There are several symptoms of delirium, including confusion, disorientation, memory loss, hallucinations, and mood swings. Delirium is a sudden and severe change in mental state that affects a person's attention, awareness, and thinking. Delirium is not a disease, but a sign that an underlying problem needs to be addressed immediately.
Delirium can have many possible causes, such as:
Infections, such as urinary tract infections, pneumonia, or sepsis
Dehydration or electrolyte imbalances
Medications, especially those that affect the brain, such as opioids, sedatives, anticholinergics, or steroids
Alcohol or drug withdrawal or intoxication
Surgery, anesthesia, or trauma
Lack of oxygen, blood flow, or glucose to the brain
Brain disorders, such as stroke, dementia, or seizures
Environmental factors, such as noise, lighting, unfamiliar surroundings, or lack of sleep
The symptoms of delirium usually develop quickly, within hours or days, and often fluctuate throughout the day. They may be worse at night or in dim light. The main symptoms of delirium are:
Reduced awareness of the environment, such as not knowing where one is, who one is, or what time it is
Difficulty focusing or shifting attention, such as being easily distracted or unable to follow a conversation
Impaired thinking and memory, such as having trouble remembering recent events, speaking coherently, or making sense of things
Changes in behavior and emotion, such as being restless, agitated, irritable, depressed, fearful, or euphoric
Changes in sleep patterns, such as sleeping too much or too little, or having a reversed day-night cycle
Hallucinations or illusions, such as seeing, hearing, or feeling things that are not there
There are three main types of delirium, based on the predominant symptoms:
Hyperactive delirium: The person is restless, agitated, nervous, or aggressive. They may have hallucinations or delusions.
Hypoactive delirium: The person is sluggish, drowsy, apathetic, or withdrawn. They may have reduced speech or movement.
Mixed delirium: The person has both hyperactive and hypoactive symptoms, and may switch between them.
Delirium can be hard to diagnose, especially in older adults or people with dementia, who may have chronic cognitive impairment. To diagnose delirium, a doctor will:
Ask about the person’s medical history, medications, and recent events
Perform a physical examination and check for signs of infection, dehydration, or other problems
Do some tests to measure the person’s attention, orientation, memory, and thinking, such as the Confusion Assessment Method (CAM) or the 4 A’s Test (4AT)
Order some blood tests, urine tests, or imaging tests to look for the cause of delirium
The treatment of delirium depends on the cause and the severity of the symptoms. The main goals of treatment are to:
Identify and treat the underlying problem, such as giving antibiotics for an infection, adjusting medications, or correcting dehydration or electrolyte imbalances
Provide supportive care, such as ensuring adequate oxygen, hydration, nutrition, and pain relief
Manage the symptoms, such as using medications to calm agitation, anxiety, or psychosis, or to improve sleep
Prevent complications, such as falls, injuries, or pressure ulcers
Involve the family and caregivers, such as providing education, reassurance, and emotional support
Delirium can be prevented or reduced by addressing the risk factors and modifying the environment. Some of the strategies to prevent delirium are:
Reviewing and optimizing the medications, especially avoiding those that can cause delirium
Monitoring and treating infections, dehydration, or other medical problems
Encouraging mobility and physical activity, as long as it is safe and appropriate
Providing adequate sensory stimulation, such as glasses, hearing aids, or music
Maintaining a regular sleep-wake cycle, such as avoiding naps, limiting caffeine, and using natural or artificial light
Orienting the person to the time, place, and situation, such as using clocks, calendars, or photos
Engaging the person in meaningful activities, such as conversation, games, or hobbies
Communicating clearly and calmly, using simple and familiar words and gestures
Ensuring the person’s comfort and safety, such as keeping the room quiet, clean, and comfortable
Involving the family and caregivers, such as having them visit, stay, or participate in the care
There are many causes and symptoms of delirium, and it can be difficult to diagnose. Delirium is a serious and common mental health condition. It can lead to serious complications and poor outcomes and requires immediate medical attention and treatment. There are ways to reduce or prevent delirium, including addressing the risk factors and altering the environment. Delirium is usually temporary and reversible, but can affect someone’s cognitive abilities and functioning for a long time.
