Dementia Vs. Delirium

Dementia and delirium are two conditions of mental dysfunction that are seen most often in the elderly. Although they are separate and distinct disorders, they have many symptoms in common. Some patients may suffer from both, which further complicates the diagnosis. Both dementia and delirium are characterized by impaired cognitive function, which is usually the most obvious symptom, but they differ from one another in some other respects.

Dementia

Dementia, which is rarely seen in patients under the age of 50, is defined at the Johns Hopkins Medicine website as "a progressive decline in memory and at least one other cognitive area." These other areas of cognition include orientation, abstract thinking, attention, personality and judgment. Dementia is caused by damage to the brain, which can occur as a result of a head injury or as an effect of one of the following diseases: alcoholism, AIDS, Alzheimer's disease, stroke, Down syndrome, Pick's disease, Huntington's disease, Parkinson's disease, Creutzfeldt-Jakob disease and other neurodegenerative disorders.

Delirium

Usually a result of physical or mental illness, delirium is defined by MedlinePlus as "sudden severe confusion and rapid changes in brain function." Symptoms may include wandering attention; confusion as to time and place; disordered thinking; difficulties with short-term memory and recall; physical restlessness; and changes in personality, emotional affect, awareness, perception, sleep patterns and alertness.

Differing Outlooks

Perhaps the most significant difference between dementia and delirium is the long-term outlook for the two conditions. While dementia is a permanent condition that comes on slowly and gradually worsens over time, delirium is characterized by quick onset but is amenable to treatment if the treating doctor can pinpoint the causes. As noted above, a patient with dementia may also be suffering from delirium.

Slowing Dementia's Effects

There are treatments---both pharmacologic and nonpharmacologic---that can slow the advance of dementia, according to Johns Hopkins Medicine. Although there is no cure, the following nonpharmacologic modes of intervention have proved beneficial in dementia patients: occupational therapy, social interaction, adequate sleep and hydration, and the support of caregivers. Patients who are held to a strict schedule and are intellectually stimulated on a regular basis have also benefited by a slowing of dementia's progress. Medications used to treat dementia include antidepressants; antipsychotics; mood stabilizers; acetylcholinesterase inhibitors, such as tacrine; and NMDA (N-methyl d-aspartate) receptor antagonists, such as memantine. Both tacrine and memantine have been used in the treatment of Alzheimer's disease.

Treatment of Delirium

Delirium, which is almost always a short-term phenomenon, is treated by both pharmacologic and nonpharmacologic means. Drugs used to treat the symptoms of delirium include mood stabilizers, tranquilizers, dopamine blockers, thiamine and antidepressants, according to MedlinePlus. Nonpharmacologic treatments that have produced positive results include behavior modification, monitoring by a caretaker, reality orientation and maintenance of a quiet environment for the patient.

References

• Johns Hopkins Medicine: Dementia and Delirium
• MedlinePlus: Delirium
• Geriatric Fast Facts: Delirium vs. Dementia

Resources

• The Merck Manuals: Delirium and Dementia: Introduction
• SelfhelpMagazine: Dementia Versus Delirium