OBSERVING THAT A SENIOR loved one is suddenly experiencing worse-than-usual mental confusion or disorientation can be alarming to family members. The most common concern when this symptom arises is that the individual must be developing dementia. However, this sudden shift in the person’s mental status more likely indicates that he or she has delirium—a very common condition among older adults.
Delirium vs. dementia
Delirium and dementia can be superficially similar, but there are noteworthy differences between the two conditions—the most significant being the rate of onset. Whereas dementia typically begins with minor symptoms and gradually worsens over months or years, delirium tends to develop suddenly, often over a matter of hours to days.
Another difference between the two states is that people with delirium typically have difficulty focusing or paying attention from the onset, while people with dementia are generally alert in the early stages of the disease. Also, the severity of delirium symptoms tends to fluctuate between mild and severe throughout the day, potentially including periods with no symptoms. People with dementia may also have better or worse times of day (e.g. “sundowning”), but they usually exhibit the same level of memory and cognitive function regardless of the time.
While these two conditions are distinct, it should be noted that, according the National Institutes of Health, delirium is a strong risk factor for dementia. In fact, research shows that delirium not only increases the risk of dementia but is also associated with worsening dementia severity.
Signs of delirium
There are two general categories of delirium—hyperactive delirium, in which the individual becomes overactive, and hypoactive delirium, in which the individual becomes underactive. Common symptoms of the former include agitation, restlessness, difficulty concentrating, anxiety, disorientation, rapidly changing emotions, and hallucinations. The latter might cause the individual to become drowsy, apathetic, withdrawn, unmotivated, and less responsive. Hypoactive delirium is more common than the hyperactive form and, thus, more easily overlooked or mistaken for another problem such as depression.
Causes of delirium
It’s important to understand that delirium is not a disease, but a symptom, and a wide variety of underlying factors can cause or contribute to this condition in older adults. For example, as many family and professional caregivers can attest, older individuals with urinary tract infections, pneumonia, systemic infection, or other forms of infection often experience delirium.
In addition to infection, other potential causative/contributing factors include (but aren’t limited to):
- Chronic or acute illness
- Medication side effects
- Hospitalization/ICU stays
- Long-term care residency
- Lack of adequate sleep
- Vision or sight impairment
- Metabolic imbalances
- Alcohol/drug addiction or withdrawal.
Do people with delirium get better?
Episodes of delirium can resolve within a matter of hours to days, but they can also persist for weeks to months or even become a long-term issue. In any case, because the underlying cause can be a serious or even life-threatening condition, delirium requires prompt medical treatment. Any time symptoms of delirium are observed, it’s vital to seek a doctor’s care or to alert hospital/care facility staff, who may not be as attuned to your loved one’s normal state of mind as you are. Once the underlying cause has been identified and addressed, your senior loved one can begin to heal and hopefully recover his or her prior level of cognitive function. Furthermore, addressing known risk factors can help prevent episodes of delirium from occurring.