Diagnosis and Treatment

If delirium is suspected, it is a medical emergency, and a healthcare provider should be contacted immediately to find and treat the underlying cause. 

  • Diagnosis: Doctors rely on medical history, physical exams, and mental status tests (like the 4AT test) to identify the sudden changes in mental function. Lab tests and imaging may also be used to find the cause.

  • Treatment: The primary goal is to address the underlying cause (e.g., treating an infection, adjusting medications, ensuring hydration).

  • Supportive Care: Creating a calm and well-lit environment, ensuring the person has their glasses and hearing aids, and having family members present can help manage symptoms and reorient the individual. 

While many people recover fully, especially if the cause is identified quickly, delirium can lead to longer hospital stays, increased risk of falls, and long-term cognitive decline, particularly in vulnerable patients. 

Recovering from delirium takes time. It can take weeks or months for you to think, speak, and feel physically like your old self. Sometimes, certain changes may be permanent. The course of recovery is different for everyone.

To reduce the chance of delirium coming back, follow your treatment plan carefully to address underlying causes. Do your best to avoid stress and maintain health-promoting habits, such as eating well, drinking lots of water, and getting quality sleep.

Delirium can often Trusted Source go unrecognized. If you notice a changed mental state or level of alertness in yourself or your loved one, it’s important to talk with a doctor. Sudden changes may be a sign of a medical emergency.


Delirium

Delirium is a sudden change in mental status that affects attention, awareness, and thinking, often indicating an underlying medical condition. It is a serious but often temporary and treatable syndrome, not a disease itself. 

Key Characteristics

Symptoms of delirium typically develop over a few hours or days and tend to fluctuate throughout the day, often worsening at night (known as sundowning). 

  • Changes in alertness: May swing between being restless and agitated (hyperactive) or being sluggish and withdrawn (hypoactive).

  • Confusion and disorientation: Trouble knowing the time, date, or where they are.

  • Memory problems: Difficulty with short-term memory and recalling recent events.

  • Disorganized thinking: Speech may be rambling, make little sense, or be difficult to follow.

  • Perceptual disturbances: May experience hallucinations (seeing or hearing things that are not there) or delusions (false, unfounded beliefs).

  • Emotional changes: Includes anxiety, anger, depression, irritability, or fear. 

Causes and Risk Factors

Delirium can be triggered by a wide range of factors, which stress the brain's function. Common causes include: 

  • Infections: Such as urinary tract infections (UTIs), pneumonia, or flu.

  • Medications: Side effects from certain medicines (e.g., sedatives, opioids) or withdrawal from alcohol or drugs.

  • Dehydration and electrolyte imbalances: Problems with body chemistry.

  • Surgery and anesthesia: A common cause in older adults post-operation.

  • Severe pain or sleep deprivation: Physical and environmental stressors.

  • Underlying medical conditions: Organ failure (kidney or liver), stroke, or severe illness. 

Older adults, especially those with pre-existing dementia or multiple health conditions, are at the highest risk. 

Types of delirium

Delirium is categorized by its cause and characteristics.

Hypoactive delirium

People with hypoactive delirium may be:

  • unusually drowsy or sleepy

  • unable to focus or pay attention

  • quiet and withdrawn

  • slower than usual when moving their body

Hyperactive delirium

People with hyperactive delirium may:

  • appear agitated or anxious

  • speak fast or loud

  • become restless, or unable to sit still

  • respond negatively or aggresively to caregivers

  • seem watchful or paranoid

Who’s at risk for delirium?

In general, older adults with multiple health conditions are more likely to experience delirium. But it can happen in younger people, too.

Factors that may increase your risk for delirium include: