Delirium

What is delirium?

Delirium is a medical condition causing a loss of attention, a lack of awareness, and an inability to think clearly. It includes rapid changes in the level of consciousness. Delirium may develop in a matter of hours or over the course of several days. Symptoms may come and go. The key symptom is disorientation and confusion. If a person is panicked, upset, and agitated but knows who they are, where they are, and what is going on around them, they do not have delirium.

People with dementia sometimes have delirium as well. Delirium is different from dementia. Dementia is a permanent state in which the mind no longer works normally. Delirium is usually temporary while dementia is usually long-lasting and never gets better. When a person has delirium as well as dementia, their confusion gets worse but may get better with treatment.

How does it occur?

Experts think delirium is caused by a change in the way the brain is working. Something:

• decreases the supply of oxygen to the brain
• affects the use of oxygen by the brain or
• changes the chemicals in the brain.

Medicines are the most common cause of delirium. Many medicines can cause or contribute to delirium, especially drugs used to treat:

• pain
• mental health problems, including anxiety and depression
• stomach ulcers
• heart problems.

Delirium caused by medicines can be a particular problem for older adults. Older adults may be taking several different drugs, high doses of drugs, or drugs that are harmful when taken together. Also, as you get older, your body does not process drugs as well as it used to. As a result, drugs can stay too long in the body and cause toxicity (poisoning).

Even cold medicines can sometimes cause this serious level of confusion.

Medical illness can lead to delirium. Common causes include conditions that:

• decrease the brain's oxygen supply
• lower blood pressure
• change body chemistry
• cause low or high blood sugar.

Infections in the lungs and bladder or kidneys are common causes of delirium. Sometimes it is caused by a physical change in the brain, which can happen, for example, from a stroke or tumor.

Pain can contribute to delirium.

Alcohol use and withdrawal can cause delirium. Delirium tremens (DTs) is probably the best known form of this condition. DTs can happen to a long-time heavy drinker who suddenly stops drinking. He or she may have tremors, seizures, and hallucinations (seeing or hearing things that are not there).

People who have a heavy drinking habit may be afraid to stop drinking because they fear having DTs. These people should see their healthcare provider. There are several ways to stop drinking heavily and keep from having DTs.

Delirium can also result from mental factors such as depression or grief, or major mental illness, such as schizophrenia. Often, the diagnostic term used is "psychosis" rather than delirium. Both terms mean that someone has lost their orientation to present-day reality.

Delirium is very common among people who are in the hospital, especially if they are in the critical care unit (CCU) or intensive care unit (ICU). There may be no windows and no day and night routines in the ICU to help keep patients oriented.

Delirium is a serious problem for older adults in the hospital. For many frail older adults, just having surgery is a risk factor for delirium. Delirium is also common after a move into a new environment.

What are the symptoms?

The key symptom of delirium is disorientation (not knowing the time, date, where you are, or who you are). Other symptoms of delirium may include:

• agitation alternating with times of sleepiness
• mood swings (depression and fear are common)
• memory problems
• trouble concentrating
• trouble following directions
• sleep problems, including not being able to sleep at night and being sleepy during the day
• seeing or hearing things that are not there
• rambling speech

Poor vision and hearing do not cause delirium, but someone who doesn't hear or see well is more likely to get disoriented. This is especially true when they are in surroundings that are strange to them. If a confused person is aware of their surroundings but says that they don't know where they are or how to get around, they may be disoriented but they do not have delirium. However, a disoriented person can panic and develop delirium.

How is it diagnosed?

A diagnosis of delirium can be determined from talking to the person. They will show disorientation and several of the symptoms listed above.

The next key question is what might be causing the delirium. To find the cause of delirium, the healthcare provider will:

• ask about medical history, including medicines being taken
• check with family, friends and hospital staff to see if something said by the person is true or if it was imagined because they are delirious
• do a physical exam
• order blood and urine tests.

Your provider may also order X-rays or special scans.

How is it treated?

Delirium is an emergency. Keep calm and try to protect someone who is delirious from harm. If you cannot reach your healthcare provider right away, get emergency medical care. The causes must be found and treated. Even with proper treatment, delirium may not go away quickly. Sometimes people need to stay in the hospital where they can be watched closely until the confusion has cleared.

Treatment may include:

• help with personal care and meals for a time
• supportive care and, when needed, medicine for agitation and unruly behavior
• calm and quiet surroundings without background noise from TVs, radios, or distant conversation
• support from family, friends, doctors, and nurses to help calm the person and help the person to get his or her bearings
• glasses or hearing aids to lessen the feeling of isolation if the person has poor hearing or eyesight.

Physical restraints should be used with great caution. They may make the person more upset and can lead to falls and injuries. Very rarely, restraints may be needed to prevent the person from removing an IV or tube. When possible, a family member or friend can sit with the person so that restraints will not be needed.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File neur3408.htm Release 13/2010