- Delirium has a sudden onset, within hours or a matter of days, whereas with dementia deterioration is seen over a much longer time frame.
- A person with delirium may experience fluctuation in mental state with significant variation in lucid and confused states that would be unusual in a person with dementia.
- Confusion in a younger person is much more likely to be caused by delirium rather than dementia.
- A person with dementia is generally alert in spite of their cognitive difficulties. Delirium has a much greater impact on the ability to stay focused and concentrate.
During assessment it is helpful for healthcare professionals to take a history from friends and family about the onset and nature of symptoms to differentiate between diagnoses. Family or friends may wish to challenge a diagnosis of dementia especially if there has been a sudden onset of symptoms. This is important as unlike dementia, delirium is often reversible if treatment is timely.
What Causes Delirium?
- Drug therapy: Many types of medication, commonly prescribed and available over the counter, including those for mental health problems, insomnia, heart conditions, pain relief and urinary conditions have the potential to cause delirium. Be particularly suspicious of drugs which have been newly prescribed as being the potential cause. Anaesthetics used during operative procedures can also be a cause.
- Infection: Urinary or respiratory tract infections, infected wounds and systemic bacterial or viral infections are all common causes of delirium.
- Drug and alcohol abuse or withdrawal
- Physiological imbalance: Delirium can be indicative of abnormal blood composition or hormonal imbalance.
- Inability to eliminate waste products from body: Urinary retention and faecal impaction have the potential of causing delirium alongside other medical complications.
Treatment will include addressing the medical causes of the delirium which might be multi-factorial. However it will also include provision of extra care and support. For example a person may require more assistance than usual to maintain activities of daily living. They might have reduced insight and be more prone to safety lapses. In particular their falls risk may increase. Short term use of medication or non pharmacological approaches might be needed to manage agitation and distress. More intensive care support and environmental adaptations may be required in a care home, hospital setting or the home environment to meet these temporary needs. As care needs may be different from the norm for the individual concerned specialist advice and support may be needed at these times.