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Delirium: Causes, Symptoms, Diagnosis, Treatment, and Prevention

There are several symptoms of delirium, including confusion, disorientation, memory loss, hallucinations, and mood swings. Delirium is a sudden and severe change in mental state that affects a person's attention, awareness, and thinking. Delirium is not a disease, but a sign that an underlying problem needs to be addressed immediately.

Causes of Delirium

Delirium can have many possible causes, such as:

• Infections, such as urinary tract infections, pneumonia, or sepsis

• Dehydration or electrolyte imbalances

• Medications, especially those that affect the brain, such as opioids, sedatives, anticholinergics, or steroids

• Alcohol or drug withdrawal or intoxication

• Surgery, anesthesia, or trauma

• Lack of oxygen, blood flow, or glucose to the brain

• Brain disorders, such as stroke, dementia, or seizures

• Environmental factors, such as noise, lighting, unfamiliar surroundings, or lack of sleep

Symptoms of Delirium

The symptoms of delirium usually develop quickly, within hours or days, and often fluctuate throughout the day. They may be worse at night or in dim light. The main symptoms of delirium are:

• Reduced awareness of the environment, such as not knowing where one is, who one is, or what time it is

• Difficulty focusing or shifting attention, such as being easily distracted or unable to follow a conversation

• Impaired thinking and memory, such as having trouble remembering recent events, speaking coherently, or making sense of things

• Changes in behavior and emotion, such as being restless, agitated, irritable, depressed, fearful, or euphoric

• Changes in sleep patterns, such as sleeping too much or too little, or having a reversed day-night cycle

• Hallucinations or illusions, such as seeing, hearing, or feeling things that are not there

Types of Delirium

There are three main types of delirium, based on the predominant symptoms:

• Hyperactive delirium: The person is restless, agitated, nervous, or aggressive. They may have hallucinations or delusions.

• Hypoactive delirium: The person is sluggish, drowsy, apathetic, or withdrawn. They may have reduced speech or movement.

• Mixed delirium: The person has both hyperactive and hypoactive symptoms, and may switch between them.

Diagnosis of Delirium

Delirium can be hard to diagnose, especially in older adults or people with dementia, who may have chronic cognitive impairment. To diagnose delirium, a doctor will:

• Ask about the person’s medical history, medications, and recent events

• Perform a physical examination and check for signs of infection, dehydration, or other problems

• Do some tests to measure the person’s attention, orientation, memory, and thinking, such as the Confusion Assessment Method (CAM) or the 4 A’s Test (4AT)

• Order some blood tests, urine tests, or imaging tests to look for the cause of delirium

Treatment of Delirium

The treatment of delirium depends on the cause and the severity of the symptoms. The main goals of treatment are to:

• Identify and treat the underlying problem, such as giving antibiotics for an infection, adjusting medications, or correcting dehydration or electrolyte imbalances

• Provide supportive care, such as ensuring adequate oxygen, hydration, nutrition, and pain relief

• Manage the symptoms, such as using medications to calm agitation, anxiety, or psychosis, or to improve sleep

• Prevent complications, such as falls, injuries, or pressure ulcers

• Involve the family and caregivers, such as providing education, reassurance, and emotional support

Prevention of Delirium

Delirium can be prevented or reduced by addressing the risk factors and modifying the environment. Some of the strategies to prevent delirium are:

• Reviewing and optimizing the medications, especially avoiding those that can cause delirium

• Monitoring and treating infections, dehydration, or other medical problems

• Encouraging mobility and physical activity, as long as it is safe and appropriate

• Providing adequate sensory stimulation, such as glasses, hearing aids, or music

• Maintaining a regular sleep-wake cycle, such as avoiding naps, limiting caffeine, and using natural or artificial light

• Orienting the person to the time, place, and situation, such as using clocks, calendars, or photos

• Engaging the person in meaningful activities, such as conversation, games, or hobbies

• Communicating clearly and calmly, using simple and familiar words and gestures

• Ensuring the person’s comfort and safety, such as keeping the room quiet, clean, and comfortable

• Involving the family and caregivers, such as having them visit, stay, or participate in the care

Summary

There are many causes and symptoms of delirium, and it can be difficult to diagnose. Delirium is a serious and common mental health condition. It can lead to serious complications and poor outcomes and requires immediate medical attention and treatment. There are ways to reduce or prevent delirium, including addressing the risk factors and altering the environment. Delirium is usually temporary and reversible, but can affect someone’s cognitive abilities and functioning for a long time.