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Patient education: Delirium (confusion) (The Basics)

Patient education: Delirium (confusion) (The Basics)

What is delirium? — Delirium is a brain disorder that causes people to be confused. There are other terms doctors might use when they talk about delirium, too. They sometimes use the term "altered mental status" for when a person's brain isn't working normally. The word "confusion" means that a person isn't thinking clearly.

What are the symptoms of delirium? — People with delirium can be sleepy or hard to wake up. Or they can be more active or agitated than usual. Sometimes, they see or hear things that aren't really there.

People with delirium also often have:

Trouble paying attention, or switching attention from 1 thing to another

Memory, language, or other thinking problems

Trouble knowing where they are, when it is, or who the people around them are

Symptoms of delirium start quickly, over a few hours or a day or 2. Symptoms can come and go over the course of a day, and often get worse toward the end of the day. This is 1 way that delirium is different from "dementia," a brain disorder that causes memory and thinking problems. In dementia, the symptoms start very gradually and worsen over several months or longer.

What causes delirium? — Different kinds of conditions or situations can cause delirium. The most common are:

A medical condition, such as low blood sugar, pneumonia (infection of the lungs), or kidney failure

A side effect of medicines

Drug misuse

Alcohol withdrawal – This is when people suddenly stop drinking after they have been drinking a lot of alcohol every day.

A problem in the brain, such as infection, seizure, or some types of strokes:

Seizures are waves of abnormal electrical activity in the brain that can make people move or behave strangely.

A stroke is when a part of the brain is damaged because of a problem with blood flow.

Delirium happens more often in people who:

Are older, have a lot of medical problems, or take a lot of medicines

Have another brain disorder, such as dementia

Have vision or hearing problems

Delirium is most likely to happen when a person is in the hospital, especially if they just had surgery or are in pain.

Should I call the doctor or nurse? — Yes. Call the doctor or nurse if you notice the above symptoms in yourself or someone else. Many people who get delirium are already in a hospital.

Will tests be needed? — Yes. The doctor or nurse will do an exam and ask questions to check thinking and attention. They will do tests to find out what's causing the delirium. The tests will depend on the situation and can include:

Blood tests

Urine tests

CT scan of the head – A CT scan is an imaging test that creates pictures of the brain.

Lumbar puncture – This is sometimes called a "spinal tap." During this procedure, a doctor puts a thin needle into the lower back and takes out a small amount of spinal fluid. Spinal fluid is the fluid that surrounds the brain and spinal cord. They send the spinal fluid to a lab for tests to look for infection or other problems.

Electroencephalogram ("EEG") – This test measures electrical activity in the brain and records brain wave patterns (figure 1).

How is delirium treated? — Doctors treat delirium by treating the cause, if possible. For example, if a medicine is causing delirium, the doctor will stop or change that medicine. If an infection is causing delirium, they will treat the infection. Even if the cause is treated, delirium can last days to weeks, depending on what's causing it.

Doctors also treat delirium by helping relieve symptoms until the delirium gets better. Different ways doctors can do this include:

Making the person's hospital room as quiet as possible, especially at night

Giving the person medicine to help them sleep better at night

Having the hospital staff remind the person where they are, and why they are in the hospital

Giving the person medicine to help calm them down

Also, it often helps people with delirium to have family and other familiar people around them in the hospital.

Most people with delirium recover completely. But people who are older or have other brain problems, such as dementia, might not.

What help is needed at home? — After a person is treated for delirium, they might still need help if they go home.

If you are caring for someone with delirium, you might need to:

Check on them to make sure that they are safe

Make sure that they are taking their medicines as instructed

Keep their space quiet and restful

Make sure that they are getting enough sleep

Help them with their meals

Take them to medical appointments

Make note of any changes you notice in the person – These could include:

How much they seem to understand what's happening around them

Changes in sleep habits

If they have trouble remembering things

If they are having trouble paying attention

Changes in their mood

Changes in how they are speaking, including not being able to speak or sounding confused

Problems with bladder or bowel control

Not being in control of their movements

Having help at home can help the person recover.

Can delirium be prevented? — Sometimes. Doctors try to lower the chances that a person in the hospital will get delirium by doing a few different things. These might include:

Avoiding certain medicines

Making the person's room quiet at night so they can sleep

Giving the person eyeglasses or hearing aids in the daytime if they are used to using them

If your family member is in the hospital, talk with their doctor or nurse about how to help prevent delirium.

What problems should I watch for? — Call the doctor for advice if a person who was treated for delirium has:

Confusion that lasts for 10 minutes or longer

Very fast heartbeat

Cold sweats

Thoughts that are not normal

Seeing or hearing things that are not really there

More on this topic

Patient education: EEG (The Basics)
Patient education: Dementia (including Alzheimer disease) (The Basics)
Patient education: Neuroleptic malignant syndrome (The Basics)
Patient education: Toxic-metabolic encephalopathy (The Basics)

Patient education: Delirium (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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