If your loved one seems confused or disoriented, you might wonder if they have delirium or dementia. Both conditions can affect someone’s memory, attention or awareness. But what causes them, how they progress and how they are treated are different. So it’s important to understand the differences and how they may overlap.
“It’s a tough topic because delirium can occur on its own, and it can occur in someone who has dementia. Plus, delirium can mimic the symptoms of dementia,” said Helle Brand, a physician assistant with Banner Alzheimer’s Institute. “They can impact people in similar ways mentally, physically and emotionally.”
What is delirium?
Delirium disturbs a person’s mental abilities suddenly (more acutely) and even severely. “It can come on over hours or days,” Brand said. With it, a person might be confused and less aware of what’s happening around them. Delirium can fluctuate, meaning there might be some periods of clarity or more alertness, which can make it difficult to spot.
Typical causes of delirium are:
- Infections like urinary tract infections (UTIs), pneumonia or sepsis
- Medications, especially sedatives, narcotics and those that affect neurotransmitters (chemicals) in the brain
- Dehydration or electrolyte imbalances
- Liver or kidney failure
- Surgery, procedures and/or anesthesia
- Stroke or brain injury
- Changes in surroundings
- Hospitalization
Watch for symptoms of delirium such as:
- Sudden confusion
- Inability to focus or maintain attention
- Disorientation to time or place
- Fluctuations in alertness and awareness
- Hallucinations
- Delusions, which are false beliefs about reality
- Agitation or restlessness
- Poor memory
- Unclear or rambling speech
- Marked changes in behavior or personality
“Delirium can also be subtle, where the person doesn’t seem bothered by the symptoms,” Brand said.
What is dementia?
Dementia is a decline in brain function that interferes with a person’s ability to perform daily tasks they could previously do well, automatically and efficiently. It is associated with a range of symptoms beyond memory loss, including trouble reasoning and problem-solving, increasing difficulty with communicating and changes in coordination.
Some of the causes of dementia are:
- Alzheimer’s disease, where abnormal proteins build up in the brain. This is the most common cause of dementia.
- Vascular dementia is where blood flow to the brain is reduced due to conditions like stroke or disease of the small blood vessels in the brain.
- Lewy body dementia, where abnormal protein deposits in the brain cause fluctuations in thinking, hallucinations and Parkinson’s-like symptoms of slowness and stiffness.
- Frontotemporal dementia, which causes changes in behavior, personality and language and generally affects people under age 65.
- Mixed dementia, which is more than one type of dementia occurring together, often Alzheimer’s disease and vascular dementia.
Common symptoms of dementia include:
- Gradual memory loss, with recent memories affected early on, then older memories as the disease progresses.
- Difficulty with tasks like cooking or managing finances.
- Challenges in problem-solving or planning.
- Confusion or disorientation, especially in unfamiliar places.
- Changes in mood or personality, such as increased irritability, apathy or withdrawal.
- Difficulty communicating, finding the right words or following conversations.
- Problems with judgment or decision-making.
- Withdrawing from social activities or losing interest in hobbies.
- Wandering or getting lost in familiar places.
Dementia symptoms usually get worse slowly, typically over years. In the early stages, a person might have a little trouble remembering or completing complex tasks. As dementia gets worse, symptoms can interfere with daily life and independence.
Differences between delirium and dementia
Delirium and dementia have a lot of similarities. Here are some of the ways you can tell them apart:
- Delirium starts within hours or days. Dementia slowly gets worse over the years.
- Delirium might come and go, with clear periods and times of confusion or disorientation. Dementia symptoms are more stable, gradually worsening. Symptoms could fluctuate in a day based on stress or tiredness.
- People with delirium have a lot of trouble paying attention and being aware of what’s going on. People in the early stages of dementia have small problems with memory or thinking, but they know where they are and can join in conversations. They have more trouble with symptoms as the condition gets worse.
However, delirium and dementia can occur together. “If last week someone was able to dress themselves and this week, they don’t know how to put the clothes on and they’re more confused, we might be looking at dementia having changed and delirium coming on board,” Brand said.
Diagnosing delirium and dementia
To diagnose these conditions, health care providers will ask about the person’s symptoms, medical history, medications and recent changes in health. They will conduct physical exams to look for signs of medical or neurological problems. They may test memory, attention, language and organizational skills.
Treatment options for delirium
“Delirium signals an underlying health problem, and if we can treat what’s causing that, delirium will resolve over days, weeks or months,” Brand said.
Treating delirium may involve:
- Identifying and treating the conditions or factors causing delirium, such as infections, medication side effects or health problems.
- Medication to control symptoms like agitation or hallucinations. However, some medications can make delirium worse.
- Making sure the person is in a calm and familiar place, drinking plenty of water, eating healthy foods and sleeping well. These steps can manage symptoms and help with recovery. Having familiar people with a person who is confused while hospitalized or after surgery or a procedure can be very helpful.
Treatment options for dementia
There’s no cure for dementia, but treatments can help manage symptoms and improve a person’s quality of life. Options include:
- Medications such as cholinesterase inhibitors like donepezil (Aricept) or memantine (Namenda) to manage symptoms and slow the progression.
- Cognitive stimulation programs, memory training exercises and other therapies help maintain function and make it easier to do daily tasks.
- Support, such as preparing meals, providing personal care and helping people get out of the house.
When to seek medical help
If you notice symptoms of delirium or changes in memory and thinking or in mood and personality in a loved one or yourself, seek treatment. With early diagnosis, you can start to manage symptoms and improve outcomes. In the case of dementia, early recognition and diagnosis are also important for connecting with support systems, educational opportunities and community resources, as well as to plan for the future.
Caring for someone with delirium or dementia
It can be tough to care for someone with delirium or dementia. Here are some tips:
- Maintain a consistent routine for meals, activities and rest to help reduce confusion and agitation.
- Include familiar and comfortable objects in your loved one’s surroundings.
- Make sure glasses and hearing aids are used if they are needed.
- Stimulate thinking and socializing with activities like puzzles, music, art or reminiscence therapy. Don’t rely on the TV too much. “Watching TV can feed into confusion,” Brand said.
- Work closely with health care providers to manage symptoms and other health conditions.
- Follow medication schedules and watch for side effects or behavior changes.
- When someone is very confused in their thinking or memory, correcting them, challenging or arguing with them can cause behavioral issues. It is better to simply agree with them (validation), apologize if needed and find a distraction such as music or food to move past a difficult moment.
- Caregivers need to watch for their own physical and emotional well-being to avoid burnout and exhaustion. If you are a caregiver, take part in activities that bring you joy and relaxation. Ask for or accept help from friends, family or support services.
- Consider joining a caregiver support group to get advice, support and a sense of community.
- Connect with home health agencies, respite care programs and memory care facilities for help.
- Review the Alzheimer’s Association’s educational materials and consider joining a caregiver training class or workshop.
The bottom line
Delirium and dementia have similar symptoms, and they could occur at the same time. But delirium comes on quickly in response to a medical condition, while dementia develops slowly. And another health condition usually causes delirium.
When communicating with health professionals, it is important to share what a person with dementia’s usual (baseline) abilities are in thinking, orientation and function so that they can understand any changes if delirium has developed.
If you have questions about delirium and dementia in yourself or a loved one, connect with an expert at Banner Health for answers.
