Delirium Vs. Dementia – Understanding The Differences
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As you age, some change may be inevitable. You may notice slight changes in your memory, problem-solving skills, and other abilities. While some changes are expected, more serious shifts in your mental state could be unsettling. These changes may be caused by dementia, which affects memory, problem-solving, language, and behavior, most frequently experienced among older adults.
In conversations about dementia, you may have also heard the phrase “delirium” used to describe a sudden change in mental state. While the symptoms of dementia and delirium often overlap, distinguishing between these two conditions may ensure proper treatment. Below, explore the symptoms and risk factors of delirium and dementia, the differences between these conditions, and the treatment options available for people experiencing them.
What is delirium?
Delirium is a sudden, worsening change in a person’s mental state. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnostic criteria for delirium include the following:
A disturbance in attention, characterized by a reduced ability to direct, focus, sustain, and shift attention
Reduced awareness of one’s environment
As an onlooker or loved one, it can be distressing to watch someone experience delirium, especially if the cause of their symptoms is unclear. Healthcare providers may use various tools, such as the Confusion Assessment Method (CAM), which is used to identify delirium in people who may be at risk for dementia. This test can measure the severity and frequency of potential delirium symptoms, possibly leading to a diagnosis.
Delirium superimposed on dementia
Delirium superimposed on dementia (DSD) is a condition in which an individual with pre-existing dementia experiences an acute delirious state. Diabetes, cerebrovascular disease, and the use of sedatives are a few of the independent risk factors for DSD. Diagnosis is often challenging due to overlapping symptoms, potentially requiring an urgent evaluation for sudden changes in behavior and cognitive decline.
Mixed delirium
Mixed delirium is characterized by symptoms of hyperactive and hypoactive delirium simultaneously. Individuals may have fluctuating levels of activity, from agitation to withdrawal, complicating treatment. Understanding the underlying pathophysiology involves recognizing the link between various inciting events and brain dysfunction.
Hyperactive delirium
Hypoactive delirium occurs when someone shows less activity, seems tired, and has trouble paying attention. This form can be hard to notice, especially in those with memory problems, and is often not recognized enough.
Substance-induced delirium
Substance-induced delirium arises from intoxication or withdrawal from substances, including medications, alcohol, or illicit substances. The clinical picture depends on the substance involved and requires specific treatment for the intoxication or withdrawal process.
Infectious delirium
Infectious delirium occurs because of an acute infection, such as sepsis or pneumonia. Management often involves treating the underlying infection alongside supportive care for delirium symptoms.
Postoperative delirium
Postoperative delirium can develop after surgery, particularly in elderly patients or those with existing cognitive problems. Contributing factors include anesthesia, pain, stress, and disruption of normal routines.
What are the causes of delirium?
Health concerns that could cause delirium include:
- Withdrawal from substances
- Substance intoxication, such as from illicit or prescribed medications or substances
- An abnormal metabolism, like from fever or other physical stress
- Low salt or blood sugar levels
- Visual or hearing impairment
- Social isolation
- Sensory deprivation
- A traumatic experience
- Acute illness, such as an infection
- An underlying medical condition, including epilepsy and insomnia
- Intense pain
Because the potential causes of delirium are varied, it can be crucial to see a medical provider who can rule out any serious or even life-threatening concerns.
What is dementia?
Dementia is the most significant risk factor for delirium. Dementia is an umbrella term for brain-related disorders that impact a person’s mental abilities, including memory, problem-solving, and language. This condition often affects older patients, usually over 65, and the symptoms may worsen over time. There are four main types of dementia, including the following.
Alzheimer’s disease
Alzheimer’s disease is the most common form of dementia. Often, the first signs of Alzheimer’s disease are changes in memory, thinking, language, or perception.
Vascular dementia
Vascular dementia is the second most common form of dementia and the most varied in its symptoms. While each person experiences it differently, common symptoms include difficulty planning, organizing, following steps, concentrating, and thinking quickly.
Dementia with Lewy bodies (DLB)
Dementia with Lewy bodies (DLB) is caused by Lewy body disease. People with DLB develop clumps of protein, called Lewy bodies, in their brain cells. Over time, the build-up of Lewy bodies and other proteins in the brain can lead to delusions and difficulty with focus, movement, and sleep.
Frontotemporal dementia (FTD)
Frontotemporal dementia (FTD) is a less common form of dementia affecting personality, behavior, or language. In some cases, people are diagnosed with mixed dementia when they have symptoms of more than one type.
What causes dementia?
At a biological level, dementia is caused by changes in specific brain regions that prevent nerve cells and their connections from working correctly.
Researchers are still working to understand the reasons why certain people develop dementia. Across all types of dementia, rare genetic variants may increase the likelihood of developing these conditions, but these variants may only affect a small portion of people. Some healthcare providers might recommend genetic testing when diagnosing dementia to determine if genetic factors are contributing to the condition.
In Alzheimer’s disease, scientists believe that the build-up of two proteins, amyloid and tau, forms deposits in the brain that lead to the loss of brain cells. Contrarily, vascular dementia is caused by reduced blood flow to the brain. This reduced flow may be caused by blocked blood vessels in the brain, a stroke, or a series of “mini” strokes that cause gradual, widespread damage to brain cells.
In dementia with Lewy bodies, the tiny clumps of protein that develop inside brain cells damage their ability to communicate with one another. In frontotemporal dementia, abnormal protein clumps cause damage to nerve cells in the front and temporal lobes of the brain, which leads to shrinkage of these areas.
Delirium vs. dementia
While delirium and dementia may be characterized by symptoms like memory problems, confusion, and visual hallucinations, they differ in several ways. Dementia develops slowly over months or years, while delirium usually has an abrupt onset and may last for a few days. During that time, a person may become more confused, sleepier, or drowsier than usual. Individuals with either condition are at a higher risk of complications, including increased mortality, highlighting the importance of consulting a doctor immediately if severe signs or symptoms arise.
Delirium may sometimes be a symptom of underlying dementia, but these two conditions are recognized as separate diagnoses in the DSM-5. When making a diagnosis, a doctor may carefully consider the similarities between delirium and dementia, which include confusion, agitation, and delusions.
Because delirium and dementia are the two most common causes of altered mental states among older people, distinguishing delirium from dementia can be difficult, especially if delirium starts suddenly or occurs in someone with pre-existing dementia. A thorough physical examination is often required to make an accurate diagnosis and differentiate between dementia and delirium symptoms. A comprehensive evaluation of an individual’s mental health status is also typically necessary.
Doctors can often accurately diagnose based on how quickly the symptoms appear or subside, how much they change within a day, and other aspects of a person’s health that may influence this case.
Treatment for delirium
Treatments can vary depending on the cause of delirium. In some cases, treatment is recommended to prevent delirium in the first place. For example, healthcare professionals might recommend supportive measures, such as using hearing aids for someone in the hospital who has hearing problems.
To treat delirium, a medical team might address medical concerns that could cause the condition. They might address low blood sugar, monitor your metabolism, prescribe antibiotics for an infection, or take other medical actions to stabilize your mental and physical health. Behavioral modifications, reorientation, and environmental familiarity are imperative to treat delirium. Psychotherapy can also help individuals address the cognitive and emotional symptoms of delirium. With an accurate health assessment and a proactive, compassionate response, the symptoms of delirium often improve.
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Treatment for dementia
Because dementia is progressive and comes in several varieties, its treatment is often more complicated. While there is currently no cure for dementia, several interventions may help individuals manage the symptoms or slow down their progression. Some of these interventions include the following:
- Medications
- Cognitive-stimulation therapy (CST)
- Cognitive rehabilitation
In managing dementia, cholinesterase inhibitors are often prescribed to slow the progression of symptoms in conditions like Alzheimer's disease. These medications can help manage memory problems and confusion, which are common in dementia.
Using therapy to cope
For people with dementia and their caregivers, the progression of symptoms can be distressing and isolating. However, you don’t need to explore treatment options alone. As you learn more about the diagnosis, a licensed therapist can provide emotional support and help you develop essential coping skills. While some people prefer face-to-face therapy, online therapy through platforms like BetterHelp is an increasingly popular option for people who want to invest in their mental health from home.
Using an online platform, you can complete a brief questionnaire and get matched to a licensed therapist, often within 48 hours. In addition, you can use their worksheets, messaging, optional group sessions, and webinars. If your loved one has been diagnosed with dementia, delirium, or another serious condition, you may find that therapy helps you remain healthy and grounded, even while providing ongoing care to your loved one.
Online therapy can also be highly effective. One study assessed the value of an online cognitive-behavioral therapy (CBT) program for family caregivers to people with dementia. After completing online CBT, the caregivers reported they were better able to manage the behavioral and psychological symptoms of dementia. The caregivers also reported being less distressed by those symptoms, and the dementia symptoms seemed to decrease in severity, possibly because they felt less anxious, stressed, and better equipped to communicate with their loved ones.
Takeaway
Whether experiencing these conditions directly or witnessing them in someone else, delirium and dementia can be upsetting, overwhelming experiences. However, the scientific understanding of both conditions is growing. Many therapists in the mental health community have years of experience working with people with dementia or delirium and the loved ones who walk alongside them.
The first step in treating delirium and dementia is often understanding their differences. Early intervention, proper diagnosis, and various therapies can support you, whether you’re a caregiver or someone impacted. Consider reaching out to a professional to explore your experience in further detail.
What is the difference between delirium and dementia?
Delirium and dementia are distinct conditions, and there are key differences to note when differentiating delirium from dementia. Delirium is characterized by an acute onset of confusion, fluctuating attention, and impaired cognitive function. It is an acute illness that often results from underlying medical issues, infections, or medication side effects, and its symptoms may be reversible when the underlying cause is addressed.
In contrast, dementia is a chronic and progressive condition marked by a gradual decline in cognitive abilities, including memory, language, and problem-solving skills. Dementia, such as Alzheimer's disease, Lewy body dementia, normal pressure hydrocephalus, or vascular dementia, is typically irreversible and linked to degenerative changes in the brain. While both delirium and dementia can involve cognitive impairment, delirium is often temporary and tied to specific inciting events, whereas dementia is a long-term, irreversible condition with a more gradual onset.
What stage of dementia is delirium?
Delirium is not a specific stage of dementia; rather, it is a separate medical condition that can occur independently or in conjunction with dementia. The symptoms of delirium superimposed with the symptoms of dementia show how the two mental disorders overlap. Delirium is an altered mental status that may be characterized by acute confusion, altered awareness, and fluctuations in cognitive function. This state is often incited by various factors, including infections, medication side effects, metabolic imbalances, or other medical issues. These signs and symptoms are not altogether different from the signs and symptoms seen in a person developing dementia.
Individuals with dementia may develop delirium at any stage, but it is particularly common during the later stages, when individuals may be more vulnerable to medical complications. In a person with dementia, the presence of delirium suggests a cognitive and functional decline. In diagnosing delirium, medical professionals may use the confusion assessment method to distinguish delirium from other mental health conditions. Delirium is a medical emergency that requires prompt evaluation and intervention to identify and address the underlying cause.
Is delirium reversible?
Delirium is often reversible with prompt identification and appropriate management of the underlying causes. Delirium is a state of acute confusion and altered consciousness that can result from various factors, including infections, medication side effects, metabolic imbalances, and other medical issues.
The key to reversing delirium is addressing the specific causes or underlying factors contributing to the condition. Once the root cause is identified and treated, individuals with delirium may experience a gradual improvement in cognitive function and a return to their baseline mental state.
Do dementia patients recover from delirium?
Recovery from delirium in individuals with dementia can vary depending on several factors, including the underlying causes of delirium, the severity of the condition, and the timeliness of intervention. Delirium is often reversible, but the extent of recovery can be influenced by the effectiveness of addressing the specific inciting events or contributing factors.
When the underlying causes of delirium, such as infections, medication side effects, or metabolic imbalances, are promptly identified and appropriately treated, individuals with dementia may experience a significant improvement in cognitive function and a return to their baseline mental state.
Individuals with dementia may be more vulnerable to the negative effects of delirium, and the recovery process can be more challenging. Delirium can contribute to a decline in cognitive function and exacerbate existing cognitive impairment. Additionally, the presence of dementia may complicate the identification and management of delirium.
What are the 5 Ps of delirium?
The "five Ps" of delirium are a pneumonic device used to help healthcare professionals remember common precipitating factors or causes of delirium. These factors contribute to the onset or exacerbation of delirium. The five Ps are as follows:
- Predisposing factors: Pre-existing factors make an individual more susceptible to delirium and may include age, cognitive impairment, pre-existing medical conditions, or a history of delirium.
- Precipitating factors: Precipitating factors are events or conditions that cause or contribute to the development of delirium. Common precipitating factors include infections (e.g., urinary tract infections, pneumonia), medication changes or side effects, surgery, or metabolic imbalances.
- Pain: Individuals experiencing pain, especially if it is unmanaged or underreported, may be at an increased risk of developing delirium. Adequate pain management may help individuals prevent and manage delirium.
- Polypharmacy: Polypharmacy refers to the use of multiple medications, and it is a known risk factor for delirium. The interactions between medications or the side effects of specific medications can contribute to cognitive impairment and delirium. Reviewing and optimizing medication regimens may prevent or manage these symptoms.
- Procedures: Medical procedures, surgeries, or other interventions can precipitate delirium. Stress, anesthesia, and the postoperative recovery process can contribute to cognitive changes or postoperative delirium. Careful management before, during, and after procedures may minimize the risk.
What is the life expectancy of someone with delirium?
The life expectancy of an individual with delirium is challenging to determine precisely, as it depends on various factors, including the underlying causes of delirium, the person's overall health, and the effectiveness of medical interventions. Delirium itself is an acute confusional state and altered consciousness that is often reversible with proper management of the underlying triggers.
It may be important to differentiate between delirium, which is a transient and often reversible condition, and other chronic conditions that may contribute to or coexist with delirium. Delirium can occur in the context of various medical issues, such as infections, medication side effects, or metabolic imbalances, and addressing these underlying causes is crucial for recovery.
If the underlying causes of delirium are identified and appropriately treated, individuals can experience a significant improvement in cognitive function and a return to their baseline mental state. However, if delirium is associated with severe or life-threatening medical conditions, the prognosis may be influenced by the individual's overall health and the success of medical interventions.
What causes delirium?
Delirium can be caused by various factors, and identifying the underlying cause can be part of effective management. The events that incite delirium can be broadly categorized into medical, environmental, and medication-related factors, including these factors:
- Medical conditions
- Environmental factors
- Medication-related factors
- Substance use or withdrawal
- Pain
- Surgery or medical procedures
- Psychiatric conditions
- Trauma or injury
How does a person with delirium act?
The behavior of a person experiencing delirium can vary widely, but there are common signs and symptoms associated with this acute state of confusion and altered consciousness. The key features of delirium include:
- Fluctuating levels of consciousness: Individuals with delirium may experience changes in their level of awareness, ranging from periods of hyperactive delirium and agitation to hypoactive delirium or reduced responsiveness.
- Disorganized thinking: Delirium often manifests as disorganized or incoherent thinking. The person may struggle to maintain a coherent conversation, have difficulty concentrating, or exhibit confusion about time, place, or person.
- Impaired attention: Individuals with delirium may have difficulty focusing or sustaining attention on a task or conversation. Their attention may shift rapidly from one topic to another.
- Disturbed sleep patterns: Sleep-wake cycle disruptions are common in delirium. The person may experience insomnia, daytime sleepiness, or fragmented sleep.
- Hallucinations or delusions: Some individuals with delirium may experience sensory disturbances, such as seeing or hearing things that are not present (hallucinations) or holding false beliefs (delusions).
- Agitation or restlessness: Agitation, restlessness, or an inability to sit still may be observed in individuals with delirium. They may pace, fidget, or exhibit purposeless movements.
- Emotional disturbances: Emotional changes, such as heightened anxiety, irritability, or mood swings, are common in delirium.
What is the best treatment for delirium?
Treating delirium often involves addressing the underlying causes and managing the symptoms to restore normal cognitive function. The specific approach to treatment may vary depending on the contributing factors to delirium. Here are the key components of the treatment for delirium:
- Identification and management of underlying causes: The first step is to identify and treat the underlying medical, environmental, or medication-related causes of delirium. This process may involve a thorough medical assessment, laboratory tests, imaging studies, and a review of medications.
- Medication management: In some cases, medications may be used to manage specific symptoms associated with delirium. For example, antipsychotic medications may be prescribed to address severe agitation, hallucinations, or delusions. However, using medications requires careful consideration of potential risks and benefits and should be supervised and prescribed by a doctor.
- Supportive care: Creating a calm and familiar environment may help individuals with delirium. Reducing excessive noise, maintaining a consistent routine, and ensuring adequate lighting may minimize confusion.
- Promotion of sleep: Addressing sleep disturbances can be beneficial. Strategies to promote a regular sleep-wake cycle may include minimizing disruptions during nighttime hours, providing a comfortable sleeping environment, and managing pain or discomfort.
- Monitoring and management of behavior: Behavioral management strategies, such as providing reassurance, redirection, and engaging in calming activities, can be helpful in managing agitated or restless behavior.
- Multidisciplinary care: In some cases, treating delirium requires a multidisciplinary approach involving healthcare professionals from various specialties, including physicians, nurses, pharmacists, and other allied health professionals.
- Rehabilitation and follow-up: Following the resolution of delirium, rehabilitation services may be beneficial to support the individual's recovery, particularly if there are lingering cognitive or functional deficits. Regular follow-ups with healthcare providers can monitor progress and address any ongoing concerns.
Delirium is a medical emergency, and prompt intervention may improve treatment outcomes. Family members and caregivers often play a vital role in providing information about the individual's medical history, recent changes, and potential causes of delirium.
How do you get someone out of delirium?
Getting someone out of delirium often involves identifying and addressing the underlying causes while providing supportive care to manage symptoms. Below are ten steps that healthcare professionals may take to help resolve delirium:
- Identify and treat underlying causes: Conduct a thorough medical assessment to identify the specific inciting causes of delirium, such as infections, medication side effects, metabolic imbalances, or other medical conditions. Treatment should address these underlying causes.
- Implement medication management: In certain cases, medications may be used to manage symptoms associated with delirium, such as severe agitation, hallucinations, or delusions. The choice of medication depends on the individual's specific symptoms and needs.
- Create a calm and familiar environment: Provide a quiet and familiar environment to minimize confusion and agitation. Reduce excessive noise, maintain a consistent routine, and ensure adequate lighting. Familiar objects or personal belongings may also create a sense of safety.
- Promote sleep: Establish a regular sleep-wake cycle, minimize disruptions during nighttime hours, and manage pain or discomfort to contribute to improved sleep.
- Ensure hydration and nutrition: Monitor and address hydration and nutrition needs. Dehydration and malnutrition can contribute to delirium, so ensuring the individual receives adequate fluids and nutrition is important.
- Consider behavioral management: Use behavioral management strategies, such as providing reassurance, redirection, and engaging in calming activities. Avoid confrontational or challenging approaches, as these can exacerbate symptoms.
- Encourage mobility and physical activity: Encourage mobility and physical activity as appropriate for the individual. Regular movement and activity may prevent complications associated with immobility and contribute to overall well-being.
- Involve family and caregivers: Collaborate with family members and caregivers to provide information about the individual's baseline mental state, recent changes, and potential causes of delirium.
- Ensure regular monitoring and adjustments: Continuously monitor the individual's progress and adjust the care plan as needed. Regular communication with healthcare professionals is crucial to address any changes or concerns.
- Center rehabilitation and follow-up: Following the resolution of delirium, rehabilitation services may be beneficial for those who experience lingering cognitive or functional deficits. Regular follow-up with healthcare providers helps individuals monitor ongoing progress and address any remaining issues.
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