The difference between delirium and dementia
Although delirium and dementia are both the result of a disease process resulting in a confused patient, they are critically different medically, says Terasita Hogan, MD, FACEP, director of emergency medicine residency program at Resurrection Medical Center in Chicago.
Delirium is an acute, reversible, potentially life-threatening condition that requires extreme emergency care. It is an abrupt disorientation for time and place, usually with illusions and hallucinations. The mind wanders, speech may be incoherent, and the patient is in a state of mental confusion and excitement.
Elderly patients with delirium tend to be quiet. "If the patient is quiet, we often won’t delve into the problem, although serious pathology could be going on. If a patient is screaming and ranting, we are more likely to give them attention," Hogan notes. "This may very well cause you to miss a life-threatening event."
Dementia is very slowly progressive and requires support, but is not an emergency treatment priority. It is a loss of awareness for time and place, usually with inability to learn new things or remember recent events. The person may be lost in a time years prior to today. Remote memories may be intact. Total loss of function and a regression to an infantile state may result. This is often referred to as "senility."
Often, when nurses ask elderly patients specific questions, the patient sidesteps the question, says Hogan. "They may say, That’s not important’ or I’m just fine,’ and it’s because the patient is demented and doesn’t know the answer to the question." If you don’t put the patient on the spot and ask pointed questions, you may miss the dementia.
Dementia embarrasses the patient, so they become experts at covering it up, says Hogan. "It makes the nurse look like the bad guy if he or she presses the issue to get an answer to the question," she explains. "You may miss the diagnosis of dementia because primary concern is to be kind to the individual rather than get an accurate medical history."
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