavior and emotional changes
These may include:
Anxiety, fear or distrust of others
Depression
A short temper or anger
A sense of feeling elated
Lack of interest and emotion
Quick changes in mood
Personality changes
Seeing things that others don't see
Being restless, anxious or combative
Calling out, moaning or making other sounds
Being quiet and withdrawn — especially in older adults
Slowed movement or being sluggish
Changes in sleep habits
A switched night-day sleep-wake cycle
Treatment Options
Delirium treatment focuses on addressing the underlying cause of the delirium and keeping the person comfortable. Treatment may include medications, helping with sleep, and keeping the environment calm and familiar.
Medications
Calming medications: May help with agitation or fear, but some sedatives can make delirium worse
Antipsychotics: May help with hallucinations, delusions, or aggressive behavior, but can have severe side effects
Pain medications: May help with pain that's causing delirium
Support
Reassure the person: Let them know they're safe and you're there to help
Help with mobility: Encourage physical therapy or occupational therapy to help them move around
Help with sleep: Help them maintain a normal sleep schedule
Help with orientation: Use a clock and calendar to help them remember the time and date
Help with activity: Encourage them to do activities like reading the news or puzzles
Environment
Keep the environment calm: Reduce extra noise and stimulation
Keep the environment familiar: Avoid changing their surroundings or caregivers
Include family members: Have familiar people stay with them to reduce anxiety and fear
Other considerations:
Avoid physical restraints. Monitor and adjust medications, and Treat any medical conditions.
Delirium can take weeks or months to improve, and some people may have long-term memory and thinking problems.
When to see a doctor:
If a relative, friend or someone in your care shows symptoms of delirium, talk to the person's health care provider. Your input about symptoms, typical thinking and usual abilities will be important for a diagnosis. It also can help the provider find the cause of the disorder.
If you notice symptoms in someone in the hospital or nursing home, report your concerns to the nursing staff or health care provider. The symptoms may not have been observed. Older people who are in the hospital or are living in a long-term care center are at risk of delirium.