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» Conditions » Alzheimer's and Dementia » Dementia » Featured Columns
What is Delirium?
Delirium is a rapid change in a person's mental state, including their perception of the world, attention span, alertness, speech, memory, and other brain functions. Delirium can arise from virtually any medical illness or medication, although frequently a specific cause is not identified. Delirium may be diagnosed when someone becomes extremely disoriented and their thinking becomes very confused. The person may seem "out of it" or unable to understand what's going on around them. The fluctuations of delirium can happen over a minute, or an hour, or a day; the fluctuations begin very quickly and they do not build up over time. Often the symptoms of delirium are the worst at night when there are fewer people around and less things going on. When this is the case, it is often referred to as "sundowning."
The exact occurrence rate of delirium is unknown because it is often overlooked. However, some groups are more susceptible to delirium than others. These groups include:
- The elderly.
- Children.
- Burn patients.
- Those who have undergone major heart surgery.
- Those with previous brain damage (stroke).
- Those with AIDS.
It's important to remember that anyone can develop delirium, especially when exposed to some of its common causes. Delirium usually lasts a few hours or a few days, depending on the person, the cause of delirium, and how quickly they receive treatment. Most patients recover completely from delirium.
Symptoms of Delirium
The symptoms of delirium can start rather suddenly--within a few hours or a few days. There should be fluctuations of the symptoms over an hour or throughout the day. Delirium is usually characterized by:
- Unawareness of surroundings.
- Confusion - they don't know where they are or what they're doing.
- Not knowing the time, date, day, etc.
- Difficulty concentrating.
- Forgetting past events or recent information.
- Incoherent or rambling speech.
- Disorganized thinking.
- Misinterpretations of other's speech.
- Hallucinating.
The combination of any of these symptoms often makes a patient distressed, frustrated or anxious.
Causes of Delirium
Delirium can be caused by a medical condition, a medicine or substance, substance withdrawals, or other unknown factors. Common causes of delirium include:
- Alcohol or drugs in excess.
- Alcohol and drugs in combination.
- Substance withdrawal after long us.
- Brain infection.
- Head injuries.
- Heart surgery.
- High fever.
- Hypoglycemia.
- Lack of blood to the brain.
- Lack of oxygen.
- Liver or kidney disease.
- Mental disorders.
- Multiple medications.
- Steroids.
- Sensory deprivation.
- Unfamiliar environment.
- B-1 vitamin deficiency.
Many medical conditions alone or in combination can cause delirium. The most common sources of delirium in the elderly include infections such as pneumonia and urinary tract infections, conditions that cause hypoxia such as chronic obstructive pulmonary disease or congestive heart failure, and toxicity or withdrawal from medications with central nervous system effects. Delirium may be the presenting feature of an intracranial process such as meningitis, malignancy (primary or metastatic), seizure, stroke, or subdural hematoma.
Treatment of Delirium
To treat delirium, the underlying cause must be found, then treated. This may involve many different specialists, different tests, and a review of medical history. In some cases, emergency treatments are necessary, for example, thiamine for high fevers or oxygen for oxygen depravation. While treating the underlying cause, a doctor may also prescribe medications to help the patient sleep at night or to help him or her to stay calm during the day. Medication may be given to reduce anxiety or hallucinations.
While in treatment, the patient must be under continuous supervision to make sure they do not hurt themselves. This may be in the form of one-on-one nursing or video monitoring. The family can help the patient by stimulating them and reorienting them to the present. They can do this by:
- Carefully explaining what is going on around them.
- Reading a newspaper out loud or talking about the radio or the news.
- Bringing a TV into their room.
- Providing calendars and clocks.
- Bringing photographs or cherished objects.
- Making sure there is plenty of light.
With treatment (and depending on the underlying cause), most patients can completely recover from delirium within a few days.
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