Delirium - Symptoms and Causes (2023)

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Delirium is a severe change in mental capacity. This leads to muddled thinking and a lack of awareness of your surroundings. The disorder usually occurs quickly - within hours or a few days.

Delirium can usually be traced back to one or more factors. The factors could be a serious or long-term illness or an imbalance in the body, such as B. low sodium. The disorder can also be caused by certain medications, infections, surgery, or alcohol or drug use or withdrawal.

Symptoms of delirium are sometimes confused with symptoms of dementia. Health professionals may rely on information from a family member or caregiver to diagnose the disorder.


Delirium symptoms usually begin within hours or days. They usually occur with a medical issue. Symptoms often come and go throughout the day. There may be phases without symptoms. Symptoms are usually worse at night when it's dark and things look less familiar. They also tend to be in unfamiliar surroundings, like B. in a hospital to be worse.

Primary symptoms include the following.

Reduced awareness of the environment

This can lead to:

(Video) Delirium: Causes, Symptoms, Diagnosis and Treatment

  • Difficulty concentrating on a subject or changing subjects
  • Adhering to an idea instead of answering questions
  • easily distracted
  • Being withdrawn, with little or no activity or little reaction to the environment

Weak thinking skills

This might look like this:

  • Poor memory, such as forgetting recent events
  • Not knowing where they are or who they are
  • Difficulty speaking or remembering words
  • Erratic or meaningless speech
  • Problems understanding the language
  • Problems reading or writing

behavioral and emotional changes

This can include:

  • Fear, anxiety, or distrust of others
  • Depression
  • Short temper or anger
  • A feeling of high spirits
  • Lack of interest and emotions
  • Quick mood swings
  • personality changes
  • See things others don't see
  • Being restless, anxious, or combative
  • Screaming, moaning or making other noises
  • Being quiet and withdrawn - especially in older adults
  • Slow movement or sluggishness
  • changes in sleep habits
  • An alternating night-day-sleep-wake rhythm

types of delirium

Experts have identified three types:

  • Hyperactive delirium.This is possibly the easiest type to spot. People with this type may become restless and pace around the room. They may also be anxious, have rapid mood swings, or see things that aren't there. People with this type often resist grooming.
  • Hypoactive delirium.People with this type may be inactive or have reduced activities. You tend to be sluggish or sleepy. You look stunned. They do not interact with family or other people.
  • Mixed delirium.Symptoms include both types of delirium. The person may switch quickly between restlessness and sluggishness.

delirium and dementia

Delirium and dementia can be difficult to tell apart, and a person can have both. Someone with dementia has a gradual decline in memory and other thinking skills due to brain cell damage or loss. The most common cause of dementia is Alzheimer's disease, which develops slowly over months or years.

Delirium is common in people with dementia. However, episodes of delirium do not always mean that a person has dementia. Testing for dementia should not be done during an episode of delirium as the results can be misleading.

Some differences between the symptoms of delirium and dementia are:

  • start.The onset of delirium occurs in a short time - in a day or two. Dementia usually starts with mild symptoms that get worse over time.
  • Heads up.The ability to stay focused or maintain concentration is impaired with delirium. A person in the early stages of dementia is usually awake. Often, someone with dementia is not sluggish or fussy.
  • Rapid changes in symptoms.Delirium symptoms may come and go several times a day. Although people with dementia have better and worse times of day, their memory and thinking skills generally remain at a constant level.

when to the doctor

If a relative, friend, or someone in your care has symptoms of delirium, talk to that person's doctor. Your information about symptoms, typical thinking, and usual skills is important for a diagnosis. It can also help the provider to find the cause of the malfunction.

If you notice symptoms in someone at the hospital or nursing home, report your concerns to the nurse or healthcare provider. Symptoms may not have been observed. Elderly people who are hospitalized or live in a long-term care facility are at risk for delirium.

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Delirium occurs when signals in the brain are not being sent and received properly.

The disorder may have a single cause or more than one cause. For example, a medical condition combined with the side effects of a medication can cause delirium. Sometimes no cause can be found. Possible causes are:

  • Certain medications or medication side effects
  • Use or abstinence from alcohol or drugs
  • A medical condition, such as a stroke, heart attack, worsening lung or liver disease, or injury caused by a fall
  • An imbalance in the body, such as B. low sodium or low calcium
  • Severe and prolonged illness or an illness leading to death
  • Fever and a new infection, especially in children
  • urinary tract infection, pneumonia, flu orCOVID-19, especially in older adults
  • Exposure to a toxin, such as carbon monoxide, cyanide, or other poisons
  • Poor diet or loss of too much body fluid
  • Lack of sleep or severe emotional distress
  • pains
  • Surgery or other medical procedure that requires induction of a sleep-like state

Some drugs taken alone or in combination can cause delirium. These include medications used to treat:

  • pains
  • sleep disorders
  • Mood disorders such as anxiety and depression
  • allergies
  • Asma
  • swelling
  • Parkinson disease
  • spasms or spasms

risk factors

Any condition that leads to hospitalization increases the risk of delirium. This is especially true when someone is recovering from surgery or being admitted to the intensive care unit. Delirium is more common in older adults and in people who live in nursing homes.

Examples of other conditions that can increase your risk of delirium include:

  • Brain diseases such as dementia, stroke or Parkinson's disease
  • Previous episodes of delirium
  • vision or hearing loss
  • various medical problems


The delirium can last from a few hours to several weeks or months. If the causes are addressed, recovery time is usually shorter.

(Video) Causes and Symptoms of Delirium | The Disorders Care

Recovery depends to some extent on the state of health and mental state before the onset of symptoms. For example, people with dementia may experience a general decline in memory and thinking ability after an episode of delirium. People in better health are more likely to make a full recovery.

People with other serious, long-term, or terminal illnesses may not regain the thinking or functioning skills they had before the onset of delirium. Delirium in critically ill people is more likely to:

  • A general decline in health
  • Poor recovery from surgery
  • The need for long-term care
  • An increased risk of death


The best way to prevent delirium is to address the risk factors that can trigger an episode. Hospital environments present a particular challenge. Hospitalizations often involve changing rooms, invasive procedures, loud noise and poor lighting. Lack of natural light and lack of sleep can make confusion worse.

Some measures can help prevent or reduce the severity of delirium. To do this, encourage good sleep habits, help the person stay calm and well oriented, and help prevent medical problems or other complications. Also, avoid sleeping medications like diphenhydramine (Benadryl Allergy, Unisom, others).

By the staff at the Mayo Clinic

October 14, 2022

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