Incorrect diagnosis of elder confusion can lead to longer hospital stays, missed opportunities for treatment, unnecessary medications potentially exacerbating memory problems, and poorer quality of life for the elderly. Understanding the differences between delirium and dementia is essential for proper elder care.
Elderly Delirium
Delirium is generally caused by an underlying condition. When you treat the problem, cognitive function improves. Delirium is characterized by a sudden onset of confusion. Even if confusion has become chronic due to a neglected illness, family and caregivers will recall cognitive function rapidly diminishing. Symptoms include drowsiness or agitation, variable short-term memory, inattention, disorganized thought processes, and hallucinations in the most severe cases.
Simple conditions like untreated urinary tract infection (UTI), urinary retention, constipation, colds, and under-managed pain can cause delirium. More serious causes include a variety of vascular conditions such as myocardial infarction, pulmonary embolism, and cerebral ischemia. Drug interactions and side effects are oft-missed causes of elder dementia. Be sure to report any changes in cognitive functioning and personality that emerge after starting a new medication.
With treatment of the physical condition underlying delirium, cognitive function should return to previous levels. A possible exception is cerebral ischemia, a reduction in blood flow resulting in brain tissue degeneration. A lack of prompt, appropriate treatment can lead to a stroke and multi-infarct dementia, a permanent reduction of cognitive function.
Elderly Dementia
Dementia results from a variety of progressive, untreatable diseases. Alzheimer’s disease, frontal lobe atrophy, Lewy body dementia, and multi-infarct (stroke related) dementia are common causes of elderly senility. These neurodegenerative diseases are irreversible. Dementia symptoms include short-term memory loss, difficulty performing simple tasks, and language impairment. Caregivers may also notice personality changes and aggression.
Dementia and Delirium Screening
A brief physician exam and health history can determine whether an elderly patient is suffering from dementia or delirium. According to the June 2008 article “Distinguish Delirium From Dementia With Brief Exams” by Michele Sullivan appearing in ACEP News, a publication of the American College of Emergency Physicians, two screening methods are useful for accurate diagnosis.
The Confusion Assessment Method (CAM) has a sensitivity of 95-100% for diagnosing delirium. CAM uses family and caregiver provided health histories to assess symptoms of inattention, disorganized thinking, and altered consciousness, along with sudden onset. Delirium diagnosis is conditional on acute onset of symptoms and an inability to pay attention.
The Mini-Mental State Exam (MMSE) helps identify cognitive symptoms more indicative of progressive, degenerative mental disease. MMSE measures short-term memory, calculation skills, language ability, and orientation. Out of a total possible score of 30, scores of 21-22 indicate minimal impairment, 10-19 demonstrate moderate impairment, and scores below 9 support diagnosis of severe impairment. Sullivan cautions that performance is mediated by education- even with moderate impairment a highly educated patient may score 30.
During the exam, the physician will also use blood tests and urinalysis to determine complete blood count (CBC), electrolytes, liver function, and detect C-reactive protein to detect physical causes of delirium. Additional tests such as a brain CT, electrocardiogram, or chest x-ray may also be required.
Treatment and Supportive Care
Treatment of delirium will depend on the underlying organic cause. Infections may require antibiotic treatment, cardiac issues will need to be addressed, and medications may need to be switched. Proper diagnosis and treatment can be complicated when a patient with early dementia develops symptoms of delirium. Although dementia cannot be cured, depending on the form, there are treatments that may slow further degeneration.
Proper supportive care is essential for an elderly patient suffering from dementia or delirium. Link dementia patients to proper elder care services for long-term supervision. Those suffering from delirium will need adequate follow-up health care to insure physical problems are managed or resolved. In all instances, outcomes are better when patients have constant care, family support, and are surrounded by familiar faces and home comforts.
Carla Marie Boulianne - Background and Interests I am a former feature writer for Parenting a Gifted Child. I relish combining personal parenting and childhood ...
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