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SALEM COMMUNITY HOSPITAL... Understanding delirium in contrast to dementia

September 16, 2012
Salem News

Delirium is a common complication of disease or hospitalization in older adults, and may be mistaken for dementia, depression or the aging process. This condition can affect anywhere from 30-40 percent of elderly hospitalized patients.

"Delirium is a sudden, temporary change in brain function that causes confusion, hallucinations and memory problems," explained Family Medicine physician Homer Skinner, D.O. "These changes usually appear suddenly, within a few hours to a few days. People with delirium may be lethargic or agitated, or they may have significant personality or mood changes, such as anger, anxiety or paranoia.

"This condition is most often traced to a disease process outside of the brain that affects the brain, such as an infection or an electrolyte or body chemical imbalance. In a hospital or long-term care setting, delirium can be the result of the use of certain medications, lack of sleep due to strange surroundings, pain, the effects of anesthesia, inactivity or the side effects of a person's underlying health problems. Most often, it is a combination of many of these factors."

"In addition, the symptoms of delirium may occur with varying degrees of intensity," Dr. Skinner continued. "For example, a person may have a mild disability to focus his or her attention when solving complex problems. As delirium becomes more severe, it can disrupt other mental functions and may be so severe that it borders on unconsciousness, as the person becomes unable to perform any meaningful mental processing tasks."


"Delirium is often difficult to diagnose because it may be mistaken for dementia or other medical conditions," Dr. Skinner continued. "Dementia is the progressive decline of brain function that occurs over time and is related to certain diseases, such as Alzheimer's. In dementia, changes in memory and intellect are slowly evident over months or years, compared to the quick onset of delirium. Most types of dementia are considered to be degenerative, which means that they progressively get worse."

Fact Box

Symptoms of Delirium

- Changes in level of awareness, alertness or consciousness

- Extreme personality and emotional changes (agitation, anxiety or depression)

- Disorganized and unclear thinking

- Difficulty speaking or rambling in speech

- Decreased short-term memory and recall

- Changes in sensation and perception

- Altered movement (either slow or hyperactive)

- Disturbed sleep patterns

Unlike the subtle decline of Alzheimer's disease, the confusion of delirium may be sudden and can change frequently during the day. "When someone is experiencing delirium, his or her thinking may become more disorganized and it is difficult to maintain a conversation," he said. "In addition, the person may be extremely alert or easily startled and then change to a state to drowsiness and lethargy. The sign that separates delirium from underlying dementia is inattention. With delirium, the person cannot focus on one idea or task."

According to the American Delirium Society, delirium is unrecognized in 60 percent of people who have it, because it closely imitates the symptoms of other conditions. For example, sudden changes in behavior, such as increased agitation or confusion in the late evening, may be labeled as "sundowning," and dismissed as the natural progression of a person's dementia. However, blood tests, brain imaging and improved evaluation tools can help doctors recognize this condition.

Risks of Delirium

"Older adults, who are recovering in a hospital or other health care facility, are the most susceptible to delirium," Dr. Skinner advised. "Delirium may prolong the length of time a person has to stay in a hospital, increases the risk of transfer from a hospital to a nursing home, doubles the risk of death, and may lead to permanent brain damage. Researchers also suspect that delirium raises the risk of developing dementia."

The treatment of delirium usually depends on how the root cause of their symptoms is managed. "Delirium may resolve simply by stopping or changing a person's medications," he stated. "Most older adults who develop delirium, return to their normal cognitive state within a few weeks of treatment for their condition. During their recovery, they often need extra support and understanding from their healthcare professionals and friends and family."

"Family members can serve as a valuable advocate during their loved one's medical treatment, hospitalization and recovery. Your presence may help keep your loved one calm and oriented. However, if you do note any significant personality or mental health changes, notify a physician. These symptoms may be the first sign of delirium, which can be helpful in alerting healthcare providers to the presence of an infection, medication side effects or other complications. It is important to be alert to the signs of delirium and address them as soon as possible."

Homer Skinner, D.O., is a Family Medicine physician affiliated with Salem Community Hospital's medical staff and PRIMA Healthcare, with offices at 107 Royal Birkdale Drive, Suite A in Columbiana 330- 482-9350.



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