Delirium - Symptoms and causes - Mayo Clinic

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. COVID-19:Advice,updatesandvaccineoptions Weareopenforsafein-personcare. Learnmore: MayoClinicfactsaboutcoronavirusdisease2019(COVID-19) OurCOVID-19patientandvisitorguidelines,plustrustedhealthinformation Lateston COVID-19vaccination bysite: Arizonapatientvaccinationupdates Arizona, Floridapatientvaccinationupdates Florida, Rochesterpatientvaccinationupdates Rochesterand MayoClinicHealthSystempatientvaccinationupdates MCHS Skiptositenavigation SkiptoContent ThiscontentdoesnothaveanEnglishversion.ThiscontentdoesnothaveanArabicversion. SectionsforDeliriumSymptoms&causesDiagnosis&treatmentDoctors&departments Print OverviewDeliriumisaseriousdisturbanceinmentalabilitiesthatresultsinconfusedthinkingandreducedawarenessoftheenvironment.Thestartofdeliriumisusuallyrapid—withinhoursorafewdays. Deliriumcanoftenbetracedtooneormorecontributingfactors,suchasasevereorchronicillness,changesinmetabolicbalance(suchaslowsodium),medication,infection,surgery,oralcoholordrugintoxicationorwithdrawal. Becausesymptomsofdeliriumanddementiacanbesimilar,inputfromafamilymemberorcaregivermaybeimportantforadoctortomakeanaccuratediagnosis.Products&ServicesBook:MayoClinicFamilyHealthBook,5thEditionNewsletter:MayoClinicHealthLetter—DigitalEditionShowmoreproductsfromMayoClinic SymptomsSignsandsymptomsofdeliriumusuallybeginoverafewhoursorafewdays.Theyoftenfluctuatethroughouttheday,andtheremaybeperiodsofnosymptoms.Symptomstendtobeworseduringthenightwhenit'sdarkandthingslooklessfamiliar.Primarysignsandsymptomsincludethosebelow. ReducedawarenessoftheenvironmentThismayresultin: Aninabilitytostayfocusedonatopicortoswitchtopics Gettingstuckonanidearatherthanrespondingtoquestionsorconversation Beingeasilydistractedbyunimportantthings Beingwithdrawn,withlittleornoactivityorlittleresponsetotheenvironment Poorthinkingskills(cognitiveimpairment)Thismayappearas: Poormemory,particularlyofrecentevents Disorientation—forexample,notknowingwhereyouareorwhoyouare Difficultyspeakingorrecallingwords Ramblingornonsensespeech Troubleunderstandingspeech Difficultyreadingorwriting BehaviorchangesThesemayinclude: Seeingthingsthatdon'texist(hallucinations) Restlessness,agitationorcombativebehavior Callingout,moaningormakingothersounds Beingquietandwithdrawn—especiallyinolderadults Slowedmovementorlethargy Disturbedsleephabits Reversalofnight-daysleep-wakecycle EmotionaldisturbancesThesemayappearas: Anxiety,fearorparanoia Depression Irritabilityoranger Asenseoffeelingelated(euphoria) Apathy Rapidandunpredictablemoodshifts Personalitychanges TypesofdeliriumExpertshaveidentifiedthreetypesofdelirium: Hyperactivedelirium.Probablythemosteasilyrecognizedtype,thismayincluderestlessness(forexample,pacing),agitation,rapidmoodchangesorhallucinations,andrefusaltocooperatewithcare. Hypoactivedelirium.Thismayincludeinactivityorreducedmotoractivity,sluggishness,abnormaldrowsiness,orseemingtobeinadaze. Mixeddelirium.Thisincludesbothhyperactiveandhypoactivesignsandsymptoms.Thepersonmayquicklyswitchbackandforthfromhyperactivetohypoactivestates. DeliriumanddementiaDementiaanddeliriummaybeparticularlydifficulttodistinguish,andapersonmayhaveboth.Infact,deliriumfrequentlyoccursinpeoplewithdementia.Buthavingepisodesofdeliriumdoesnotalwaysmeanapersonhasdementia.Soadementiaassessmentshouldnotbedoneduringadeliriumepisodebecausetheresultscouldbemisleading. Dementiaistheprogressivedeclineofmemoryandotherthinkingskillsduetothegradualdysfunctionandlossofbraincells.ThemostcommoncauseofdementiaisAlzheimer'sdisease. Somedifferencesbetweenthesymptomsofdeliriumanddementiainclude: Onset.Theonsetofdeliriumoccurswithinashorttime,whiledementiausuallybeginswithrelativelyminorsymptomsthatgraduallyworsenovertime. Attention.Theabilitytostayfocusedormaintainattentionissignificantlyimpairedwithdelirium.Apersonintheearlystagesofdementiaremainsgenerallyalert. Fluctuation.Theappearanceofdeliriumsymptomscanfluctuatesignificantlyandfrequentlythroughouttheday.Whilepeoplewithdementiahavebetterandworsetimesofday,theirmemoryandthinkingskillsstayatafairlyconstantlevelduringthecourseofaday. WhentoseeadoctorIfarelative,friendorsomeoneinyourcareshowsanysignsorsymptomsofdelirium,seeadoctor.Yourinputabouttheperson'ssymptoms,typicalthinkingandeverydayabilitieswillbeimportantforaproperdiagnosisandforfindingtheunderlyingcause. Ifyounoticesignsandsymptomsofdeliriuminapersoninahospitalornursinghome,reportyourconcernstothenursingstaffordoctorratherthanassumingthatthoseproblemshavebeenobserved.Olderpeoplerecoveringinthehospitalorlivinginalong-termcarefacilityareparticularlyatriskofdelirium. RequestanAppointmentatMayoClinic CausesDeliriumoccurswhenthenormalsendingandreceivingofsignalsinthebrainbecomeimpaired.Thisimpairmentismostlikelycausedbyacombinationoffactorsthatmakethebrainvulnerableandtriggeramalfunctioninbrainactivity. Deliriummayhaveasinglecauseormorethanonecause,suchasacombinationofamedicalconditionanddrugtoxicity.Sometimesnocausecanbeidentified.Possiblecausesinclude: Certainmedicationsordrugtoxicity Alcoholordrugintoxicationorwithdrawal Amedicalcondition,suchasastroke,heartattack,worseninglungorliverdisease,oraninjuryfromafall Metabolicimbalances,suchaslowsodiumorlowcalcium Severe,chronicorterminalillness Feverandacuteinfection,particularlyinchildren Urinarytractinfection,pneumoniaortheflu,especiallyinolderadults Exposuretoatoxin,suchascarbonmonoxide,cyanideorotherpoisons Malnutritionordehydration Sleepdeprivationorsevereemotionaldistress Pain Surgeryorothermedicalproceduresthatincludeanesthesia Severalmedicationsorcombinationsofdrugscantriggerdelirium,includingsometypesof: Paindrugs Sleepmedications Medicationsformooddisorders,suchasanxietyanddepression Allergymedications(antihistamines) Asthmamedications Steroidmedicinescalledcorticosteroids Parkinson'sdiseasedrugs Drugsfortreatingspasmsorconvulsions RiskfactorsAnyconditionthatresultsinahospitalstay,especiallyinintensivecareoraftersurgery,increasestheriskofdelirium,asdoesbeingaresidentinanursinghome.Deliriumismorecommoninolderadults. Examplesofotherconditionsthatincreasetheriskofdeliriuminclude: Braindisorderssuchasdementia,strokeorParkinson'sdisease Previousdeliriumepisodes Visualorhearingimpairment Thepresenceofmultiplemedicalproblems ComplicationsDeliriummaylastonlyafewhoursoraslongasseveralweeksormonths.Ifissuescontributingtodeliriumareaddressed,therecoverytimeisoftenshorter. Thedegreeofrecoverydependstosomeextentonthehealthandmentalstatusbeforetheonsetofdelirium.Peoplewithdementia,forexample,mayexperienceasignificantoveralldeclineinmemoryandthinkingskills.Peopleinbetterhealtharemorelikelytofullyrecover. Peoplewithotherserious,chronicorterminalillnessesmaynotregainthelevelsofthinkingskillsorfunctioningthattheyhadbeforetheonsetofdelirium.Deliriuminseriouslyillpeopleisalsomorelikelytoleadto: Generaldeclineinhealth Poorrecoveryfromsurgery Needforinstitutionalcare Increasedriskofdeath PreventionThemostsuccessfulapproachtopreventingdeliriumistotargetriskfactorsthatmighttriggeranepisode.Hospitalenvironmentspresentaspecialchallenge—frequentroomchanges,invasiveprocedures,loudnoises,poorlighting,andlackofnaturallightandsleepcanworsenconfusion. Evidenceindicatesthatcertainstrategies—promotinggoodsleephabits,helpingthepersonremaincalmandwell-oriented,andhelpingpreventmedicalproblemsorothercomplications—canhelppreventorreducetheseverityofdelirium. ByMayoClinicStaff RequestanAppointmentatMayoClinic Diagnosis&treatment Sept.01,2020 Print Shareon:FacebookTwitter Showreferences Delirium.In:DiagnosticandStatisticalManualofMentalDisordersDSM-5.5thed.Arlington,Va.:AmericanPsychiatricAssociation;2013.http://dsm.psychiatryonline.org.AccessedMay1,2018. Delirium.MerckManualProfessionalVersion.https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium.AccessedMay1,2018. FrancisJJr,etal.Diagnosisofdeliriumandconfusionalstates.https://www.uptodate.com/contents/search.AccessedMay1,2018. FrancisJJr.Deliriumandacuteconfusionalstates:Prevention,treatment,andprognosis.https://www.uptodate.com/contents/search.AccessedMay1,2018. Gettingstartedwithlong-distancecaregiving.NationalInstituteonAging.https://www.nia.nih.gov/health/getting-started-long-distance-caregiving.AccessedMay1,2018. HshiehTT,etal.Effectivenessofmulti-componentnon-pharmacologicdeliriuminterventions:Ameta-analysis.JAMAInternalMedicine.2015;175:512. BlairGJ,etal.NonpharmacologicandmedicationminimizationstrategiesforthepreventionandtreatmentofICUdelirium:Anarrativereview.JournalofIntensiveCareMedicine.Inpress.AccessedMay1,2018. Overviewofdeliriumanddementia.MerckManualProfessionalVersion.https://www.merckmanuals.com/professional/neurologic-disorders/delirium-and-dementia/overview-of-delirium-and-dementia#v1036241.AccessedMay7,2018. 10tipsforfamilycaregivers.CaregiverActionNetwork.http://caregiveraction.org/resources/10-tips-family-caregivers.AccessedMay7,2018. TakahashiPY(expertopinion).MayoClinic,Rochester,Minn.June8,2018. Related AssociatedProcedures Urinalysis Products&Services Book:MayoClinicFamilyHealthBook,5thEdition Newsletter:MayoClinicHealthLetter—DigitalEdition ShowmoreproductsandservicesfromMayoClinic DeliriumSymptoms&causesDiagnosis&treatmentDoctors&departments Advertisement MayoClinicdoesnotendorsecompaniesorproducts.Advertisingrevenuesupportsournot-for-profitmission. 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