Causes, Treatment, Types, and Management of Delirium

Symptoms of Delirium

Early recognition of signs of delirium is essential for diagnosis and treatment. Here are some of the major symptoms to be aware of:

• Confusion: A noticeable change in cognitive function, resulting in difficulty thinking clearly and making decisions.
• Disorientation: Difficulty knowing where you are, what time it is, or even who you are.
• Attention Deficit: Difficulty maintaining focus or shifting attention between tasks.
• Memory Problems: Short-term memory issues, such as trouble recalling recent events or conversations.
• Hallucinations: Experiencing sights or sounds that are not present.
• Language Difficulties: Issues with speaking or understanding speech, frequently resulting in nonsensical or slurred speech.
• Restlessness and Agitation: Physical restlessness, which can include pacing or agitation, and sometimes even aggressive behavior.
• Sleep Disturbances: Changes in sleep patterns, including severe insomnia or daytime drowsiness.
• Mood Swings: Rapid and unpredictable changes in mood, ranging from apathy to depression to euphoria.

Types Of Delirium

Delirium can be categorized into different types based on its causes and characteristics. The primary types of delirium are:

Hyperactive Delirium

This type of delirium is characterized by heightened arousal and increased motor activity. Symptoms include:

• Restlessness and agitation
• Rapid mood swings
• Hallucinations and delusions
• Increased sensitivity to stimuli

Hypoactive Delirium

Hypoactive delirium is often more subtle and can be mistaken for depression. Symptoms include:

• Reduced motor activity
• Drowsiness and lethargy
• Withdrawal and apathy
• Slow or sluggish responses

Mixed Delirium

Mixed delirium consists of the symptoms of both hyperactive and hypoactive delirium. People may alternate between hyperactive and hypoactive states. Symptoms include:

• Alternating between periods of agitation and lethargy
• Unpredictable behavior changes
• Varied levels of awareness and responsiveness

Condition Causes of Delirium

• Infections: Urinary tract infections, pneumonia, sepsis, or flu, especially in older adults.
• Neurological Disorders: Dementia, Parkinson's disease, stroke, brain tumors, or head injuries.
• Organ Failure: Heart failure, liver failure, kidney failure, or severe lung disease.
• Metabolic Imbalances: Low sodium, low calcium, blood sugar extremes, or dehydration.
• Substance-Related Issues: Alcohol or drug intoxication, withdrawal from alcohol, sedatives, or narcotics.
• Medication Side Effects: Reactions to sedatives, anticholinergics, steroids, or certain pain medications.
• Severe Illness or Injury: Serious infections, major surgeries, trauma, or burns.
• Exposure to Toxins: Carbon monoxide poisoning or exposure to harmful chemicals.
• Nutritional Deficiencies: Vitamin B12 deficiency, malnutrition, or prolonged fasting.
• Emotional and Sleep Disturbances: Extreme stress, anxiety, or prolonged sleep deprivation.

A urinary tract infection or pneumonia can lead to delirium in older people. The prognosis varies according to the underlying cause of the disease.

When to Visit a Doctor?

See a doctor immediately if you or someone else suddenly:

• Sees or hears things that others do not see
• Gets confused and doesn't know where they are
• They no longer recognize the people around them

Diagnosis of Delirium

Diagnosing delirium involves assessing the patient's symptoms, medical history, and mental status. Since it can resemble dementia or psychiatric disorders, early and accurate diagnosis is vital.

Key steps include:

• Medical History: Identifying recent surgeries, infections, medication changes, or substance use.
• Physical Examination: Checking for infections, dehydration, or organ dysfunction.
• Cognitive Assessment: Using tools like the Confusion Assessment Method (CAM) to evaluate attention, memory, and thinking.
• Laboratory Tests: Detecting infections, metabolic imbalances, or organ issues.
• Imaging Studies: CT or MRI scans if brain injury or stroke is suspected.
• EEG: Performed if seizures are a concern.
• Medication Review: Identifying drugs that may trigger delirium.

Prompt diagnosis helps address the cause, prevent complications, and promote recovery.

Treatment and Management for Delirium

• Identify and Treat the Cause: Address underlying problems like infections, dehydration, medication side effects, or metabolic imbalances.
• Supportive Care: Maintain proper hydration, nutrition, sleep, and provide a calm, reassuring environment to help brain recovery.
• Medications: Low-dose antipsychotic medicines (such as haloperidol) may be given if the patient is severely agitated, but only under a doctor's supervision.
• Environmental Adjustments:
  • Keep lighting natural during the day and low at night.
  • Use clocks, calendars, and familiar objects to help with orientation.
  • Minimize noise and unnecessary stimulation.
• Reassurance and Supervision: Frequent, calm interactions and the presence of familiar people help reduce fear, anxiety, and confusion.
• Physical Therapy: Gentle movement and exercises help maintain strength and prevent complications from long periods of bed rest.
• Cognitive Stimulation: Encourage simple conversations, memory exercises, familiar music, and daily routines to support brain healing.
• Ongoing Monitoring: Regularly check mental status and vital signs to detect any worsening or improvement early.

Prevention of Delirium

• Manage Chronic Conditions: Control diseases such as diabetes, heart disease, and dementia.
• Review Medications: Regularly check and adjust medications to avoid high-risk drugs like sedatives and anticholinergics.
• Stay Hydrated and Nourished: Maintain good hydration and a balanced diet to prevent imbalances.
• Promote Healthy Sleep: Encourage regular sleep patterns and good sleep hygiene.
• Encourage Mobility: Help patients move soon after surgeries or illnesses to maintain orientation and physical strength.
• Monitor for Early Signs: Notice changes in behavior or confusion, especially during hospital stays.

Lifestyle Changes for Delirium

• Stay Physically Active: Gentle activities like walking boost blood flow and brain health.
• Keep Mentally Engaged: Reading, puzzles, conversations, and hobbies help keep the mind active.
• Routine Health Checkups: Visiting a doctor regularly can help detect signs of illness or side effects of medications.
• Create a Calm Environment: Reduce noise, clutter, and sudden changes to lower confusion risk.
• Use Glasses and Hearing Aids: Support good vision and hearing to improve awareness and prevent disorientation.
• Follow a Daily Routine: Maintaining regular daily habits keeps patients grounded and oriented.

Home Remedies to Support Delirium Recovery

• Orientation Aids: Place clocks, calendars, and family photos where the person can easily see them.
• Good Lighting: Keep rooms naturally lit during the day and dim at night to maintain the body's natural rhythm.
• Encourage Familiarity: Surround the person with familiar objects, scents, and comforting routines.
• Hydration and Light Meals: Provide water and light, nutritious meals frequently to prevent weakness and dehydration.
• Gentle Communication: Speak calmly, make eye contact, and provide reassurance to ease anxiety and confusion.
• Provide Supervision: A familiar presence can help reduce fear and help the person stay oriented and safe.