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How To Differentiate Delirium From Dementia

The Differences Between Delirium And Dementia

How to know the difference between dementia and delirium

Delirium, or a sudden onset of confusion or cognitive impairment, frequently occurs in individuals with dementia, but experiencing delirium is not the same thing as having dementia. Dementia can be defined as a more progressive decline in cognitive abilities due to gradual dysfunction or a loss of brain cells, most commonly caused by Alzheimers disease. So, what are three differences between dementia and delirium?

  • Onset: While the onset of delirium is rapid , the onset of dementia is more subtle. The symptoms appear as relatively minor in the beginning, but gradually worsen over time.
  • Attention: Individuals with delirium will have a very difficult time staying focused, as cognitive impairment with delirium is more significant than that of dementia in the beginning stages. Individuals in the early stages of dementia are generally more alert and focused with the occasional lapse in cognitive function.
  • Fluctuation: Delirium causes symptoms that fluctuate rapidly and significantly even throughout the span of one day; in contrast, individuals with dementia have a more constant level of thinking and memory skills with a gradual decline as the disease progresses.
  • How Delirium And Dementia Are Related

    Delirium and dementia are tightly related, though distinct, and often the two terms are confused in common usage. In fact, dementia is often a root cause in the manifestation of delirium, along with other contributing causes like electrolyte disorders; severe infections of the lungs, liver, heart, kidney or brain, prescription drug use and an unfamiliar environment.

    Symptoms common in both delirium and dementia include:

    • Difficulty solving complex problems
    • Lack of focus and coherent thought
    • Difficulty or complications when attempting to form new memories

    There are no clear diagnostic tests to verify the presence of delirium, so acknowledgment relies solely on clinical observations. Before a patient is diagnosed with dementia, delirium must be ruled out as the condition.

    Differences Between Delirium And Dementia

    Delirium and dementia are conditions that can be confusing, both to experience and to distinguish. Both can cause memory loss, poor judgment, a decreased ability to communicate, and impaired functioning. While the question of delirium vs dementia may seem difficult to answer, there are many differences between the two, including the following:

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    The Delirium Definition: What Exactly Does It Mean

    According to the Mayo Clinic, delirium is a rapid-onset cognitive disturbance that seriously impacts thinking and causes disorientation or reduced awareness of surroundings.

    Delirium and dementia are closely related because dementia is one of the top delirium causes, especially in individuals over the age of 65. Additional risk factors;and causes include having multiple medical conditions like a severe or chronic illness, poor hearing or vision, an electrolyte disorder or infection, taking multiple prescription medications, or injury, pain or stress.

    Symptoms of delirium;typically come on rapidly, either within a couple of hours or a few days, and include:

    • Exhibiting a reduced ability to stay focused on a conversation or getting stuck on one idea.
    • Becoming withdrawn with little or no response or reaction to the surrounding environment.
    • Demonstrating cognitive impairment in the form of poor memory or disorientation.
    • Having trouble speaking or recalling words; rambling; having trouble with reading or writing.
    • Experiencing restlessness, disturbed sleep habits, or a reversal of the sleep and wake cycles.
    • Displaying changes in behavior such as combativeness; anxiety, fear or paranoia; apathy or, conversely, an extreme sense of elation or euphoria; depression; and other rapid shifts in mood or personality.

    What Can I Do To Help Someone With Delirium

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    If you have contacted the persons GP and are awaiting treatment, there are a few things you could do to make the situation a little easier for them:

    • keep calm and reassure the person
    • use short simple sentences when talking
    • observe the person to see if they are in any pain
    • make sure theres nothing obscuring their senses, and have their glasses and hearing aid to hand if they use them
    • use familiar photos and objects to distract the person and provide familiarity
    • help ground the person by making sure they know the time and date
    • help the person to find the toilet if needed
    • avoid too much stimulation and having too many people around if possible
    • keep a low light on at night
    • avoid disagreeing with the person too much; change the subject if they express ideas that seem odd to you
    • offer them drinks to maintain hydration.

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    Dementia And Delirium: Differences In Alterations

    To distinguish dementia and delirium it is interesting to look at the elements raised below. We highlight:

    • Onset : dementia has an insidious or chronic onset , while delirium is acute.
    • Course : dementia is stable throughout the day, but delirium is fluctuating with lucid intervals. Also, it gets worse at night.
    • Duration: While dementia can last from months to years, delirium usually lasts from hours to weeks.
    • Consciousness : while in the case of dementia the conscience remains clear, in delirium it is cloudy.
    • Attention: in dementia it is relatively normal, while in delirum it is very difficult for the person to focus their attention.
    • Memory: it is altered in both.
    • Thinking: in dementia, thinking is impoverished, but in delirium it is disorganized and delusional.
    • Perception: in dementia, perception is normal in the initial stages, but in delirium, illusions and hallucinations appear .
    • Speech: while in dementia there are aphasic signs , in delirium an incoherent, doubtful and rapid speech is characteristic .
    • Sleep-wake cycle: in dementia this is usually normal, while in delirium it is always altered.

    How To Support Patients Of Dementia

    While dementia cannot be cured, support from friends and family members goes a long way in alleviating the symptoms and making life easier for the patient.

    Dementia patients can benefit from the involvement of family, friends, or caregivers who spend time with them. Patients may become confused about their surroundings and require calm reassurance, or they may require assistance with everyday tasks like eating and bathing. People with mild dementia often remain in their homes, but more severe cases frequently require hospitalization in a nursing home or special care facility where they can receive around-the-clock supervision and treatment.

    Some of the sensory impairments associated with dementia, such as vision or hearing loss, can be alleviated with the use of properly fitted sensory aids like glasses or hearing aids. Labels and reminders, medication organizers, and special large-button phones and remote controls may also be helpful. It is also important to maintain a clutter-free and organized home, as many people with dementia have difficulty with coordination or have other diseases that affect mobility, like arthritis.

    Some researchers believe people can reduce their risk of developing dementia by keeping their minds active playing puzzle games, reading challenging material, etc. but this alone will not prevent the condition.

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    Practical Advice For Differentiating Depression Delirium And Dementia

    Generally speaking, an acute behavioral or mood change is suggestive of delirium. Once medical contributors have been ruled out, depression, characterized by a more pervasive or chronic low-mood state with or without cognitive impairment should be considered. Patients with dementia are less likely to self-report their cognitive problems than are patients with depression .

    Table 1. Characteristics of depression, delirium and dementia


    Delirium In People With Dementia

    What is the difference between Delirium and Dementia? | Delirium vs Dementia Mnemonic OCD CAMPS

    Distinguishing between delirium or dementia is important; however, a more difficult task may be identifying delirium in someone who already has dementia. According to a study by Fick and Flanagan, approximately 22% of older adults in the community with dementia develop delirium. However, that rate skyrockets to 89% for those who have dementia and are hospitalized.

    Knowing how to identify delirium in someone who is already confused is critical for appropriate treatment and a faster recovery. Delirium superimposed on someone with dementia also is connected with a more than double mortality risk compared to those with delirium or dementia alone.

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    Alternative Dementia Treatments And Research

    In addition to the FDA-approved drugs, alternative treatments for Alzheimers disease are also available, including dietary supplements. Most of these are not regulated by the FDA or quality controlled. There may be limited research on their effectiveness and side effects. Please consult a physician before starting an alternative treatments, as there may be serious side effects or drug-drug interactions.

    A popular supplement for Alzheimers disease treatments that is currently not FDA approved is ginkgo biloba. Research has been inconsistent regarding its efficacy. Some studies report that ginkgo biloba is safe and may improve or stabilize mental and social functioning in those with dementia. One study found that it was as effective as donepezil in treating Alzheimers disease. The American Academy of Neurology has stated that vitamin E supplements, also known as alpha-tocopherol, may delay symptom progression in some people with Alzheimers disease. One should consult a physician prior to taking vitamin E due to possible side effects including increased risk of bleeding. Research is ongoing to evaluate the benefits of vitamin E and other antioxidants, aspirin and other nonsteroidal anti-inflammatory drugs , estrogen, progesterone, and selegiline, an MAO inhibitor, at slowing the progression or reducing the risk of developing Alzheimers.

    Overview Of Delirium And Dementia

    , MD, PhD, Department of Neurology, University of Mississippi Medical Center

    Delirium and dementia are the most common causes of cognitive impairment, although affective disorders can also disrupt cognition. Delirium and dementia are separate disorders but are sometimes difficult to distinguish. In both, cognition is disordered; however, the following helps distinguish them:

    • Delirium affects mainly attention.

    • Dementia affects mainly memory.

    Other specific characteristics also help distinguish the two disorders :

    • Delirium is typically caused by acute illness or drug toxicity and is often reversible.

    • Dementia is typically caused by anatomic changes in the brain, has slower onset, and is generally irreversible.

    Delirium often develops in patients with dementia. Mistaking delirium for dementia in an older patienta common clinical errormust be avoided, particularly when delirium is superimposed on chronic dementia. No laboratory test can definitively establish the cause of cognitive impairment; a thorough history and physical examination as well as knowledge of baseline function are essential.

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    What Is Treatment And Support For Delirium

    Delirium is treated first by addressing the medical problem that have caused it. For example, if the person has low blood oxygen or low blood sugar levels these will be corrected quickly. If the person has an infection they may be given antibiotics. If they are in pain, constipated or not passing urine then these will be treated.;Doctors will also review the persons medication and stop any non-essential drugs that may be linked to delirium. Staff will make sure the person is supported to eat and drink regularly.Delirium will usually improve if its cause is found and treated.A supportive and calm environment can also help someone recover from delirium. Nursing staff, and visiting family and friends, can all help by:;

    Doctors wont normally give someone medication to treat delirium, because there is very little evidence that drugs help. Drugs should be considered only if the persons behaviour poses a risk of harm to themselves or others, or if hallucinations or delusions are causing the person severe distress.;In either case a doctor may try a low dose of a sedative or an antipsychotic for a few days.

    Difference Between Delirium And Dementia

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    Delirium vs Dementia

    Delirium and dementia are two old age disorders. With old age, gradual loss or impairment of cognitive abilities is a natural phenomenon. However, when there are improper and often abnormal changes in thinking and behavior they may be indicative of an underlying disease or ailment. Delirium and dementia are two ailments that have many similarities and often spoken of in interchangeable manner though they are separate and different diseases. This article will highlight the differences between delirium and dementia by bringing out their features so as to enable readers to find out what they are their close ones are suffering from.

    Abnormal changes in a persons behavior and thinking are often indicative of physiological changes taking place inside the brain. There may be events in life that have deep impact on the higher functions of brain directly affecting a persons thinking, memory, outlook and interaction with others and environment.



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    Enhancing Healthcare Team Outcomes

    Differentiating delirium and dementia is critically important;and can be challenging in many cases. Delirium is a common occurrence in elderly patients and is often overlooked in the elderly due to concurrent history of dementia. The two are distinct;pathologic processes;with different management and prognoses. Delirium suggests serious medical issues and usually carries a poor prognosis.

    Interprofessional teamwork, including an emergency room provider, neurologist, neuropsychologist, geriatrician, and intensivist, is warranted. Besides, pharmacists, physical and occupational therapists, nursing, and case management staff also play a vital role. Pharmacists play an important role by providing us with important information about pharmacokinetics and potential drug interactions requiring frequent monitoring. Physical and occupational therapists help with mobility and structured activities to focus patients. The role of the nursing staff is pivotal in;taking care of all the basic needs of demented patients. Social workers play a significant role by getting the providers in touch with their;family and during transitions of care.

    Some of the barriers that may hinder clinical improvement are failing to distinguish the two early on or identifying superadded delirium in a demented patient. Therefore a holistic and integrated approach via an interprofessional team can lead to early recognition and risk stratification, improving;patient outcomes.

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    Understanding The Difference Between Dementia Vs Delirium Symptoms

    As your senior loved one ages, you may begin noticing subtle shifts in their health or behavior, especially when those changes result in some form of cognitive impairment. What happens, though, when the cognitive impairment or confusion appears quite suddenly and without warning? Does this mean your loved one has dementia? Not necessarily. This may be a case of what is known as delirium. While both deal with confusion and cognitive impairment, dementia and delirium are two different things. So, what are delirium symptoms, and how can you differentiate symptoms of delirium from dementia? And what is the difference between dementia, delirium and Alzheimers? Read on to find out!

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    Dementia Vs Delirium: Key Differences

    When it comes to these separate cognitive conditions, it’s important to realize that an individual can experience both at the same time. For example, if your loved one has Alzheimer’s disease but then experiences an episode of extreme hallucinations, radical mood changes, and unusual confusion and disorientation, then they may need to seek medical treatment for delirium.

    However, in general, here are the key differences to look out for:

    • Memory: One of the major differences between delirium and dementia is that, while delirium affects attention and concentration, dementia is primarily associated with memory loss.
    • Attention: Though seniors with dementia may have some issues with attention in the late stages of the condition, for the most part, they are able to remain relatively attentive. By contrast, individuals in a state of delirium will be easily distracted, unable to concentrate, and generally going in and out of consciousness.
    • Speech: Although individuals with dementia in late stages may have difficulty putting their thoughts to words, they usually won’t demonstrate the sudden slurred speech common to delirium.
    • Hallucinations: Though hallucinations occasionally occur with dementia, they are very common with delirium.
    • Illness: Delirium is often caused by illness, surgery, or drugs. Those with dementia often will have no signs of physical illness or conditions.

    Dementia Delirium And Alzheimers Disease

    Dementia vs Delirium | What’s the difference? | Health

    Understanding the differences between these terms can be considered a first step in understanding what may be going on with you, a family member, a friend, or;colleague.

    Dementia;is often incorrectly used as an interchangeable term for Alzheimers disease. Dementia is a generic term, rather like saying car or fever.; What type of car? Why is there a fever?

    Dementia in simplest terms is a term used for a group of approximately 130 or more cognitive disorders. Those disorders can result in problems with: memory, judgment, using and understanding the language, problems and deficiencies in motor activity, and problems with recognizing objects and people.; It can also include difficulty with executive function which is the ability to plan, organize and think in the abstract.; These disorders are a result of the death of neurons or permanent damage to the neurons.

    Dementia is generally of a gradual onset.; Unless the dementia is one of the types that can be reversed dementia is a progressive illness that, at this time has no known cure. There are treatments available to alleviate some of the symptoms for a certain time period, such as behavioral therapies, and medications. Alzheimers disease is the most common form of dementia.

    Obtaining an accurate diagnosis is critical to understanding the prognosis, obtaining treatment and planning for the future.

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    Providing Support For Cognitive Issues

    As a loved one or caregiver, you can make all the difference by noticing any changes in your loved one’s thinking, reasoning, or behavior. If your loved one’s memory and judgment seem to be deteriorating over time, then it might indicate the progressive cognitive decline associated with dementia. In these cases, it’s important to know when to seek professional care for your loved one.

    If, however, your loved one experiences a sudden onset of confusion at home, in the hospital, or after surgery; then it’s important to alert emergency medical professionals right away. Want to learn more about how to help your loved one remain safe and healthy? Please don’t hesitate to contact us today.


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