Recognizing and Preventing Delirium in People with Dementia

Ask the Experts by Christine P. Chelladurai, D.O.

Q: My husband has dementia, and we are adjusting to his normal decline. I have also heard about something called delirium that affects dementia patients. What is it and what should I know to look for?

A: Delirium is a brain disorder that causes a worsening state of confusion usually due to one or more inciting factors.  People who have delirium have trouble paying attention, orientation (knowing where they are or what day it is) and fluctuating levels of consciousness (being very sleepy to being very hyperactive or agitated).

It is important to distinguish between the two clinical disorders of Dementia and Delirium as symptoms can be similar.

There are unique characteristics to delirium. Mental status changes in delirium occur quickly over a very short period of time (hours to days) compared to Dementia, where changes are usually gradual and seen over a longer period of time (weeks to months). In delirium, symptoms themselves fluctuate several times and change over the course of several hours.

Although people with dementia may experience some acceleration in their confusion on a daily basis (i.e., Sundowning,) people with dementia do not have drastic improvements in their confusion and disorientation throughout the day. Delirium usually has one or more causes and once addressed and/or treated, the symptoms of delirium improve.

Delirium is caused by the sum of a person's predisposing factors (things we cannot control) and precipitating factors (things we can control to an extent.) Predisposing factors include having dementia, advanced age, poor nutritional status, experiencing functional impairment (needs help performing tasks such as bathing and toileting) and sensory impairment (difficulty with vision and hearing) and having multiple medical co-morbidities/conditions.

Precipitating factors include infections (pneumonia, urinary tract infections, etc.), dehydration, strokes, heart attacks, constipation, uncontrolled pain, sleep deprivation, urinary retention, post-surgery, being hospitalized, change in environment and medication effects. The more predisposing factors a person has, the fewer precipitating factors are required to cause delirium.

Recognition, evaluation, and management of delirium usually requires a coordinated interdisciplinary effort between family members, physicians, nurses and other health care professionals.

Prevention of delirium is key. Although delirium is reversible to an extent and can be treated, it is extremely important to try to prevent it in the first place. Studies have shown that people who experience delirium have significantly more negative consequences such as longer hospital stay, longer functional recovery, increased rates of nursing home institutionalization, increased medical complications including higher mortality, and worsening cognitive changes even after the delirium is treated.

Preventing some of the precipitating factors by maintaining proper sleep, nutrition, hydration, hygiene, following proper preventative care strategies such as immunization, regular medication reviews, and establishing proper support for patients and caregivers can significantly reduce chances of being hospitalized, infections, medication adverse effects and overall improve a person's quality of life.

Christine P. Chelladurai, DO is a Geriatric Medicine physician at Beaumont Hospital- Grosse Pointe and Royal Oak. She heads the Beaumont Geriatric Evaluation Center and is the Medical Director of ShorePointe Nursing Center in St. Clair Shores, MI. She can be reached at 586-447-8021. Beaumont Hospital is a member of The Family Center's Association of Professionals.

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