Since the term altered mental status can be broad, categorizing the change as chronic or acute and then further classifying acute changes as fluctuating or nonfluctuating may be helpful figure 111. Elderly patients are at high risk for depression and cognitive disorders, the latter of which can be chronic as in dementia or acute as in delirium. Delirium is an acute disorder of attention and global cognition memory and perception and is treatable. Constipation 23 icu delirium incidence of 7087% of the elderly patients admitted to the icu. Pierluigi dal santo, antonino andriolli, giuseppe burattin, laura rossi. Delirium is a temporary state of being and does not progress over time. Some patients have both affective mood and cognitive disorders. Comparison of the clinical features of delirium, dementia, and. Delirium is usually referred to an acute stage of confusion which is commonly mistaken as dementia, depression, or a part of the aging process. Sometimes a person has more than one of these conditions at the same time.
Dementia and delirium are perplexing conditions both to differentiate and experience. Longer duration is directly associated with worse short and longterm outcomes. Patient presentation of dementia, delirium, and depression. Unlike dementia, delirium is usually reversible if the underlying cause is treated pdf. Learn vocabulary, terms, and more with flashcards, games, and other study tools. In hospitals, approximately 20 30% of older people on medical wards will have delirium and up to 50% of people with dementia. Instead, this is one of those symptoms that occurs within a short span of time. Delirium day iris universita degli studi di napoli federico ii. Dementia is a progressive intellectual function and other cognitive skills decline condition which results to a decline in an individuals performance of their daily activities. Dementia is generally a chronic, progressive disease that is incurable. Request permission export citation add to favorites track citation. This can include things like a single dose of a new medication or a change in residence. With this information, you should be able to tell the differences between delirium vs dementia and understand why awareness of delirium and its causes is important. Our observed rate of delirium was comparable to other rates published in the literature for elective noncardiac surgeries, which range from 9.
Depression and delirium, particularly hypoactive delirium, may present with apathy. Etiology and assessment of delirium delirium is one of the most prevalent symptoms in palliative care and, since it. Costs of associated delirium in the icu between 4 billion and 16 billion dollars a year. Dementia dementia is an irreversible state of cognitive impairment and short term memory loss related to organic brain disease most commonly alzheimers disease or multiple cerebral infarcts. A patient whose mental status change is acute may have either fluctuating. With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. However, when there are improper and often abnormal changes in thinking and behavior they may be indicative of an underlying disease or ailment. However, dementia and delirium are distinctly different illnesses. With old age, gradual loss or impairment of cognitive abilities is a natural phenomenon. Some memory lapses are a natural part of aging, but when it is combined with confusion, disorientation, difficulty concentrating, or speech problems, then there is a reason for concern. It describes the causes, consequences, diagnosis and management of delirium.
Dementia develops slowly, over several months or years. Pdf the world population is becoming older and proportion of people older than 65 years is growing significantly. T he diagnosis and documentation of encephalopathy can be confusing and controversial. The risk for delirium is greatest in individuals with dementia, and the incidence of both.
In order to make a diagnosis of dementia, delirium must be ruled out. Dementia and delirium, including alzheimers article khan. Comparison of the clinical features of delirium, dementia, and depression feature delirium dementia depression onset acute chronic, progressive decline variable. Delirium is a state of cognitive impairment and confusion usually of recent onset related to another illness. Mar 12, 20 delirium is an impaired mental state in which people become confused, with difficulty with attention and concentration. Delirium has an abrupt onset, in a matter of hours, while dementia must have memory problems with decreased functioning for at least one month. Delirium sometimes called acute confusional state and dementia are the most common causes of cognitive impairment, although affective disorders eg, depression can also disrupt cognition. Delirium can be easily overlooked in persons with dementia because some of the symptoms of delirium are shared with dementia. This form of acute brain dysfunction is associated with.
Venn diagram of delirium, dementia, and depression. Distinguishing between delirium or dementia is important. Between 1050% of people having surgery can develop delirium. Pdf depression, dementia and delirium continuum or comorbidity. Genetic and environmental factors associated with delirium severity. Apr 24, 2017 delirium can last for a few days, weeks or even months but it may take longer for people with dementia to recover. The following chart was adapted from several sources arnold, 2004. Delirium in dementia appears to have similar diagnostic criteria17. Delirium is quite common among the elderly who have been diagnosed with dementia.
Because delirium is usually a sign that something potentially damaging is occurring, it is important to seek medical help immediately. Objective to determine 1 whether delirium severity was associated with apolipoprotein e apoe. Dementia and delirium are very similar, but delirium is an acute condition that can be aggravated by an overuse of prescription medication. Delirium cannot be accounted for by a preexisting dementia. Delirium is common, although far from normal, in older adults. While the question of delirium vs dementia may seem difficult to answer, there are many differences between the two, including the following. Canadian coalition for seniors mental health, 2006. Dementia and depression are also risk factors for delirium. Delirium is seen as a medical emergency that needs to be treated right away.
Seniors with delirium show some of the same symptoms as those with dementia, but delirium is treatable. Genetic and environmental factors associated with delirium. But they have different causes, treatment, and outcomes. In hospitals, approximately 2030% of older people on medical wards will have delirium and up to 50% of people with dementia. Mistaking delirium for dementia in an older patienta common clinical errormust be avoided, particularly when delirium is superimposed on chronic dementia.
Dementia vs delirium in order to make a diagnosis of dementia, delirium must be ruled out. In fact, dementia is the most common risk factor for delirium, and twothirds of cases of delirium occur in patients who already have dementia. Dementia, diagnosed or undiagnosed, increases the risk of developing delirium approximately fivefold. Temporary state of confusion and disorientation that may last for a few days to a few months. Dec 06, 2017 delirium is caused by organic processes, usually an acute medical disease, alcohol or drug abuse, and infections such as urinary tract infection and pneumonia.
Differentiating among depression, delirium, and dementia. The interface of delirium and dementia in older persons. A print booklet combines all the topics, and can be downloaded and printed, or ordered. These are common symptoms of dementia, but they can also be signs of a dangerous but treatable condition called delirium. Causes and symptoms of dementia unlike delirium, dementia occurs gradually, often going unnoticed until significant decline in cognitive function has occurred. In delirium speech can be confused or disorganized. Differential diagnosis depression, delirium and dementia.
Delirium can last for a few days, weeks or even months but it may take longer for people with dementia to recover. In delirium cognitive changes develop acutely and fluctuate. Delirium is caused by an underlying medical problem such seemingly simple things as a bladder infection or constipation can precipitate a bout of dementia drug toxicity caused by taking medications improperly, incorrect dosage, incorrect medication, anesthesia, among other. Agitation, confusion, imagining things that arent there. Nair3 d elirium is a common syndrome affecting many elderly patients not only admitted into acute medical wards but also in the community. Delirium, dementia, and depression in older adults. Feb 06, 2018 i explain the difference between dementia and delirium, even though the actions may seem the same the causes are different. Delirium can last for a couple of days to even a couple of months.
Its also a medical emergency that needs immediate evaluation and care. Pdf a description and explanation of the distinguishing characteristics of depression, delirium, and dementia in elderly patients. The presence of dementia makes the brain more susceptible to developing a delirium. I explain the difference between dementia and delirium, even though the actions may seem the same the causes are different.
There are some reversible causes of dementia symptoms such as vitamin b12 deficiency, normal pressure hydrocephalus, and thyroid dysfunction. Dementia and delirium are both health conditions that change a persons ability to think clearly and care for themselves. Delirium vs dementia difference and comparison diffen. Genetic and environmental factors associated with delirium severity in older adults with dementia. High rates of delirium and depression are reported in people with dementia so these conditions may coexist and each needs to be addressed. Depression, dementia and delirium have some features in common. Continued on page 2 dementia is a disorder of the brain that can affect learning, memory, mood and behaviour. Dementia vs delirium in the geriatric patient samantha undarischwartz, agnpc, anpc 1 june 3, 2016 no disclosures delirium occurs in.
For the purposes of this book, delirium will generally be used in place of confusion, and dementia used as it implies. What is the difference between delirium, dementia, and. On the other hand, dementia can be caused by an illness or brain damage e. Dementia has an insidious onset, chronic memory and executive function disturbance, tends not to fluctuate. Dementia is a chronic progressive mental disorder that adversely affects higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning. Most times delirium is caused by a combination of factors. Dementia has intact alertness and attention but impoverished speech and thinking. Both can cause memory loss, poor judgment, a decreased ability to communicate, and impaired functioning.
Apr 01, 2004 delirium is often confused with other disorders of cognitive function, such as dementia. Pdf care home staff can detect the difference between. Whats the difference between dementia and delirium. Learning the difference between delirium and dementia is critical if you care for an older adult because. Dec 17, 2019 delirium is a temporary state of being and does not progress over time.
Delirium and dementia are conditions that can be confusing, both to experience and to distinguish. Clinicians struggle with, for example, the distinction between delirium and encephalopathy, and with recognizing encephalopathy when a patient with dementia. Read and learn for free about the following article. Between 10 50% of people having surgery can develop delirium.
May 04, 2017 but delirium is an underrecognized problem that is often mistaken for dementia, particularly when caregivers dont know a patients typical demeanor. Care home staff can detect the difference between delirium, dementia and depression article pdf available in nursing older people 241. Although the time course and pattern of symptoms differ, many of the symptoms of delirium and dementia are shared. Being a condition which is diagnosed clinically, the main features of delirium include the acute onset of fluctuating course, poor attention span, inattention, distraction, impaired rational thinking ability and altered level of. Short period of time and fluctuates behavioral disturbances with either hyper or hypoactive sx mc hypoactive actue hours to days.
However, patients with dementia are at increased risk of delirium and may have both. Nov 05, 2010 223 delirium and dementia usmle step 1 presented by usmle ace duration. Delirium, dementia and depression are different from one another, but it can be hard to distinguish between them because their signs and symptoms may be alike. It is more common in individuals who also have dementia.
Mental health nursing azusa pacific university 2011. According to a study by fick and flanagan, approximately 22% of older adults in the community with dementia develop delirium. Unlike dementia, delirium is usually reversible if the underlying cause is treated. Delirium, dementia, and depression in older adults rnao.
Delirium and dementia are separate disorders but are sometimes difficult to distinguish. Difference between delirium and dementia compare the. At a glance, the issues associated with it are very similar to dementia, since it includes memory problems, hallucinations, and language difficulties. Effect of delirium and other major complications after.
It is common for delirium to be superimposed on dementia. The incidence and prevalence rates of dementia and delirium are reflected in the following prevalence rates. Dementia and delirium are brain diseases but their symptoms, progression and how they affect behaviour are different. Delirium, dementia and depression can all manifest with cognitive symptoms which overlap at times.
The syndrome of delirium can be defined as acute brain failure associated with autonomic dysfunction, motor dysfunction. By closely observing the exact symptoms, you can differentiate between the two conditions and see that accurate treatment is administered. Even worse is that delirium can occur in combination with dementia and that untreated delirium can deteriorate into dementia. Pdf differentiating among depression, delirium, and dementia in. Delirium and dementia are both syndromes of neurologic dysfunction that present as a change in mental status. Aging does not cause dementia but it is more common among older adults. Not a specific disease, but rather a term that refers to symptoms of mental and communicative impairment found in a variety of brain conditions and diseases, including alzheimers. Main cognitive impairment is that of inattention vs memory in dementia generally develops over hours to days. Postoperative delirium is seen is approximately 5%10% of. A diagnosis of either delirium or dementia should be considered if patient exhibits some or all of. Symptoms are classically described as fluctuating throughout the day ie may appear normal in between episodes ed. No laboratory test can definitively establish the cause of cognitive impairment.
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