It’s World Delirium Awareness Day!
What is delirium?
Delirium (AKA acute confusional state) is a serious disturbance in mental abilities, resulting in confused thinking and reduced awareness of the environment. It involves a decline in mental functioning that develops over a short period of time, typically hours or days.
The DSM-5 criteria for the diagnosis of delirium include:
- Disturbance in attention and awareness. This involves easy distraction, inability to maintain attentional focus, and varying levels of alertness.
- Onset is acute (from hours to days) – representing a change from the baseline, with fluctuations throughout the day.
- At least one additional cognitive disturbance – in memory, orientation, language, visuospatial ability or perception.
- The disturbances are not better explained by another neurocognitive disorder.
- There is evidence that the disturbances are direct physiological consequences of perhaps another medical condition, substance abuse or withdrawal, toxins, or other combinations of causes.
What causes delirium?
Delirium is caused by an acute organic process, which is a physically identifiable, structural, chemical or functional problem in the brain that can rise from an external disease process. Problems causing delirium may include an underlying disease process (e.g. an infection), side effect of a medication, withdrawal from drugs, over-consumption of alcohol, used of hallucinogenic deliriants or from any number of factors affecting one’s overall health (e.g. pain, malnutrition, etc.).
Although delirium and dementia both affect thinking, they are different conditions. Delirium primarily affects attention, whereas dementia primarily affects memory. Delirium begins suddenly, and often has a definite and identifiable point of origin. Whereas, dementia typically begins gradually and has no definite beginning.
Who is affected by delirium?
Anyone can be affected by delirium. However, predisposing factors include: older age, male sex, cognitive impairment/dementia, physical comorbidity, psychiatric comorbidity, sensory impairment, functional dependence, dehydration/malnutrition, drugs and drug-dependence, alcohol dependence, and more.
Delirium affects 14-24% of all hospitalized individuals. The overall prevalence in the general population is 1-2%, but this increases with age, with 14% of adults over the age of 85 affected by it. Among those requiring critical care, delirium runs the risk of death, the following year.
How is delirium diagnosed?
Delirium can be challenging to diagnose without establishing the person’s usual mental functioning properly. It can be easily confused with a number of psychiatric disorders or chronic organic brain syndromes that cause overlapping signs and symptoms (e.g. dementia, depression, psychosis, etc.). Moreover, delirium may manifest from a baseline of existing mental illness, baseline intellectual disability or dementia, without any of these problems being the true cause.
In younger people, once drugs and alcohol are excluded, the cause of delirium is usually a condition that directly affects the brain, such as a brain infection (e.g. meningitis or encephalitis). In older people, the cause is often a common infection, such as a urinary tract infection, pneumonia or influenza.
Usually, friends, family members or other observers are asked for information about the patient in order to understand the delirium. Important questions may include:
- How the confusion began
- How quickly it progressed
- What the person’s physical and mental health has been like
- What drugs and dietary supplements the person uses
- Whether any drugs have been started or stopped recently
How is delirium treated?
Delirium is usually reversible. Effective treatment involves identifying, managing and treating its underlying causes. Additionally, managing delirium symptoms and reducing the risk of complications is key. This would require patient physiology and conditions for brain recovery to be optimized, by focusing on oxygenation, hydration, nutrition, pain control, and addressing other factors that might disrupt brain function.
Can delirium be prevented?
At least 30-40% of all bases of delirium can be prevented. Episodes of delirium can be prevented by identifying the hospitalized people at risk of the condition, and warranting close observations for early signs. People at risk possibly include those over the age of 65, those with a known cognitive impairment or with severe illness.
The PINCH ME method may be a helpful way to identify, prevent and treat delirium. This method involves assessing all of the following to identify whether any issues arise which may result in delirium:
What is the prognosis for delirium?
Most people with delirium fully recover. However, any delay in delirium identification or treatment decreases the chances of full recovery. In some people, delirium evolves into chronic brain dysfunction, a condition similar to dementia.
So, how can we be delirium ready?
You can raise awareness today, for World Delirium Day, by educating yourself on the subject, starting conversations with those around you about delirium, and sharing information on social media using the hashtag #WDAD2021!
Where can I learn more about delirium?
- Check out Dr Shibley Rahman’s blog, where he explains how delirium changed his life, and his mother’s life forever: https://drshibleyrahman.wordpress.com/2021/02/26/world-delirium-awareness-day-2021-wdad2021-theres-something-here-for-everyone/
- Have a listen to the MDTea podcast, where they discuss what delirium is and delirium supportive measures: https://thehearingaidpodcasts.org.uk/episode-1-2-delirium
Featured photo: Muskan Anand on Pexels.
Edited by Malavika Ramanand