Delirium and Dementia
Delirium
Definition
State of mental confusion; global mental dysfunction with prominent alteration, often fluctuating, of alertness or attention.
Common features: disorientation, fluctuating level of consciousness, inability to maintain attention, agitation. May progress for hours or days. Often worse at night. Usually reversible.
Variable features: drowsiness, restlessness, incoherence, irritability, emotional lability, perceptual misinterpretations (illusions), hallucinations.
Etiology
Primary Neurologic Disorders
Head injury, stroke, raised intracranial pressure, epilepsy, CNS infection.
Delirium tremens: follows alcohol withdrawal (24 to 48 hours); tremor, hallucinations, autonomic hyperactivity; potentially fatal.
Systemic Illness
Delirium present in 10–20% of patients in hospital.
Systemic infection, dehydration (especially in older patients).
Cardiovascular, endocrine, toxic-metabolic derangement.
Medications: atropine, barbiturates, benzodiazepines (chlordiazepoxide, diazepam, flurazepam), cimetidine, clonidine, cocaine, digitalis, dopamine agonists (pergolide, pramipexole, ropinirole), haloperidol and other neuroleptics, lithium,
mephenytoin, meprobamate, opioids, phencyclidine hydrochloride (PCP), phenytoin, prednisone, propranolol, tricyclic antidepressants.
Evaluation
History: trauma, alcohol use.
Examination: fever, jaundice, focal neurologic signs.
Laboratory data: serum electrolytes, complete blood count, liver and thyroid function tests, ESR, toxicology screen, syphilis serology, blood cultures, urine cultures, chest x-ray, ECG. Consider CT or MRI, CSF, EEG, HIV antibody titer, cardiac enzymes, blood gases, autoantibody screen.Related posts:
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