Seniors: Delirium – the great mimicker

One of my relatives was diagnosed with early dementia recently. This was unexpected because I had chatted with the person only a few days before, and she sounded perfectly healthy. When I heard about her symptoms, I asked the family to get her urine tested and her diagnosis was changed to delirium caused by urinary tract infection.

There are several conditions that closely mimic dementia. One such great mimicker is delirium. Delirium is a sudden change in a person’s mental abilities that results in confused thinking and reduced awareness of their environment.

Delirium is often misdiagnosed as dementia or depression, and sometimes not even detected. While 95% of dementia is incurable, delirium is a condition that can be completely reversed and even prevented.

Delirium is quite common in older adults. It is believed that up to 75% of older adults experience delirium after an illness such as infection or surgery.

Knowing the signs and symptoms can help us identify the condition and seek prompt medical care. One unique feature of delirium is that the signs and symptoms appear suddenly and often fluctuate throughout the day, with periods of time when the person has no symptoms.

What are the common signs and symptoms of delirium? A delirious person can appear confused, forgetful, disoriented – unable to recognize people and/or surroundings, easily distractible, and unable to think and communicate clearly. The person could have rapid and unpredictable mood changes, changes in sleep habits, and have hallucinations (seeing or hearing things that do not exist).

In hyperactive delirium the person is restless, agitated, and hyperactive. These prominent symptoms facilitate an earlier diagnosis. Alternatively, the person could be in hypoactive delirium – where he /she is predominantly drowsy, inactive and slow to respond. Hypoactive delirium often gets missed or mistaken for depression or dementia.

What causes delirium? Delirium is often triggered by high fever, or common infections such as urinary tract infection, pneumonia, or flu. It can also be associated with changes in metabolic balance (low sodium etc.), some medications, surgery, or even hospitalization. All these conditions can interfere with normal brain function.

Delirium is a medical emergency and needs prompt attention. When treated, the person usually recovers completely in a couple of weeks to a couple of months.

Left untreated, it can lead to reduced functional ability, onset of dementia, and cause significant distress to the person and family necessitating early admission to long-term care, decreased quality of life and increased care costs.

There are some predisposing factors that increase a person’s risk of developing delirium. These include advanced age, dehydration, malnutrition, constipation, urinary retention, dementia, and being on multiple medications. Having vision and hearing impairment and a history of substance use can also increase an older person’s risk of delirium.

Is there something we can do to prevent delirium? Yes, there are six proven strategies or actions we can take to prevent delirium.

Keeping the brain active through a variety of stimulating activities every day such as doing puzzles, socializing, reading, listening to music, and engaging in activities or conversations that help us remember what day/month/year it is.

Keep moving- be physically active at least 3 times a day for 10-20 minutes each. Going for a short walk, doing some strength exercises, shoveling the snow etc. are beneficial both for the body and the brain.

Ensuring a good night’s sleep. Being active during the day, avoiding daytime naps, cutting back on caffeine, and doing a relaxing activity such as reading a book, or listening to music, all help to improve sleep.

Ensuring hearing aids and glasses are available at all times, if needed.

Staying hydrated is important for health of our body and brain. Ensure that you are drinking plenty of fluids throughout the day.

Eating nutritious and healthy food every day is helpful. For those with low appetite, eating with others makes mealtimes more enjoyable and effective.

If you see sudden changes in memory, thinking, or personality in your family member, please discuss with the concerned family physician immediately and take appropriate action. Delirium is a medical emergency and can be completely cured.

Padmaja Genesh, who holds a bachelor degree in medicine and surgery as well as a bachelor degree in Gerontology, has spent several years teaching and working with health care agencies. A past resident of Red Deer, and a past board member of Red Deer Golden Circle, she is now a

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