May 25, 2016

Dementia and Delirium: What’s the Difference?

Dementia and Delirium are two common brain-related diseases that are often confused with one another; they share some similar symptoms including, but not limited to: memory problems, confusion, hallucinations, changes in behaviour, inability to focus, agitation, and decrease in ability to communicate or impaired speech.

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

Delirium is an acute medical condition that occurs suddenly, causing acute confusion, inattention and an altered conscious state which may only last a short time. It’s often those closest to the person that raise the alarm saying “they are not quite themselves”.

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 in the absence of a detailed medical history from a relative or the patients’ primary carer about what the person’s baseline status was. 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 as a 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: Delirium on a background of someone with dementia are over fifty-percent mortality risk 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 consider that will help you differentiate between delirium and a progression of dementia.

  • Did the change in activity seem sudden?
  • Fluctuating alertness or conscious state noted? Either hypoactive or hyperactive
  • Noticed increased 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 your 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, among others—or hospitalisation stress (change of environment). This makes the treatment for each, different. Sometimes the cause for delirium cannot be identified.

As mentioned previously the importance differentiate one from the other would assist medical professionals in providing the most suitable treatment and what other courses of action can be done to help, support, assist and reduce the symptoms associated with either condition.

Video: Learn more about delirium, from ACSQHC

Take away messages

  • 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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