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Symptoms
By Mayo Clinic staffSigns and symptoms of delirium usually appear in a short period of time, from a few hours to a few days. The symptoms often fluctuate throughout the day. Therefore, a person may have periods of no symptoms. The primary signs and symptoms of delirium include the following factors.
Reduced awareness of the environment
This may result in:
- An inability to stay focused on a topic
- Wandering attention
- Getting stuck on an idea rather than responding to questions or conversation
- Being easily distracted by unimportant things
Cognitive impairment, or poor thinking skills
This may appear as:
- Poor memory, particularly of recent events
- Disorientation, or not knowing where one is, who one is or what time of day it is
- Difficulty speaking or recalling words
- Rambling or nonsense speech
- Difficulty understanding speech
- Difficulty reading or writing
Other common symptoms
- Seeing things that don't exist (hallucinations)
- Agitation, irritability or combative behavior
- Little or no activity or little response to the environment
- Disturbed sleep habits
- Extreme emotions, such as fear, anxiety, anger or depression
Delirium and dementia
Other medical conditions can result in symptoms associated with delirium. Dementia and delirium may be particularly difficult to distinguish, and a person may have dementia and delirium. In fact, the majority of cases of delirium occur in people with dementia.
Dementia is the progressive decline of memory and other thinking skills due to the gradual dysfunction and loss of brain cells. The most common cause of dementia is Alzheimer's disease.
Some common distinguishing differences between the symptoms of delirium and dementia include the following:
- Onset. The onset of delirium occurs within a short time while dementia usually begins with relatively minor symptoms that gradually worsen over time.
- Attention. The inability to stay focused or maintain attention is significantly impaired with delirium. A person in the early stages of dementia remains generally alert.
- Fluctuation. The appearance of delirium symptoms can fluctuate significantly and often throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.
One type of dementia called Lewy body dementia is more difficult to distinguish from delirium because hallucinations and fluctuations in symptoms are common to both disorders.
When to see a doctor
If a relative, friend or someone in your care shows any signs or symptoms of delirium, see a doctor. If the person has dementia, be aware of relatively sudden changes in his or her overall awareness and engagement. Your input about the person's symptoms, as well as his or her typical thinking and everyday abilities, will be important for a diagnosis.
Older people recovering in the hospital or living in a long term care facility are particularly vulnerable to delirium. Because symptoms can fluctuate and because some symptoms are "quiet" — such as depression or poor responsiveness — delirium may be missed. If you notice signs and symptoms of delirium in a person in a hospital or nursing home, report your concerns to the nursing staff or doctor rather than assuming that those problems have been observed.
- Delirium. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Dec. 8, 2009.
- Inouye SK. Delirium in older persons. New England Journal of Medicine. 2006;354:1157.
- Gleason OC. Delirium. American Family Physician. 2003;67:1027.
- Saxena S, et al. Delirium in the elderly: A clinical review. Postgraduate Medical Journal. 2009;85:405.
- Francis J, et al. Diagnosis of delirium and confusional states. http://www.uptodate.com/index.html. Accessed Dec. 8, 2009.
- Potter J, et al. The prevention, diagnosis and management of delirium in older people: Concise guidelines. Clinical Medicine. 2006;6:303.
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