Written by Amanda Thornton MSN, BSN, RN, CIC, VA-BC
So often when older adults come into the hospital for any reason, they may become increasingly confused. This can be for a variety of reasons. For example, when an older adult presents to the emergency room with acute confusion, one of the first things any doctor will rule out is infection. New onset of infection (for example a urinary tract infection) almost always presents along with confusion in the older adult, in fact confusion can often be a telltale sign that infection is present in such persons. Does this mean that the person also has dementia? No! Absolutely not! But sadly very often this can be a misdiagnosis for an older adult that truly does NOT have an underlying case of dementia. Also conversely, persons living with dementia very frequently will experience delirium when in the hospital, as they will be more prone to such a condition, however to be clear dementia is NOT delirium, they are two totally different things and should be treated VERY differently as well! Can a person with dementia have delirium? YES! Does the delirium in a person with dementia usually clear up and resolve? Yes to that as well (but it can take longer than a normal person). How can you as an advocate and a caregiver for any older adult help the medical staff trying to take care of your loved one determine if it is truly dementia or delirium? There are some easy tips to follow.
What is Dementia compared to delirium?
Dementia and delirium can have many of the same symptoms such as confusion and memory loss, but the two are vastly different. Dementia is a condition with a slow stable onset with progressive but stable symptoms lasting months to years. Delirium is an ACUTE condition and has an abrupt sudden onset with fluctuating unstable symptoms throughout the day that can last days to weeks at a time before recovery.
The root cause of dementia is a medical diagnosis such as Alzheimer’s, or other type of dementia, whereas delirium is usually caused by non-dementia related diagnosis, such as drug interactions or overdose, sudden onset of infections, or post op complication to an anesthetic, or sometimes hospital related psychosis (“ICU-psychosis”). The other big differences in delirium and dementia is that delirium is usually reversible (whereas dementia is not), and there are often times changes on the EEG (heart rhythms) with delirium but not with dementia. Also it is very often seen that patients experiencing delirium will have hallucinations but patients with dementia do not.
When looking at a patient with dementia who suddenly also develops delirium, how can you help the medical worker tell the difference? This is where the caregiver is an invaluable resource as they know the person best, and can provide a “baseline” of the persons day to day level of cognition and other functions. If a person with dementia has a sudden acute increase from their baseline of confusion along with an observable change in consciousness (less “alert and oriented” then usual) this is likely delirium. The dementia patient most often knows at least the general time of day such as day or night, the patient with acute delirium is not likely to know anything related to person, place, time or location.
Fortunately, in the medical world there are actually assessment tools which can help the doctor or the nurse to determine if the issue is dementia or delirium. A tool called the “CAM” or “Confusion assessment method instrument” is one way to do this. The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately. The CAM includes four features found to have the greatest ability to distinguish delirium from other types of cognitive impairment. There is also a CAM-ICU version for use with non-verbal mechanically ventilated patients.
Should you ask and advocate for the CAM or other assessment tool to be used on your loved one? Absolutely! Early diagnosis and proper treatment of delirium with the right medications can vastly improve patient outcomes. Always ask! Medications for acute delirium are very different than for dementia, and should not be confused or combined.
Reference:
Lyons D, Grimley S, Sydnor L. Double trouble: when delirium complicates dementia. Nursing. 2008;28(9):48-54
Bond S. Delirium at home: Strategies for home health clinicians. Home health nurse, 2009;27(1):24-34
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