May 25, 2016

Dementia and delirium: what’s the difference?

Dementia and delirium are two common brain-related conditions that are often confused with one another and due to several overlapping symptoms, being able to tell the differences can hugely affect the care and treatment outcomes for older people.

Similar symptoms including memory problems, confusion, hallucinations, changes in behaviour, inability to focus, agitation, a decease in ability to communicate, or impaired speech.

Dementia is different to delirium as it is a progressive, gradual and usually irreversible disease. Dementia is a collective term for a number of disorders, such as Alzheimer’s disease, that cause a decline in memory, poor judgment, impaired function and difficulties in expressing oneself.

Delirium is an acute medical syndrome that occurs suddenly, but is usually temporary or treatable. Delirium causes acute confusion, inattention and an altered conscious state which may only last a short time. It could last as little as a few days or over a month. It’s often those closest to the person that raise the alarm saying “they are not quite themselves”.

Up to one-third of older people admitted to hospital are diagnosed with delirium. This increases the risk of unnecessary functional decline, a longer hospital stay, falls, needing to be admitted to a residential aged care facility, and death.

Video: Learn more about the differences between dementia and delirium, from ACSQHC

How do we distinguish between the two?

Distinguishing between delirium and dementia is important. This said, identifying between delirium in someone who already has dementia can be a difficult task – especially without accessing a detailed medical history from a relative or the patients’ primary carer about their baseline status.

While delirium is potentially preventable, it is poorly recognised and cases are often missed.

Delirium can often be passed off as a natural progression of dementia, resulting in the person not receiving appropriate medical treatment. Therefore, any acute or sudden changes in one’s condition from their baseline should be considered delirium and treated as a medical emergency.

The exception to the above is when people with a dementia diagnosis and their relatives have an advanced care directive requesting no further admissions to hospital or active medical treatments. Symptoms can then be managed in their own home or the aged care facility.

Fact: Someone with delirium and dementia have a mortality risk of over 50% compared to those with delirium or dementia alone.

How to identify delirium?

Knowing how to identify delirium in someone who is already confused is critical for appropriate treatment and a faster recovery.

Questions to help you differentiate between delirium and a progression of dementia:

  • Did the change in activity seem sudden?
  • Does the person have fluctuating alertness or conscious state? For example, a sudden burst of hyperactivity or hypoactivity
  • Has the person been increasingly agitation in the last few days to week?

If you have observed one or more of the above, you may wish to consult with a medical professional to seek clarity on the changes.

Other questions to consider and to report to a medical professional:

  • Can you pinpoint when the change in behaviour or mental activity happened?
  • Has the person had a recent increase in falls?
  • Are they unusually resistive to care?
  •  Is there a decrease in communication?

What’s the cause of delirium?

Delirium can result from any of the following medical conditions—pneumonia, dehydration, pain, constipation, drug withdrawal, a change in environment or hospitalisation stress. But sometimes the cause for delirium cannot be identified.

Delirium is usually caused by a number of underlying short-term illnesses or medical complications and older people are vulnerable to it because their bodies have fewer reserves than younger people to respond to these stressors. People with dementia are also particularly at risk.

This is why it is important to differentiate between delirium and dementia the most suitable treatment is prescribed and medical professionals can effectively find other courses of action to help to reduce the symptoms associated with either condition.

About 50% of older people who are discharged from hospital with unresolved delirium symptoms can experience symptoms lasting for months. Alarmingly, some people transition into permanent states of cognitive impairment.

Video: Learn more about delirium, from ACSQHC

In summary

  • Delirium is characterised by a sudden change in condition and should be treated as a medical emergency.
  • Delirium often lasts anywhere from days to a couple of months and is usually reversible. Dementia, on the other hand, is a brain disorder that is a slow progressive condition that is incurable but not unmanageable.

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