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It is important to clarify the difference between delirium and dementia,
since they can have some of the same symptoms. Patients with delirium
develop it quickly, become agitated, and can go in and out of
consciousness over time. Memory problems are usually short-term. Dementia
develops more gradually, and effects on memory and consciousness are more
permanent.
There are three types of delirium: hypoactive (lethargic, confusion,
sedation); hyperactive (agitated, delusions, disoriented); and mixed.
More than two thirds of all delirium is hypoactive or mixed.
Features of delirium can include:
- Depression
- Delusions or
hallucinations
- Restlessness, anxiety,
sleep disturbance, irritability
- Altered level of
consciousness or awareness
- Shortened attention span
- Memory problems
- Disorganized thinking
and speech
- Disorientation
- Reversing day and night
- Difficulty writing,
drawing, or finding words
- Personality changes
Diagnosis
To
plan treatment for delirium, doctors may do a physical exam, or take some
blood tests. They will also do a mental exam, using tests that check
motor skills, memory, and attention level.
Causes
Finding the cause of delirium is often important, in case it
can be treated or reversed. The direct causes of delirium are usually a
brain tumor or cancer that started somewhere else and has spread to the
brain. Other causes:
- Brain tumor or other
cancer spread to the brain
- Medicine
- Withdrawal from medicine
- Electrolyte imbalance
- Organ failure
- Infection
- Other brain disorders
- Lack of oxygen in the
blood
People with advanced cancer are
often taking many medications, and have more than one condition relating
to age or cancer. Delirium can have many causes, and can be started by
only a slight change in medication or the patient's condition.
Managing delirium
The main goal in managing delirium is keeping each patient
comfortable and safe. These may help:
Environment. A quiet, well- lit room, familiar people and objects, and a
visible clock and wall calendar may help a patient experiencing delirium.
Medicine. In some cases, antipsychotic or other types of medication can
help bring a patient out of delirium. These drugs can also have
significant side effects.
Delirium at the end of life
Treating delirium is a delicate issue, for patients, family and friends,
and medical professionals. Some feel the hallucinations that come with
delirium at the end of life are part of the dying process and should not
be treated. For example, a patient who sees dead family members welcoming
them to heaven can be a great comfort. However, delirium can switch with
very little warning from a peaceful, pleasant experience into a
frightening one, and in these cases treatment might be helpful.
There is also a method called controlled sedation, which is giving a patient drugs that put them into a deep sleep. At
the end of life, this can make the patient more comfortable, but may also
leave family members with a premature sense of loss. Sedation is not
intended to speed up death, but to provide comfort to a patient at the
end of life. Even with sedation, a patient may experience moments of
clarity and be able to talk with family members.
Each decision about managing delirium is individual. It is important for
patients and their family members to talk with their doctors and
understand all the treatment options available.
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