Delirium is a state of mental confusion and disorganization. Delirium and dementia are different. This state of mental confusion and disorganization is found in older adults when they are experiencing a sudden or acute physical condition, or are recovering from surgery. It is sometimes called acute organic brain syndrome, acute confusional state, or mental fog. These mental conditions come on very suddenly, last a relatively brief period of time, and generally respond to medical treatment. Some of the causes of a delirious condition are infection, fever, post-surgery confusion (following anesthesia), severe drug or alcohol intoxication, and nutritional deficiency.
Signs and Symptoms of Delirium
- Altered state of consciousness, sometimes called a clouded state of consciousness. This means the person is disoriented to the time, the place, and to personal information. The condition has a dream-like quality, and the patient is completely disoriented. Another way to describe this is clouded sensorium.
- Perceptual disturbances. This means the person is misperceiving what he senses around him. It may be in the form of misperceiving what he sees, or what he hears. For example, shadows may be misperceived as animals or ghosts. Loud sounds like a door slamming may be misperceived as a gunshot. These misperceptions are called illusions.
- Hallucinations may also occur in a delirious state. Hallucinations refer to sensations of seeing things (visual), or hearing things (auditory) that are not there. There are also hallucinations of smell (olfactory), taste, and touch (tactile).
- Delusions, or false beliefs, are sometimes present with the delirious patients. These false beliefs are not strong convictions (as compared with the delusional thinking found in paranoia).
- Disturbance in the sleep/wake cycle with delirium, often reversed from the normal cycle. So, the delirious patient is often sleeping during daytime hours, and wide-awake at night.
- Altered attention and high distractibility are also common with this condition. It is very hard to have a conversation with a delirious patient because his attention span is very short, and he is hyper-alert to everything going on around him.
- Speech is illogical and has a fairy-tale like quality. This is sometimes referred to as confabulatory speech, where the person makes up nonsensical stories and explanations.
- There is a breakdown in emotional controls, or disinhibition of emotions. Emotions are intense and rapidly fluctuate from fear to anger, to tearfulness, and so on.
Distinguishing Delirium from Dementia
It is also important to understand the differences between dementia from delirium.
- Delirium has a rapid onset. Dementia progresses very slowly.
- The mental impairment in delirium is much more severe than we see in dementia. Delirious patients are so disoriented, they do not know who they are or where they are. Even though they may be able to carry on a conversation, their disorientation is striking.
- The perceptual disturbances (or, illusions) that we discussed earlier are not present in dementia patients, for the most part.
- Hallucinations can also be present with delirium, but tend to not be so with dementia.
- The disturbed sleep/wake cycle with delirious patients is not prominent in dementia.
- The altered attention and high distractibility commonly seen in delirium is not typical in the patient with dementia.
Closing
This article is referenced our new Publication, Better, Longer & Happier: A Guide to Aging with Purpose and Positivity. In the Guide, Module 08 is focused entirely on gaining a better understanding of depression, dementia, and delirium.