Delirium & Dementia

DementiaDelirium
OnsetChronicAcute
CourseStableFluctuating
ConsciousnessClearClouded
AttentionRelatively normalImpaired
DisorientedIn later stagesAlways
ThinkingImpoverishDisorganised
PerceptionIn later stagesIllusions, hallucinations
SleepUsually normalDisrupted

Dementia

Definition (ICD-10)

  1. chronic or progressive
  2. global impairment of cognition
  3. consciousness not clouded
  4. deteriorating emotional control
  5. deteriorating social behaviour

ΔΔx

  1. depression
  2. delirium
  3. pseudo-dementia
  4. mental retardation
  5. iatrogenic medication
  6. limited education

Pathology

Investigations

  1. Physical examination (CNS, CVS, AS)
  2. FBC + blood smear
  3. U&E
  4. LFT
  5. TFT
  6. ESR
  7. Ca2+
  8. B12, folate, niacin
  9. ECG

May also consider

  1. serum Cu2+ (Wilson's Disease)
  2. VDRL/WR (Neurosyphilis)
  3. HIV
  4. CT
  5. EEG

Delerium

Definition (ICD-10)

  1. Impairment of consciousness & attention
  2. global disturbance of cognition
  3. psychomotor disturbance
  4. disturbance of sleep-wake cycle
  5. emotional disturbance
Onset usually rapid, course diurnally fluctuating, total duration <6/12.

ΔΔx

  1. dementia
  2. transient psychosis
  3. acute states in schizophrenia
  4. acute states in affective disorders
  5. EtOH or drug intoxication