CaregivingCaregiving Dementia
How to Distinguish Between Dementia and Delirium
By Steve L. Flanagan, LCSW Senior Care Unit Pickens County Medical Center
their mental or cognitive behaviors, caregivers are often startled and suspect that their loved one has Alzheimer’s Disease. As it is reasonable to be concerned about the onset of dementia (Alzheimer’s Disease is a form of dementia), it is also important to rule out other factors that may be contributing to changes in a loved one’s behavior. In my practice at Pickens County Medical Center’s Senior Care Unit, an acute geriatric psychiatric hospital program, efforts are made to rule out symptoms of delirium as the primary cause of behavioral change, as often the application of a medical intervention, such as antibiotic medication or re-hydration may restore a person to previous function rapidly. A person displaying behavioral symptoms over a longer period of time may be experiencing other conditions. Consultation with a physician should be pursued in the event of signifi cant changes in behavior, but here are some tips for caregivers to help determine what may be contributing to changes:
W 1. Sudden Changes
If a loved one begins to display changes in behavior in a sudden manner (within a 24 hour period), it is possible that the changes may be in response to a medical problem. Should this be the case, the changes may be caused by delirium rather than dementia. Delirium is defi ned as a state of temporary mental confusion and clouded consciousness (The
hen an older loved one begins to display symptoms of change in
19 19
American Heritage Dictionary). Symptoms of delirium may include confusion, hallucinations (seeing or hearing things that are not observable to others), anxiety and other behaviors not routinely present. Common sources of delirium include fever, dehydration, constipation or fecal impaction, and urinary tract infection. When these sources are treated, the symptoms will diminish at a rate similar to their onset when the condition is treated.
2. Changes in Behavior Over Time If a person is observed to display changes
in behavior that are sustained over longer periods of time and include symptoms of memory loss, misplacing objects and not being able to locate them, not recognizing well known persons or places (such as home), and speaking aloud to persons not present, dementia, the irreversible deterioration of intellectual faculties (American Heritage Dictionary), may be causing the behaviors. Note, however, that a diagnosis of dementia, even by a physician, is theoretical as confi rmation of a dementia diagnosis can only be confi rmed by examination of brain tissue. Nonetheless, behavioral evidence and indicators revealed by testing can strongly suggest the presence of dementia in an individual.
3. Dementia and Delirium
A person can, of course, experience symptoms of both dementia and delirium. Due to losses of function by persons suffering from dementia, they are at risk for the frequent onset of delirium due to not being able to properly hydrate (drink fl uids) and address hygiene needs. These issues make it necessary for caregivers to be alert to activities of daily living, such as the amount of fl uid consumed, medication compliance, and the application of techniques in toileting to prevent delirium. Demented persons cannot be expected to wipe
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