Dementia vs. Delirium – How to Provide Nursing Care

When it comes to caring for the elderly, we want to make sure our loved ones get the absolute best care possible and that all their needs are being met. In order to provide the best care possible for anyone, it’s crucial that we understand exactly what kind of care they need and how to best care for the condition they have. 

Dementia vs. Delirium

Cognitive impairment requires just as much care – and sometimes even specialized care – as physical conditions like heart disease, stroke recovery and even cancers. 

Developing issues with cognitive impairment is quite common as people begin to age, however there is definitely a difference between typical aging impairment and significant cognitive issues (like someone with Alzheimer’s or dementia has). 

One of the more common issues seniors experience is what’s known as delirium. In fact, about a third of seniors treated in emergency rooms are found to be suffering from an episode of delirium. The symptoms of delirium can be similar to those of dementia, but there are key differences. 

It’s in those key differences that they would be cared for a little different, and their treatment plan would be altered. 

It’s important to understand the differences between dementia and delirium, so you know exactly how to care for your loved one and get them the help they need. 

Understanding Delirium 

The term delirium means a sudden confusion, and usually showcases as a severe disturbance in someone’s thoughts, mood or behavior. 

In short, it’s like all of a sudden your loved one isn’t acting like themselves, and doing things or saying things that would be deemed very out of character for them. These changes will also be brought on suddenly and without an obvious cause (like a head injury). 

Some of the common symptoms of delirium can include 

Mood Changes

This can present as sudden anger, fear, anxiety, depression, agitation, suspicion of others or fear. 

If your loved one is typically pretty happy and laid back, and suddenly they are hyper suspicious of everyone around them or are really enraged this could be a sign of delirium. 

 Speech

If your loved one is suddenly slurring their words or are not able to form sentences, or even are rambling on saying things that are not making sense you may not know why it’s happening. 

Changes in Sleeping

Waking up through the night or not being able to sleep (when they have usually had fairly good sleep patterns) can be a sign of delirium. 

old woman wide awake at night

Additionally, they may become much more active at night (pacing or cleaning or walking around) and then are finding themselves sleeping during the day. 

Being Disoriented or Confused

Your loved one may suddenly wonder what they are doing, or not know why they are in the place that they are. 

Becoming confused and not knowing what they are doing can definitely be a sign of delirium, especially when it’s suddenly onset. 

Hallucinations

Seeing things that are definitely not there can be really scary, especially when your loved one is convinced their visions are real. 

If your loved one is experiencing these symptoms, especially when they appear very suddenly, it’s important to seek medical treatment immediately for them. Many of these are signs of a life-threatening emergency, such as a heart attack or a stroke, so that is why it’s important to seek medical attention immediately when you notice them. 

Causes of Delirium 

This condition, while common in seniors, can be caused by a number of factors and it’s not always going to be the same reasons for every person who experiences it. 

The causes can be broken down into several very generalized categories: drugs/medications, electrolyte imbalance/dehydration, lack of (appropriately prescribed) medications, infections (like a UTI), reduced sensory input (like blindness or deafness), intracranial issues (like a tumor), urinary problems (like being constipated or unable to urinate), or myocardial/lung conditions (such as COPD or congestive heart failure). 

On top of these causes, temporary delirium is very common after just waking up from surgery.

Treating Delirium

When you bring your loved one to the emergency room due to symptoms of delirium, they will be assessed by the medical professionals there. 

If it’s happening due to a change in medication, or lack of taking the right medications, the doctors will need to identify how to give them the right medications for what they need to be treated for. They may also create a plan for how to make sure your loved one always gets the medications they need (for example – did this happen because they’re forgetting to take it or think they don’t need to). 

If the delirium has come on because of a heart attack or stroke, they will need to then treat this underlying condition as soon as possible so that as little damage as possible is done. 

old man consulting a doctor

Due to the fact that this condition can be caused by so many different factors, there isn’t just one treatment plan for delirium in the elderly. A medical team will need to determine why it’s happening for your loved one and design a treatment plan from there. 

What Is Dementia, Then?

Both dementia and delirium are considered cognitive impairment, and the symptoms can be very similar so it can be difficult to know when it’s dementia that is affecting your loved one. 

People who have dementia are actually more likely to experience temporary episodes of delirium than those who don’t, but it’s still important to know the difference.

Delirium refers to a sudden (but temporary) onset of confusion and disorientation, dementia is a very progressive illness and is not temporary. Delirium will go away fairly quickly with the right treatment (provided they can determine the underly cause), dementia will not go away once the symptoms are there. 

The most common form of dementia in the elderly is Alzheimer’s (with anywhere from 60 – 80% of people with dementia having this specific illness). Any form of dementia will affect different parts of the brain in different people, which is why the illness will display differently in different people. 

The symptoms of dementia can include 

  • Memory loss
  • Difficulty with completing daily activities (like shopping or bathing)
  • Inability to solve problems on their own 
  • Big changes in mood 
  • Changes in their personality 
  • Increasingly difficult for them to pay attention or focus

Causes of Dementia

As mentioned, the causes of delirium are always based on another underlying cause so there is a definitive treatment (once they find the cause). Dementia, however, is not that straight forward when it comes to figuring out what causes it. 

Dementia is typically associated with the death or dysfunction of neurons – which are the nerve cells in the brain. As these brain cells die, and therefore lose the ability to communicate with each other, a person can lose their ability to think clearly, reason and remember details – either short or long-term. 

The rate as which this illness will progress and the neurons die will be different for everyone, so it’s really difficult to say exactly how this illness will progress for various people and the rate at which they are unable to remember things or think clearly. 

Treatment for Dementia

As soon as the cause of delirium is found, and the treatment is started, the symptoms will often clear up and resolve. Dementia, however, does not work like that. 

There currently is no cure for dementia available to patients. Those who have been diagnosed with any form of dementia may be prescribed medications that can help slow down the progression of the symptoms or slow down how it develops, but they will not cure it. 

dementia patient

The best part of treatment for someone diagnosed with an illness like this will be to form a supportive and encouraging medical team, as well as a great group of friends and family. 

This can help manage the dementia triggers and create a supportive environment where they will feel safe and comfortable, as this will be a scary time for them when they can’t remember things clearly or are overwhelmed with what’s going on. 

The Key Differences

So, how can you tell if your loved one is experiencing an episode of delirium or if they potentially have a form of dementia? There are a few key differences which can help you identify what kind of medical attention you need, and how immediate the situation is. 

Memory

In most cases of delirium, attention and concentration will be primarily affected. However, with dementia there will be more prominent memory loss. 

Attention 

Individuals who are experiencing delirium will be easily distracted and unable to really focus on anything for any amount of time. They may even go in and out of consciousness. 

Dementia patients, however, will be better able to remain attentive to what is going on.

Speech Patterns

It won’t be until the very late stages of dementia that individuals living with this illness will experience or show troubles with slurred speech. 

For people experiencing delirium, though, there will be very sudden troubles with speech and immediately slurred speech when they previously had no troubles with it. 

Hallucinating

Seeing things that are not there (hallucinating) can happen with dementia, but it’s incredibly rare. So if this is happening, its more likely that your loved one is experiencing delirium. 

Illness

Delirium, as mentioned, is usually caused by another type of illness (even it’s not immediately apparent) whereas there won’t be any obvious signs of illness for someone who has dementia. 

Understanding the difference between an episode of delirium and true dementia can go a long way in caring for your loved one, and making sure they truly get the care they need that will help them!