Delirium

Although delirium can occur at any age, it is more common in adults over 65. This serious medical condition is characterised by various symptoms, including confusion, disorganised thinking, and emotional changes that typically develop rapidly. This comprehensive guide explores everything patients and caregivers need to know about delirium, from its subtle signs to effective management strategies and prevention techniques.

What is Delirium?

Delirium represents a neurobehavioral syndrome characterised by fluctuating mental status, disorientation, confusion and inappropriate behaviour. Unlike dementia, which develops slowly over the years, delirium appears rapidly (within hours or days), and symptoms often fluctuate throughout the day.

Delirium Types

Neurologists identify three primary types of delirium based on activity levels and symptoms:

• Hyperactive delirium: Involves increased agitation, restlessness and often hallucinations. Patients may appear anxious, combative, or refuse care.
• Hypoactive delirium: The most common yet frequently missed type, marked by unusual drowsiness, lethargy and reduced responsiveness. Patients appear withdrawn or "out of it".
• Mixed delirium: Involves alternating symptoms of both hyperactive and hypoactive states, with patients shifting between restlessness and sluggishness.

Symptoms and Signs of Delirium

The primary symptom of delirium is confusion that typically worsens at night. Patients experience:

• Reduced awareness of surroundings
• Poor thinking skills and memory problems
• Disorientation to time and place
• Speech difficulties or trouble understanding others
• Emotional changes, including anxiety, fear or mood swings
• Hallucinations or delusions
• Sleep-wake cycle disturbances

Causes of Delirium

Common causes include:

• Medications or medication side effects
• Infections (particularly UTIs or pneumonia)
• Surgery and anaesthesia
• Metabolic imbalances like abnormal sodium or glucose levels
• Alcohol or drug use/withdrawal
• Oxygen deprivation
• Pain, constipation or urinary retention

Risks of Delirium

Several factors increase vulnerability to developing delirium:

• Advanced age (especially over 65)
• Pre-existing dementia or cognitive impairment
• Severe medical illness
• Multiple chronic conditions
• Sensory impairments (vision/hearing)
• Previous delirium episodes
• Frailty and malnutrition
• Polypharmacy

Complications of Delirium

Without proper recognition and management, delirium can lead to serious complications:

• Increased mortality 
• More extended hospital stays (2-3 additional days after surgery)
• Falls and injuries
• Aspiration pneumonia
• Pressure ulcers
• Malnutrition
• Long-term cognitive impairment and functional decline

Delirium Diagnosis

Doctors diagnose delirium condition through a combination of medical history, physical examination, and mental status assessment. The diagnostic process often involves:

• Blood tests to check for infection, electrolyte imbalances, and organ function
• Urinalysis to detect urinary tract infections
• Brain imaging (CT or MRI) when neurological causes are suspected
• Electroencephalogram (EEG) to assess brain wave patterns
• Medication review to identify potentially contributing drugs
• Some research suggests the calcium-binding protein S-100 B could potentially serve as a marker for delirium.

Treatments for Delirium

Treatment starts with addressing underlying causes while creating an optimal healing environment. Effective treatments include:

• Management of infections, metabolic disorders, or other identified causes
• Adjusting the dosage of medications that cause delirium
• Have proper hydration, nutrition, and sleep patterns
• Supporting mobility while ensuring patient safety
• Providing orientation through clocks, calendars, and familiar objects

When to See a Doctor

Family members or carers should seek medical attention if they notice sudden changes in a loved one's thinking, awareness, or behaviour. Furthermore, doctors should promptly evaluate patients in hospital settings who exhibit confusion, disorientation, or abnormal drowsiness.

Prevention

Prevention strategies target risk factors through multicomponent interventions. Effective prevention measures include:

• Regular orientation, along with cognitive stimulation
• Encourage early mobility and physical activity when medically appropriate
• Proper hydration & nutrition
• Establish sleep habits with reduced noise and appropriate lighting
• Effective pain management
• Using visual and hearing aids when needed
• Minimising unnecessary medications and avoiding physical restraints

Conclusion

If you ask for the most potent way to manage delirium, the answer will be early recognition. Doctors now use validated tools like the Confusion Assessment Method to identify cases promptly. Additionally, they use comprehensive treatment approaches to address underlying causes. Though medications sometimes help manage symptoms, non-pharmacological interventions form the cornerstone of proper care.

FAQs

1. Can you fully recover from delirium?

Recovery from delirium varies significantly between individuals. Most patients recover within days or weeks, depending on their underlying health status and the severity of the onset. In some cases, patients may continue to experience issues for months after the initial episode. Generally, those with good health beforehand have better recovery outcomes compared to those managing chronic or terminal illnesses.

2. How to prevent delirium?

Prevention stands as the most effective approach to managing delirium.

• Ensure proper hydration and nutrition
• Promote good sleep habits and regular sleep-wake cycles
• Use glasses, hearing aids and other sensory supports
• Keep familiar objects, photos, and calendars visible for orientation
• Maintain a calm environment with natural lighting during the day and darkness at night

3. Is there a blood test for delirium?

Delirium cannot be diagnosed through a single blood test. Instead, diagnosis relies primarily on clinical assessment using specialised screening tools such as the Confusion Assessment Method (CAM).

• Laboratory tests help identify underlying causes rather than diagnosing delirium itself.
• Common tests include complete blood count, electrolytes, glucose, liver and kidney function.
• Urinalysis often helps detect urinary tract infections that frequently trigger delirium.

CARE Medical Team