Dementia versus Delirium: A Checklist of Symptoms

by Emily Carton, Geriatric Social Worker

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Many times in my geriatric practice a child or neighbor will notice that an older person is very forgetful, confused, and disoriented. There is often an assumption that it is just a sign of a dementia such as Alzheimer's and that there is little that can be done. This is not necessarily so. If one is attuned to the differences between a dementia, which is long term and slow progressing, and a delirium, which has a quick onset and can be caused by other medical problems, often the symptoms can be reversed or prevented from creating further medical and mental damage.

More than once in my practice I have been called upon when a older person suddenly is confused, feeling ill, and has a sudden personality change. For several of my fortunate clients, it turned out that a urinary tract infection was the cause of these symptoms or a medication had been causing severe side effects. The key factor is acting quickly and finding the source of the sudden change of mental status. Even if the older person is unaware of the change, is belligerent about seeing a doctor, trust your intuition if you feel that something is not right. Sudden changes can indicate a medical emergency.

Dementia: What is It??

Dementia is an acquired loss of intellectual functioning. It occurs over a long period of time. There are many causes of dementia including Alzheimer's Disease, strokes, longterm alcohol abuse, a reaction to medication, Vitamin B12 deficiency, thyroid disease and depression.

Symptoms and duration of dementia can be months to years. Usually speech remains normal. Generally attention is normal, although the person usually shows signs of difficulty in finding the right words. Recent memory is impaired. The older person's motor abilities remain normal until late in the disease. The individual's mood may be apathetic and there can be a loss of impulse control.

Delirium: How is It Different From Dementia?

Delirium is often caused by a sudden change in mental functioning and/or acute confusion. Emphasis needs to be placed on the word sudden. This condition can be extremely serious and require immediate medical attention to prevent any permanent damage. Some of the hallmark signs of delirium are: a quick onset of symptoms, disorganized thinking, disorientation to time and place, reduced level of attention, drowsiness, increased or decreased psychomotor activity: either apathy which can sometimes be mistaken for depression, or increased agitation. Disturbances in sleep cycle are also a sign.

Delirium can be caused by virtually any medical condition. A urinary tract infection, reaction to drugs, low blood pressure, dehydration, even sensory deprivation for hospitalized patient or with hearing or other impairments that keep them isolated, and alcohol withdrawal are just a few of the many possibilities that can cause this disorder.

Delirium is a true medical emergency. Immediate evaluation and treatment needs to be obtained. The specific cause of the delirium needs to be found, so the person can be treated. Approximately 25 percent of people over the age of 70 who are admitted to a medical hospital have delirium. Those suffering with dementia have a higher risk of developing delirium as well.

Differentiating between dementia, delirium and even depression, which can cause some of the same symptoms can be confusing. It is important not to take any of the symptoms for granted. Seek medical advice as soon as you notice a sudden change in a person's functioning. It can make an enormous difference in the outcome for the future.

5/29/98

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Emily Carton is a geriatric social worker with ElderOptions in the Washington Metropolitan Area. She is also an intern at St. Elizabeth's Hospital studying the use of bibliotherapy in clinical practice.

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