MEDICAL ENCYCLOPEDIA
NIH MedlinePlus Magazine
Delirium is a condition that features rapidly changing mental states. It causes confusion and changes in behavior. Besides falling in and out of consciousness, there may be problems with
- Attention and awareness
- Thinking and memory
- Emotion
- Muscle control
- Sleeping and waking
Causes of delirium include medications, poisoning, serious illnesses or infections, and severe pain. It can also be part of some mental illnesses or dementia.
Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse, and can last for hours or weeks. On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable, and may last for months or years.
Delirium tremens is a serious type of alcohol withdrawal syndrome. It usually happens to people who stop drinking after years of alcohol abuse.
People with delirium often, though not always, make a full recovery after their underlying illness is treated.
- Delirium (Merck & Co., Inc.)
- Delirium (Beyond the Basics) (UpToDate)
- Delirium (PDQ)
(National Cancer Institute)Available in Spanish - JAMA Patient Page: Delirium (American Medical Association) - PDF
- Delirium in Older Surgical Patients Threatens Recovery (09/09/2015, HealthDay)
- ClinicalTrials.gov: Delirium (National Institutes of Health)
- Find a Neurologist (American Academy of Neurology)
- National Institute of Neurological Disorders and Stroke Available in Spanish
- Delirium: Unique to Older Adults (AGS Foundation for Health in Aging)
- What to Ask: Delirium (AGS Foundation for Health in Aging)
- Delirium Available in Spanish
- Delirium tremens Available in Spanish
NIH MedlinePlus recently spoke with Marie A. Bernard, MD, Deputy Director of the National Institute on Aging and a recognized expert on delirium.
How is delirium distinguished from dementia?
Delirium is an acute change in cognitive function, primarily characterized by confusion and which may wax and wane—whereas dementia is a progressive decline in cognitive function that occurs over months and years.
Does delirium affect older Americans more often than their younger counterparts? Why?
It does. It appears to be that because older adults have more in the way of chronic conditions, hospitalizations, and medications, older adults tend to get delirium more often than younger adults—although younger adults are subject to developing delirium as well.
Some people affected by delirium experience its effects for weeks after the first occurrence. Why is this?
That's part of the mystery of the syndrome. We don't fully understand what's happening in the basic neuroscience of delirium. It's part of what our scientists are interested in figuring out.
Delirium often affects patients in a hospitalization situation, particularly where a patient has been heavily sedated. What is the connection between sedation, hospitalization, and delirium?
Again, we're not totally clear on what the neurological underpinnings of delirium are. There are some basic changes in the neurotransmitters that occur—changes to the serotonin system, changes to the cholinergic system. Neuroinflammation has been proposed as a possible mechanism for vulnerability to delirium. However, we have not yet established if neuroinflammation is a pre-existing state that makes one vulnerable to delirium in the presence of sedative medications and anesthesia, or if neuroinflammation may be a consequence of sedative effects on the aging brain. In the hospital, you get lots of different medications that can interact and affect the brain, and you're also off your normal schedule—frequently awakened, for example, for blood pressure readings and other needs, and that lack of sleep can contribute to delirium. Additionally, when in the hospital, patients are often on multiple medications that can potentially interact or have a direct effect on cognition. Put all those factors together and it puts one at particular risk for developing delirium.
Why is it important that we diagnose delirium and treat it more effectively?
What's been found is that delirium is a very common occurrence—a third or more of older adults in the hospital experience delirium. The challenge is that delirium can be a waxing and waning sort of thing, so that the same patient can be fine one hour and behaving erratically in the next. Whether it's a delirium episode that's difficult to manage or one where the patient is quiet, it's an issue. Delirium is linked to longer hospital stays, complications, and higher mortality.
NIA is supporting research into delirium. What do we hope to learn from this research?
We want to get a much better understanding of its underlying cause. If we can figure that out, then we'll be much more effective in treating it and preventing it. We don't have truly good means of treating it once it's developed. Through our research, we hope to get a better handle on all of those things.
Can hospitalization delirium be prevented? What should we be doing to address the problem of delirium in the hospital setting?
We simply need to be aware that it's a risk, so we need to do a baseline assessment of a patient's cognitive status. We need to try to maintain as normal a schedule as possible—interruptions during the night do not help. We also want to keep people in the hospital as short a time as possible. We need to keep them well hydrated while they're in the hospital, limit interacting medications and particularly sedatives and other centrally acting medications, and we need to make sure that glasses and hearing aids are accessible.
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