Dementia Vs Delirium

Dementia Delirium
Onset Gradual and progressive over months to years. Acute over hours to days.
Typically older adults (70yrs +, with small number Anyone, most commonly children and older adults
in 50s & 60s)
Risk Age, family history, cardiovascular risk factors, past
Age, physical illness, dementia, polypharmacy, alcohol,
Factors head injury hospital admission, head injury (etc etc)
Clinical Memory impairment, disorientation, dyspraxia, Fluctuation in conscious level, often with clear diurnal
Features dysphasia, dyscalculia, social withdrawal, disturbedvariation. Confusion and disorientation. Sleep-wake
behaviour. Less commonly psychotic symptoms cycle disturbance. May have prominent
and affective symptoms/emotional lability. hallucinations/illusions (usually visual) plus delusions
and emotional lability/irritability.
Investigati Usually as outpatient: formal cognitive assessment, Often as inpatient: full physical history and
ons blood tests, neuroimaging, occupational therapy examination, blood tests, MSU, chest Xray,
and social work assessments. neuroimaging. Consider other tests eg lumbar
puncture, EEG etc depending on history.
Manageme Pharmacotherapy: treat vascular risk factors, Pharmacotherapy: treat underlying cause. Sedation
nt consider AChEIs. has limited role.
Psychological Rx: cognitive stimulation therapy, Psychological Rx: psycho education for patient and
psychoeducation including carer/family. carers (incl staff)
Social: encourage activity, including day care.
Home support (eg social work, meals on wheels Social: Good nursing care is central, including
etc), consider more supported environment if consistent staff, well lit side room, orientation aids eg
safety concerns. Consider guardianship or Power calendar, clock, name badges. Good food and fluid
of Attorney. CPN input including carer support and intake. Regular review of medications and underlying
advice about non pharmacological management of illnesses.
behavioural problems.
Prognosis Chronic progressive illnesses. Typically 2-10 years Delirium worsens prognosis of underlying illness –
from diagnosis depending on underlying pathology. increases mortality and chronic morbidity rates.
Medication does not currently alter the duration of Many do not fully recover their premorbid cognitive
illness, although may make some difference to functioning.
early course and symptoms. Many make full recovery if underlying cause adequately
treated.
Increased risk of future delirium.