Delirium and Mental Confusion: Symptoms, Causes ...

Patients can recover completely if the cause of delirium is identified quickly and addressed. Any delay makes it less likely they'll recover ... NowschedulingCOVID-19vaccinesforages5+,boostersandthirddoses Scheduleyourappointment COVID-19vaccineFAQs GoingtoaClevelandCliniclocation? Newvisitationguidelines Masksrequiredforpatientsandvisitors(evenifyou'revaccinated) Home / HealthLibrary / Disease&Conditions Delirium Delirium,oraconfusedmentalstate,occurssuddenly.Apersonhasachangeinmentalstatusandactsdisorientedanddistracted.Deliriumismorecommoninolderadults,especiallythosewithdementia,andpeoplewhoneedhospitalization.Prompttreatmentisessentialinhelpingapersonwithdeliriumrecover. Appointments&Access ContactUs Overview SymptomsandCauses DiagnosisandTests ManagementandTreatment Prevention Outlook/Prognosis LivingWith Delirium Overview SymptomsandCauses DiagnosisandTests ManagementandTreatment Prevention Outlook/Prognosis LivingWith BackToTop Overview Whatisdelirium? Deliriumhappenswhenapersonhassuddenconfusionorasuddenchangeinmentalstatus.Thepersonmayhavetroublepayingattentionorthinkingclearly.Theymayactdisorientedordistracted. Deliriumismoreseverethanhavinga“seniormoment”—theminorproblemspeoplehavewithmemoryandunderstandingastheygetolder.Itrequirestreatmentandoftenhospitalization. Isdeliriumadisease? No,deliriumisnotadisease.It’sachangedmentalstate. Isdeliriumthesameasdementia? Deliriumanddementia(whichincludesconditionssuchasAlzheimer’sdisease)havesomesimilarities,buttheyarenotthesame. Deliriummostlyaffectsaperson’sattention.Dementiaaffectsmemory. Deliriumisatemporarystatethatbeginssuddenly.Dementiaischronic(long-term)confusionthatusuallybeginsgraduallyandworsensovertime. However,someonecanhavebothdeliriumanddementia.Seekcarequicklyifaperson,especiallyonewithdementia,beginstoshowsymptomsofdelirium. Whatarethetypesofdelirium? Thetwotypesofdeliriumare: Hyperactivedelirium:Thepersonbecomesoveractive(agitatedorrestless). Hypoactivedelirium:Thepersonisunderactive(sleepyandslowtorespond). Hypoactivedeliriumismorecommon,occurringinupto75%ofpeoplewithdelirium.Butmanypeople,includinghealthcareproviders,mayincorrectlyassumethepersonisdepressed. Peoplecanexperiencebothtypesofdeliriumtogether.Theycanbeextremelyalertoneminuteanddrowsythenext. Whoisatriskfordevelopingdelirium? Deliriumhappensmoreofteninolderpeopleandhospitalizedpatients.“Hospitaldelirium”canaffect10%to30%ofthosepatients. Peopleinthesehigh-riskpopulationsmaydevelopdelirium: Peoplewhohavehadsurgery. 80%ofpeoplewhoareattheendoflife. 70%ofpeopleinintensivecareunits(ICUs). 60%ofpeopleoverage75innursinghomes. 30%to40%ofpeoplewhohavehumanimmunodeficiencyvirus(HIV). 25%ofpeoplewithcancer. Peoplemayalsobeathigherriskfordevelopingdeliriumifthey: Areondialysis. Can’tmovebecauseofcathetersorrestraints. Don’tgetenoughsleeporaredehydrated. Haveburns. Havemorethanoneillness,haveachronicconditionortakemultiplemedications. HaveParkinson’sdisease,chronicliverdiseaseorhadastroke. Havetroublehearingorseeing. Suddenlystopusingalcoholordrugs(withdrawal). Howcommonisdelirium? Becausedeliriumistemporary,it’shardtoknowexactlyhowmanypeopledevelopit.Researchersestimatethathospitaldeliriumaffects15%to50%ofpeople. SymptomsandCauses Whatarethecausesofdelirium? Insomecases,providerscan’tfindacauseofdelirium. Knowncausesofdeliriuminclude: Alcoholorillegaldrugtoxicity,overdoseorwithdrawal. Overwhelmingreactiontoinfectionssuchaspneumonia,sepsisandurinarytractinfections. Changesintheenvironment. Dehydration. Medications,suchasthosewithanticholinergiceffects(includingantihistamines),psychoactivedrugsandopioids. Hormonalissues(suchashyperthyroidismorhypothyroidism). Hospitalizationorsurgery. Kidneyorliverinjuryorfailure. Lackofoxygentoyourtissues. Lackofsleep. Pain. Whatarethesymptomsofdelirium? Thedifferenttypesofdeliriumproducedifferentsymptoms.Symptomstendtostartsuddenlyandgetworseoverthenextfewhoursordays.Apersonwithdeliriummayactlikethey’reintoxicated.Themainsymptomisbeingunabletopayattention.Symptomstendtobecomeworseintheevening,whichisknownassundowning. Symptomsofhyperactivedeliriuminclude: Actingdisoriented. Anxiety. Hallucinations. Rambling. Rapidchangesinemotion. Restlessness. Troubleconcentrating. Symptomsofhypoactivedeliriuminclude: Apathy. Decreasedresponsiveness. Flataffect. Laziness. Withdrawal. DiagnosisandTests Howisdeliriumdiagnosed? Healthcareproviderslookforproblemswithattention,memory,orientationandvisualability.Providersmayaskthepersontoperformafewsimpletasks,suchasspellingashortwordbackwardordoingabasicmathproblem. Aprovidermaydiagnosedeliriumiftheperson: Can’tfocusorshiftattention. Haschangesinthinking. Hasarapidonsetofthinkingproblems,whichmaychangethroughouttheday. Whattestsareusedtodiagnosedelirium? Afteraskingabouttheperson’ssymptoms,healthcareprovidersdoaphysicalexam.Theymayalsouseotherteststohelpidentifyacause,including: Bloodtest. Urinetest. Imagingtests,includingchestX-ray,CTorMRIscan. ManagementandTreatment Howwilltheproviderdecidewhattreatmentisbest? Othermedicalconditionsusuallycausedelirium.It’simportanttotreatthoseconditionstotreatthedelirium.Theproviderwillreviewtheperson’s: Medicalhistory. Physicalexamresults. Labresults. Druguse,includingover-the-counterdrugs,illicitdrugsandalcohol. Thepersonmaynotbeabletoanswerquestionsaboutthemselves.Soprovidersmayasktheperson’sfamilymemberorlovedone: Didtheconfusionbeginsuddenlyorgradually? Howquicklydiditprogress? Whatwastheperson’smentalandphysicalstatebeforethis? Isthepersontakinganydrugsordietarysupplements? Didthepersonstoporstartanynewmedicinesordrugsrecently? Doesdeliriumrequirehospitalization? Insomecases,thepersonisinthehospitalwhentheydevelopdelirium.Iftheyarenot,theywillmostlikelyneedhospitalization.Inahospitalsetting,providerscanmonitorthemandkeepthemfrominjuringthemselvesorothers. Providerstrytoidentifythecauseofdeliriumquicklytogetthepatienttreatmentasfastaspossible.Onceprovidersidentifyandtreatthereason,theycanoftenreversethedelirium. Ateamofmultipleproviderscanhelpgivethebestcare.It’simportanttopreventrelatedproblemssuchasundernutritionandincontinence.Acareteammayincludea: Physician,nursepractitionerand/orphysician’sassistant. Physicaltherapist. Occupationaltherapist. Nurse. Socialworker. Howisdeliriumtreated? Treatmentfordeliriumdependsonthecause.Treatmentsmayinclude: Antibioticsforinfections. Fluidsandelectrolytesfordehydration. Benzodiazepinesforproblemsduetodrugandalcoholwithdrawal. Ahealthcareprovidermayprescribeantipsychoticdrugs,whichtreatagitationandhallucinationsandimprovesensoryissues.Antipsychoticdrugsinclude: Haloperidol(Haldol®). Risperidone(Risperdal®). Olanzapine(Zyprexa®). Quetiapine(Seroquel®). HowcanIcareforsomeonewithdelirium? Often,treatmentsfordeliriumfocusontheenvironment.It’sbestifthepersonisinaquietsetting.Ifyouarecaringforsomeonewithdelirium,trythesetips: Promotegoodsleephabits:Duringtheday,keepthemawake,andexposethemtosunlight.Avoidnaps.Helpthemsleepatnightbyreducingnoiseanddistraction. Providereassurance:Helpthemunderstandtheirenvironment.Explainwhatishappening. Bringfamiliarobjects:Surroundthemwithitemsfromhome,suchasphotos,ablanketorabedsideclock.Thesethingswillhelpthepersonfeelmorecomfortableintheenvironment.Trysoothingmusicaswell. Encourageeating:Makesurethepersoneatsanddrinksnutritiousfoodthroughouttheday,ifappropriate. Encouragemovement:Ifit’ssafe,helpthepersongetoutofbedandmovearound. Helporientthem:Talkaboutcurrenteventsandfamilynewstoprovidementalstimulation.Readingoutloudcanbehelpfulaswell. HowcanIhelpapersonwithdeliriumbeindependent? Thepersonshoulddoasmuchaspossibleontheirown.Theymayneedsomeassistanceinbecomingindependent.Thepersonshould: Understandtheircareplan:Considergettinganinterpreteriftherearelanguagebarriers. Beinvolvedintheirtreatment:Encouragethemtoasktheirprovideranyquestionstheymayhave. Getsupportdevices:Theyshoulduseeyeglassesandhearingaidstopromotegoodvisionandhearingsotheycancommunicatebetter. Getoutofbed:Duringtheday,thepersonshouldbeoutofbedasmuchaspossible.Helpthemsitinachairduringmealtimesorwalkwhenpossible. Howsoonwillapersonwithdeliriumstarttofeelbetter? Thesymptomstypicallyimproveinafewdaystoweeks.Butsomeonewhohaddeliriummayhavetostaylongerinthehospitalevenaftersymptomsimprove.Theymaystillhaveanunderlyingmedicalconditionorbeunabletofunctioncompletelyontheirown. Prevention Candeliriumbeprevented? Beforeyouoralovedonehassurgery,talktoyourhealthcareprovideraboutassessingyourmentalstatusbeforetheprocedure.Thisway,yourprovidercanestablishabaseline.Ifyourmentalstatuschangesaftersurgery,providershavepresurgicalmeasurementsforcomparison.Andifyouoryourlovedonehasriskfactorsthatincreaseyourchancesofdevelopingdelirium,talktoyourprovider. Theseothertipscanhelppreventdelirium: Keepaclockandcalendarnearby. Haveplentyoflightingduringtheday. Talktoyourhealthcareprovideraboutlimitingmedicinesthataren’tneeded,especiallythosethatmaycausedelirium. Drinkplentyofwaterandotherfluids. Takeawalkeveryday,oratleastgetoutofbedandsitinachair. Talktoyourhealthcareproviderifyouhaveanysignsofaninfection,suchascough,fever,painorshortnessofbreath. Keepyourfamilyinvolvedinthetreatmentplan. Whatconditionsputmeatriskfordelirium? Theseconditionsorsituationsraisetheriskofdevelopingdelirium: Cancer. HIV. Havingsurgery. Beinghospitalized,especiallyintheICU. Parkinson’sdisease. Dementia. Chronicliverdisease. Outlook/Prognosis Whatistheoutlookforpeoplewithdelirium? Patientscanrecovercompletelyifthecauseofdeliriumisidentifiedquicklyandaddressed.Anydelaymakesitlesslikelythey’llrecoverquicklyand/orfully.Lackoftreatmentcanleadtostupor,comaorevendeath.OlderpersonswithdementiaandthosewithHIVarelesslikelytohaveacompleterecovery. Isdeliriumfatal? Deliriumcanbelife-threateningifleftuntreated.Butwiththerightcareandtreatment,peoplecanrecover. Howlongdoesthepersonneedtobeonmedication? Ifapersonreceivesmedicationtotreatsymptomsofdelirium,thesymptomsmayimprove.However,evenwhensymptomsimprove,thepersonshouldnotsuddenlystoptakingtheirmedications.Ahealthcareprovidercanhelpgraduallydecreasethedoseandeventuallystopthemedication. LivingWith Whatarecomplicationsofdelirium? Peoplewithdeliriummayalsohave: Longerhospitalstays. Medicalcomplications,suchaspneumoniaandpressureulcers. Distressingmemoriesofdelirium,alongwithfeelingsofanxietyorfear. Higherchanceofneedingfull-timecare. Worseningmentalabilities. Whatsideeffectsdodeliriumtreatmentshave? Antipsychoticdrugscomewithsomesideeffects,althoughresearchersareworkingondevelopingdrugsthatcausefewersideeffects.Sideeffectsaremorecommoninolderadultsandcaninclude: Highillnessanddeathrates. Stroke. High-than-normalpulseratewithirregularheartbeats(sometimesoccurswhenhaloperidolisdeliveredintoavein). Benzodiazepinescancause: Drowsiness. Increasedagitation. Reducedcontroloverbehaviors. Uncoordinatedmusclemovements. Falls. WhatshouldIaskmyhealthcareprovider? Ifalovedoneisinthehospitalwithdelirium,asktheprovider: Whatcausedthedelirium? Whattreatmentaretheyreceiving? Aretheytakinganymedicationsfordelirium? Dothemedicationshaveanysideeffects? Howlongwillmylovedoneneedtostayinthehospital? WhatsignsshouldIlookforoncetheycomehome? HowcanIcontinuetokeepthemsafe? Whatistheprognosis? HowcanIpreventanotherepisodeofdelirium? AnotefromClevelandClinic Deliriumisastateofmentalconfusionthatstartssuddenly.It’smorecommoninolderadultsandpeoplewhoarehospitalized.Ifyounoticeasuddenshiftinmentalstatusinalovedone—forexample,they’reconfused,disorientedanddistracted—contactahealthcareprovider.Prompttreatmentcanhelpmostpeoplerecoverfullyfromdelirium. Share Facebook Twitter LinkedIn Email Print Getuseful,helpfulandrelevanthealth+wellnessinformation enews ClevelandClinicisanon-profitacademicmedicalcenter.Advertisingonoursitehelpssupportourmission.Wedonotendorsenon-ClevelandClinicproductsorservices. Policy RelatedInstitutes&Services NeurologicalInstitute TheNeurologicalInstituteisaleaderintreatingandresearchingthemostcomplexneurologicaldisordersandadvancinginnovationsinneurology. Head&NeckInstitute Ourprovidersspecializeinheadandnecksurgeryandoncology;facialplasticandreconstructivesurgery;generalotolaryngology;laryngology;otology,neurotologyandlateralskullbasedisorders;pediatricotolaryngology;rhinology,sinusandskullbasesurgery;surgicalsleep;dentistryandoralandmaxillofacialsurgery;andalliedhearing,speechandbalanceservices. ClevelandClinicisanon-profitacademicmedicalcenter.Advertisingonoursitehelpssupportourmission.Wedonotendorsenon-ClevelandClinicproductsorservices. Policy Morehealthnews+info ShowMore Appointments&Access ContactUs Facebook Twitter YouTube Instagram LinkedIn Pinterest Snapchat