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Dementia And/Or Delirium

August 27, 2015

By Editor
“I thought this was a normal part of Alzheimer’s” – Glenda, Alzheimer Society client &  caregiver for her husband

One of the greatest misconceptions about old age is that the older you get the more confused you will become. Although your brain does age with the rest of your body, states such as severe confusion are not a part of healthy aging and should be further investigated and treated. Delirium and dementia are two causes of confusion in older adults. Individuals living with dementia are highly susceptible to delirium, yet not all individuals with delirium have dementia. Delirium can easily go unrecognized by caregivers and even by healthcare professionals because many symptoms are shared by the two conditions.
In people with dementia, memory and understanding slowly decline and the changes are evident over months or years. Delirium, on the other hand, occurs more abruptly with sudden confusion emerging over days or weeks. Delirium is often marked by fluctuating levels of disorientation, consciousness, hallucinations, anxiety, memory impairment and altered speech. Some individuals with delirium experience changes in mood including intermittent agitated behaviour, aggression and wandering.

In people with dementia, the confusion of delirium fluctuates throughout the day - often dramatically. These sudden changes in behaviours often get dismissed as the natural progression of one’s dementia trajectory. Delirium overlaid on dementia is less likely to be recognized and treated than is delirium without dementia.
 
 
Unlike dementia, delirium is not caused by changes in brain physiology. Delirium is a temporary condition caused by underlying medical problems, drug toxicity or environmental factors. For individuals without any cognitive impairment, medications are one of the leading cause of delirium. Failure to take medication, drug interactions and characteristics of the drug itself can all cause delirium in the elderly (both cognitively stable elders and those with dementia). Underlying medical conditions such as bladder infections and pneumonia can also contribute to delirium.
If you suspect your loved one has delirium, it is vitally important to tell your doctor. Delirium may be the first and perhaps only clue of medical illness or adverse medication reaction in individuals with dementia. Individuals may completely improve from delirium if the underlying problem is identified and treated. However, failure to treat delirium can lead to long-term functional decline that may result in poor health or even fatal outcomes.
This past June, the Alzheimer Society London and Middlesex featured a panel discussion on delirium, as part of our Speaker Series. This presentation highlighted Geriatrician, Dr. Monidipa Dasgupta  as well as two caregivers who shared their experience their loved ones had with delirium. You can see the archived webcast on our website: http://www.alzheimerlondon.ca/public-education-programs/public-education-speakers-series.