Delirium vs dementia – an important difference

A new tool developed by four universities, three Australian, can help medical professionals differentiate between dementia and delirium.

The two conditions can manifest in very similar ways but have vastly different causes. Identifying the difference can play a vital role in obtaining the appropriate treatment. It can also help provide peace of mind for both the patient and their family or carer.

When you think it’s dementia, but it isn’t

Some years ago, a friend told me about a startling episode her elderly mother had experienced. Soon after moving into an aged care facility, her mother began to show sudden signs of rapid cognitive decline.

My friend had expected that her mum might experience decline over a time but was shocked at this dramatic fall. “I was horrified at the suddenness of it all, and I thought it was a direct result of her move into the facility. I was overcome by guilt,” she said.

Not long after, though, her mother was back to her normal self. How was this possible, my friend wondered. Would her mum now start bouncing between states of clarity and dementia?

To my friend’s relief, the answer was much simpler and far more positive than she could have imagined. Her mum had contracted a urinary tract infection (UTI), which in turn resulted in symptoms very similar to those of dementia.

But rather than dementia, my friend’s mother was suffering from delirium, and her symptoms disappeared after her recovery.

Until I heard that story, I had always considered delirium as a layperson’s word – like ‘crazy’ or ‘mad’. I was wrong.

Medically speaking, what is delirium?

Delirium is the manifestation of a sudden decline in a person’s usual mental function. It can be frightening not just for the person experiencing it, but also for carers attempting to support them. However, delirium is not a disease. Rather, it’s a clinical syndrome or condition that is usually temporary and treatable.

The onset of delirium is a stress response, usually caused by a number of underlying acute, short-term illnesses and medical complications. A common example is UTI. Delirium can also occur as a result of pneumonia or sometimes after surgery. 

Delirium is by no means uncommon. As many as one-third of older people admitted to hospital are diagnosed with the condition. This in turn increases the risk of unnecessary functional decline, a longer hospital stay, falls, and more serious outcomes.

But early diagnosis reduces those risks, making the newly developed tool a potential game-changer. 

Introducing PREDICT

Southern Cross University, the University of the Sunshine Coast and the University of Canberra have, together, created a new toolkit. Developed in conjunction with Canada’s University of Saskatchewan and the Northern NSW Local Health District, they have created ‘PREDICT’.

PREDICT is short for Prevention and Early Delirium Identification Carer Toolkit. The expansion of the acronym explains clearly what the tool actually does. A combined-universities pilot proved successful, with carers showing significantly increased knowledge through use of the online delirium toolkit.

Expanding PREDICT into general usage could not only provide great relief to patients and family, it could also save millions. 

The project’s lead investigator, Dr Christina Aggar, said: “Delirium is the number one hospital-acquired complication in Australia, costing our healthcare system more than $1 billion a year. The emotional and financial toll to the patient and the carer is also extremely significant.”

Dr Aggar is an associate professor of Nursing at Southern Cross University and Conjoint Northern NSW Local Health District. “Carers are well-placed to recognise subtle changes indicative of delirium and why we’ve involved them in the pilot,” she said.

“PREDICT supports family carers to understand delirium and make sense of their predicament. Having gained knowledge about delirium, carers can partner with nurses to address risk and implement strategies to prevent and manage delirium.”

Dr Kasia Bail, Professor of Gerontological Nursing at the University of Canberra, said PREDICT had already proved life-changing for carers. “In this research pilot … we found that carer knowledge about delirium increased,” said Dr Bail. The pilot also showed that carers wanted to be involved in delirium prevention and management. 

Next steps in delirium management

Dr Bail said implementing change so hospitals worked closely with carers was the next step. PREDICT would support their access to information and partnership with clinicians, she said.

The research team is now aiming to secure funding to develop a larger trial at hospitals around the country.

Has anyone close to you shown symptoms of delirium? Were they correctly diagnosed? Let us know via the comments section below.

Also read: Australians don’t know enough about dementia, and that’s a problem
Healthdisclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.