Gathering a history from other caregivers can clarify baseline mentation. Other mental illnesses: Some mental illnesses, such as a manic episode of bipolar disorder, depersonalization disorder, or some types of acute psychosis may cause a rapidly fluctuating impairment of cognitive function and ability to focus. These, however, are not technically causes of delirium per DSM-5 criteria D (i.e. fluctuating cognitive symptoms occurring as part of a primary mental disorder are results of the said mental disorder itself), while physical disorders (e.g. infections, hypoxia, etc.) can precipitate delirium as a mental side-effect/symptom. Psychosis: Consciousness and cognition may not be impaired (however, there may be overlap, as some acute psychosis, especially with mania, is capable of producing delirium-like states). Prevention
Using a tailored multi-faceted approach as outlined above can decrease rates of delirium by 27% among the elderly. At least 30–40% of all cases of delirium could be prevented, and high rates of delirium reflect negatively on the quality of care. Episodes of delirium can be prevented by identifying hospitalized people at risk of the condition. This includes individuals over age 65, with a cognitive impairment, with hip fracture, or with severe illness. Close observation for the early signs is recommended in such populations. Delirium may be prevented and treated by using non-pharmacologic approaches focused on risk factors, such as constipation, dehydration, low oxygen levels, immobility, visual or hearing impairment, sleep deprivation, functional decline and removing or minimizing problematic medications. Ensuring a therapeutic environment (e.g.
In prospective studies, people hospitalised from any cause appear to be at greater risk of dementia and faster trajectories of cognitive decline, but these studies did not specifically look at delirium. In the only population-based prospective study of delirium, older persons had an eight-fold increase in dementia and faster cognitive decline. The same association is also evident in persons already diagnosed with Alzheimers dementia.Recent long-term studies showed that many patients still meet criteria for delirium for a prolonged period after hospital discharge, with up to 21% of patients showing persistent delirium at 6 months post-discharge. Dementia in ICU survivors
Dementia is supposed to be an entity that continues to decline, such as Alzheimers disease. Another way of looking at dementia, however, is not strictly based on the decline component, but on the degree of memory and executive function problems. It is now known, for example, that between 50% and 70% of ICU patients have tremendous problems with ongoing brain dysfunction similar to those experienced by Alzheimers or TBI (traumatic brain injury) patients, leaving many ICU survivors permanently disabled. This is a distressing personal and public health problem and is getting an increasing amount of scrutiny in ongoing investigations.The implications of such an "acquired dementia-like illness" can profoundly debilitate a persons livelihood level, often dismantling his/her life in practical ways like impairing ones ability to find a car in a parking lot, complete shopping lists, or perform job-related tasks done previously for years.