Is it Dementia. Part 2: Delerium

Delirium is a word we’ve started hearing in the last few years. “It’s delirium, not dementia.”

Well, what does THAT mean? Delirium is a group of symptoms that can include almost any BPSD* as well as mental confusion and autonomic dysfunction—in other words, most LBD* symptoms. The two major differences between it and dementia are that

• It usually starts and builds quickly and
• It is almost always reversible.

Who is most likely to experience delirium? The people most at risk are those who already have dementia, any debilitating illness—and the elderly in general. Any elderly or infirm person recovering from major surgery will often experience a few hours to several months of delirium.

The more of these precursors you have, the more at risk you are—and especially with post-surgery delirium, the longer the symptoms may last. Therefore, an elderly person with dementia is more likely to experience delirium after surgery than someone who is elderly but does not have dementia. Further, if the person already has LBD, or is at risk for LBD, the delirium may turn into true dementia and become permanent.

What besides surgery can trigger delirium? The most common culprits are drugs, usually antipsychotics or anticholinergics. (See the 2013 July and August blogs about drugs and LBD.) Other triggers include dehydration, alcohol and stress.

What can you do to prevent delirium?

• Maintain hydration.
• Use non-drug methods for behavior management whenever possible.
• Work closely with the doctor so that any drugs are started out very low and stopped at the first sign of abnormal behavior or increased symptoms.
• Start new drugs in very small doses, monitor carefully and stop with the sudden advent of dementia-like symptoms.
• Review drugs with doctor regularly. Check for new drug sensitivities that can develop as the dementia progresses, or for drugs no longer needed.
• Monitor alcohol use very carefully. The amount tolerated will depend on the person, but seldom more than a very small amount per day.
• Chose non-surgery solutions whenever possible. Even milder, non-inhaled anesthetics can lead to some delirium. 

What can you do to stop the delirium once it is present?

• Look for an underlying cause, the trigger. Has a new drug been prescribed? Has the person become sensitive to a previously “safe” drug? Is the person getting enough fluids? Are they stressed more than usual?
• Correct the underlying cause, and usually the delirium will go away. It may not if the person is very frail, or has severe dementia. It can also sometimes improve but the dementia symptoms will be worse than they were before the delirium episode.

Reference: Knott L. (2015) Delirium. Patient, Professional Reference.
http://patient.info/doctor/delirium-pro

* Acronyms:
LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.