Delirium is the commonest cause of sudden onset confusion in the elderly. It is a reaction of the mind or brain to changes in physical condition and is not related to a primary brain disorder. Apart from the confusion the patient is often physically and medically very unwell. Delirium in itself is an independent predictor of death in in-hospital patients and carries a mortality risk of 10%. Therefore, early recognition and treatment of this condition is of prime importance.
The diagnosis of delirium is clinical. The following features may be present:
Neurological signs – e.g. unsteady gait and tremor.
Usually there is a precipitating medical illness for delirium. The common causes include:
The list is not exhaustive and literally any medical illness can precipitate delirium in the elderly.
The symptoms of delirium are often confused with Dementia as they are similar. Delirium is also more common in patients with dementia. However important differences exist between these conditions.
This should be guided by the clinical presentation and the main aim is to identify the underlying cause of the delirium. Typical investigations that can be performed include:
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