Diagnostic Considerations

Dementia

AIDS-related complex

Psychosis

Dementia is one of the most important risk factors for delirium. It often coexists in patients who are hospitalized. Delirium may be a risk factor or marker for the development of dementia. The safest rule is to consider delirium when recent changes in an elderly patient's level of consciousness and cognition have occurred in an acute care setting.

Patients with hypoactive withdrawn delirium may be misdiagnosed as depressed. Depressed patients also may have cognitive symptoms, but the patient's level of consciousness is normal.

Delirium may have to be differentiated from psychotic illnesses such as schizophrenia because both have psychotic features. In delirium, the patient often does not have a previous history of serious psychiatric illness. The onset of symptoms of delirium is acute or subacute, the hallucinations predominantly are visual and fluctuate, and the patient has impaired memory and orientation and clouding of consciousness.

Differential Diagnoses

Depression

Workup

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Author

Kannayiram Alagiakrishnan, MD, MBBS, MPH, MHA Professor, Department of Medicine, Division of Geriatric Medicine, University of Alberta Faculty of Medicine and Dentistry, Canada

Kannayiram Alagiakrishnan, MD, MBBS, MPH, MHA is a member of the following medical societies: American College of Physicians, American Geriatrics Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Glen L Xiong, MD Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California, Davis, School of Medicine; Medical Director, Sacramento County Mental Health Treatment Center

Glen L Xiong, MD is a member of the following medical societies: AMDA - The Society for Post-Acute and Long-Term Care Medicine, American College of Physicians, American Psychiatric Association, Central California Psychiatric Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: SafelyYou, Blue Cross Blue Shield<br/>book co-editor for: Wolter Kluwer, American Psychiatric Publishing Inc.

Additional Contributors

Mohammed A Memon, MD Psychiatrist/Geriatric Psychiatrist, Carolina Center for Behavioral Health; Assistant Professor of Psychiatry, Virginia Commonwealth University School of Medicine

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, American Psychiatric Association

Disclosure: Nothing to disclose.

Acknowledgements

Patricia Blanchette, MD Department Chair and Director, Geriatric Medicine Fellowship Program, Professor of Geriatric Medicine, John A Burns School of Medicine, University of Hawaii

Patricia Blanchette, MD is a member of the following medical societies: American College of Physicians, American Geriatrics Society, American Medical Association, American Medical Directors Association, Gerontological Society of America, and Hawaii Medical Association

Disclosure: Nothing to disclose.

Sections Delirium
Overview
Presentation
- History
- Physical
- Causes
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DDx
Workup
Treatment
Guidelines
Medication
Follow-up
Questions & Answers
Tables
References

Features	Delirium	Dementia
Onset	Acute	Insidious
Course	Fluctuating	Progressive
Duration	Days to weeks	Months to years
Consciousness	Altered	Clear
Attention	Impaired	Normal, except in severe dementia
Psychomotor changes	Increased or decreased	Often normal
Reversibility	Usually	Rarely

Delirium Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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