Delirium versus Dementia


I have written in the past about the issues seniors face from hospitalization, including delirium.  You can check them out here and here.  This is a problem that we encounter all too often working with elders at Support For Home.  Our goal is to work with the health care professionals to keep elders from being hospitalized, if at all possible, because of the serious dangers from delirium.

So, when I saw an article by Carole Larkin, on ecarediary.com, it got my immediate attention.  Carole cites quite a number of frightening statistics from a presentation by a professor at the University of Texas Southwestern Medical School, some of which I will steal with pride and report here 🙂 .

Please understand, some of my best friends work in a hospital.  🙂 We would be in bad shape without them! For seniors, however, they are not always the best solution to health care.

This Way to Re-admissions!

This Way to Re-admissions!

But first, what exactly is delirium and why are we contrasting it with dementia? Primarily, the issue is that both involve cognitive impairment.  A good article on the syndrome of delirium can be found in Wikipedia, which reads, in part,

It is typified by fluctuating course, attentional deficits and generalized severe disorganization of behavior.  It typically involves other cognitive deficits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake cycle, and psychotic features such as hallucinations and delusions.

In other words, from a symptoms point of view, it is not that hard to confuse dementia and delirium.  However, rather than being a disease, as are various forms of dementia, delirium is a syndrome or a set of symptoms,

which result from an underlying disease, from medications administered during treatment of that disease in a critical phase, from a new problem with mentation or from varying combinations of two or more of these factors.

Delirium is something that is triggered by a set of circumstances or events, rather than being a disease.  Additionally, delirium is a condition which is normally transitory, rather than permanent, as are most forms of dementia.

So, with that bit of introduction, lets look at some of the statistics from the medical school presentation that Carole has shared:

  • 25 percent of persons with delirium still have it one month after leaving the hospital
  • 18 percent still had delirium 6 months after leaving the hospital
  • 20% – 30% of people with delirium suffer from the hyperactive type, suffering from, for example, hallucinations or serious agitation
  • About 25% suffer from hypoactive delirium, which may look like depression
  • Over 40% of sufferers will have a mixed, alternating type, which is even harder to understand or address for caregivers – clinical, family or non-clinical
  • Nursing home folks over 75 who are brought to the hospital have delirium at the rate of about 60 percent
  • “Physicians directly involved in the patient’s care miss diagnosing the delirium between 33 and 67 percent of the time”

I hope this set of excerpts serves to lead you to a full reading of Carole’s article.  It is one of the best I have seen on this very important topic.

Best wishes.  Bert

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