Expansion
Onset, course, attention and consciousness separate them
Expansion
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Hours to days | Months to years |
| Course | Fluctuating, worse at night | Slowly progressive |
| Consciousness | Impaired | Clear until late |
| Attention | Markedly impaired | Preserved until late |
| Hallucinations | Common, often visual | Less common early |
| Reversibility | Usually reversible | Usually not |
Delirium may be hyperactive (agitated, the type that is recognised), hypoactive (withdrawn, drowsy, the commonest type and the most missed, with the worst prognosis), or mixed. Dementia is also the strongest risk factor for delirium, and the two coexist often.
Causes, using PINCH ME:
- P - Pain
- I - Infection
- N - Nutrition, including thiamine
- C - Constipation
- H - Hydration and hypoxia
- M - Medication, especially anticholinergics, opioids, benzodiazepines, and withdrawal
- E - Environment and electrolytes
Assessment tools: the 4AT is quick and validated (alertness, AMT4, attention via months backwards, acute change or fluctuation). A score of 4 or more suggests delirium.
The management is to treat the cause, orientate, mobilise, restore sleep, remove catheters and lines, and involve family, with sedation reserved for genuine risk.