Delirium: Causes, Symptoms and Care

Delirium is a mental state of confusion and disorientation in which a person can't think or remember clearly. It usually starts suddenly, and it is often temporary and treatable.

Three types

• Hypoactive — inactive, seeming sleepy, tired or depressed.
• Hyperactive — restless or agitated.
• Mixed — switching back and forth between the two.

Common causes

• advanced cancer;
• alcohol or drugs, through intoxication or withdrawal — including delirium tremens, a serious alcohol withdrawal syndrome that usually affects people who stop drinking after years of alcohol use disorder;
• dehydration and electrolyte imbalances;
• dementia;
• hospitalization, especially in intensive care;
• infections such as urinary tract infections, pneumonia and flu;
• medicines — side effects of drugs such as sedatives or opioids, or withdrawal after stopping a medicine;
• metabolic disorders;
• organ failure, such as kidney or liver failure;
• poisoning;
• serious illness;
• severe pain;
• sleep deprivation;
• surgery, including reactions to anesthesia.

Who is at risk

• people in a hospital or nursing home;
• people with dementia;
• people with a serious illness or several illnesses;
• people with an infection;
• older people;
• people having surgery;
• people taking medicines that affect the mind or behavior, or high doses of pain medicines such as opioids.

Symptoms

Symptoms usually begin over a few hours or days and often come and go:

• changes in alertness (usually more alert in the morning, less at night) and shifting levels of consciousness;
• confusion;
• disorganized thinking and speech that doesn't make sense;
• disrupted sleep and sleepiness;
• emotional changes — anger, agitation, depression, irritability, overexcitement;
• hallucinations and delusions;
• memory problems, especially short-term;
• trouble concentrating.

Diagnosis — and telling it from dementia

A provider may take a medical history, do physical and neurological exams, test mental status, and order lab and imaging tests.

Delirium and dementia look alike, and a person can have both:

Treatment

The first step is finding the cause; treating it often leads to full recovery, though that can take weeks or even months. Meanwhile, symptoms can be managed by:

• controlling the environment — a quiet, well-lit room, clocks or calendars in view, and family nearby;
• medicines to control aggression or agitation, and pain relievers if needed;
• making sure the person has hearing aids, glasses or other communication aids.

Prevention

Treating conditions that cause delirium may reduce the risk. Hospitals can help by avoiding sedatives, keeping rooms quiet, calm and well-lit, having family around, and, where possible, having the same staff care for the person each day.

Sources

• MedlinePlus, National Library of Medicine: "Delirium."