Delirium vs. Dementia: Causes, Symptoms, Treatments, and Preventative Measures

Feelings of confusion, difficulty focusing, and memory loss can have many causes and, especially in older adults, can be hard to tell apart from more typical signs of aging. 

Delirium is a disturbance in mental abilities, resulting in confused thinking and reduced awareness of one’s environment. Symptoms of delirium typically come on quickly, within a matter of hours or days. On the other hand, dementia is a general term used to describe a long-term decline in mental ability that is severe enough to interfere with daily life. The most well-known, and most common, type of dementia is Alzheimer’s disease.

Since delirium and dementia share many similar symptoms, family members and caregivers can often misunderstand a loved one’s condition and the potential underlying causes. To better assess your loved one’s cognitive health, it’s important to get a diagnosis from a trained healthcare professional and understand the symptoms, causes, treatments, and preventative measures that you can take if your loved one is experiencing signs of delirium or dementia.

Symptoms of Delirium vs. Dementia

Signs of delirium can be sudden and vary greatly, depending on the cause and severity of the symptoms. Symptoms of delirium can include: 

• Reduced awareness of one’s environment, such as being easily distracted or unfocused, fixated on a certain detail or idea, or being withdrawn.
• Cognitive impairment, such as disorientation, poor memory, or difficulty speaking, reading, or writing.
• Behavior changes, such as hallucinations, agitation, sleep disturbances, and reversal of the night-day sleep-wake cycle.
• Emotional disturbances, such as depression, anger, anxiety, irritation, changes in personality, and rapid and unpredictable mood shifts.

In contrast, the symptoms of dementia develop and worsen over a longer period of time. And, for a person to be diagnosed with dementia, at least two core mental functions must be significantly impacted. These core mental functions include:

• Memory, such as forgetting names of family members or regressing to childhood memories.
• Communication and language, such as forgetting the word for everyday items.
• Ability to focus and pay attention, such as “spacing out” or inability to complete tasks.
• Reasoning and judgment, such as going out in winter without a jacket or inappropriate comments and behavior.
• Visual perception, such as not being able to differentiate contrast, not detecting movement, or trouble with orientation.

Causes of Delirium vs. Dementia 

Delirium symptoms are often brought about by a specific cause. Although the cause is sometimes unknown or undetermined, known causes of delirium include:

• Metabolic imbalances, such as low sodium or low calcium
• Certain medications or drug toxicity
• Alcohol or drug abuse or withdrawal
• Severe, chronic, or terminal illness
• Fever and acute infection, particularly in children
• Malnutrition or dehydration
• Sleep deprivation
• Severe pain or emotional distress

With dementia, the impact on core mental functions including memory, communication, mental focus, reasoning, and visual perception is caused by damage to the cells of the brain. While most of the cell damage caused by dementia is permanent, memory loss caused by the following reasons may improve with treatment:

• Depression
• Certain medications
• Excess alcohol use
• Thyroid problems
• Vitamin deficiencies

Additionally, those who abuse alcohol, have HIV/AIDS, and those with learning disabilities are at a higher predisposition for dementia later in life.

Diagnosing Delirium and Dementia

Due to the similarities between delirium and dementia, it’s important to have a health care professional trained in assessing neurological status evaluate your loved one.

For a person to be diagnosed with delirium, a physician will take a detailed medical history and order several tests to assess your loved one. Tests include neurological and mental status exams, as well as blood and/or urine tests, and brain imaging. Because delirium happens quickly, it is often quite noticeable to most people. 

Oftentimes family caregivers are the first to notice the symptoms of dementia, with its progression developing over time, and flag them to their loved one’s doctor. Since there isn’t a specific test to diagnose dementia, careful review of medical history, a physical exam, lab tests, and the characteristic changes in thinking, day-to-day function, and behavior associated with each type of dementia are used in evaluation. From these results, a trained medical professional will be able to determine and diagnose the causes of your loved one’s cognitive changes.

Types of Delirium and Dementia

In addition to diagnosing your loved one with one of these conditions, a medical professional will also be able to determine the type of delirium or dementia your loved one is experiencing.

Types of delirium include:

• Hyperactive delirium, which includes restlessness, agitation, rapid mood changes, and/or hallucinations.
• Hypoactive delirium, which includes inactivity or reduced motor activity, sluggishness, abnormal drowsiness, or seeming to be in a daze.
• Mixed delirium, which may involve quick switches back and forth between hyperactive and hypoactive states.

There are many different types of dementia, with the most common being Alzheimer’s disease. Alzheimer’s accounts for about 60-80% of all dementia cases. The second leading type of dementia is called vascular dementia, which occurs following a stroke. Other types of the disease include:

• Dementia with Lewy bodies
• Frontotemporal dementia
• Creutzfeldt-Jakob disease (CJD)
• Early-onset dementia (affecting those under the age of 65)
• Alcohol-related brain damage
• Rare diseases and conditions (about 5% of total dementia cases)

Treatment for Delirium and Dementia

Whether your loved one is diagnosed with delirium or dementia, there are treatment options available that can help improve cognitive function and/or prevent or slow more severe symptoms from forming.

If your loved one is diagnosed with delirium, treatment will depend on the specific cause of the symptoms. For example, if medication is the culprit, having your loved one stop taking it should resolve the delirium. Likewise, rehydrating a person suffering from dehydration or having an overtired person rest, can treat delirium. If necessary, there are also some medications that can be used to treat delirium, which should be discussed with a medical professional.

If your loved one is diagnosed with dementia, there are treatment options available, depending on the type of dementia. And, while dementia and Alzheimer’s are progressive and have no cure, there are courses of treatment that may help your loved one cope through the progression of the disease, including:

• Medications
• Person-centered care
• Talk therapy, including counselling
• Memory care activities to exercise cognitive function

In any situation, it’s important to speak with your loved one’s doctor and caregiving team to determine the best approach to treatment for your loved one.

Ways to Prevent Delirium and Dementia

If your loved one has not yet been diagnosed with delirium or dementia but has started presenting signs of cognitive decline or memory loss, there are steps you can take as a family caregiver to prevent these symptoms from worsening.

As with most illnesses, engaging in a healthy lifestyle can help to maintain cognitive function and improve overall wellbeing. Some key factors include:

• Not smoking
• Exercising regularly
• Eating a balanced diet
• Monitoring medications
• Keeping the mind active
• Avoiding excessive alcohol intake
• Promoting good sleep habits and routines

Prioritizing Cognitive Care and Wellbeing

It’s important to not ignore changes or declines in thinking skills or memory, as it can often be caused by more than just age. Seeing a doctor at the first sign of issues can help detect a treatable condition, if delirium, and can help your loved one get an early diagnosis. After all, an early intervention is key to getting the most benefit from available treatment options for both delirium and dementia.

How Careforth Can Help

And for caregivers, it’s crucial to remember that you are not alone in your caregiving journey and in navigating your loved one’s cognitive changes. We at Careforth are here to help you feel supported at every turn. Visit the How We Help page on our site to learn more about how Careforth supports caregivers. Contact usContact us for more information.