Delirium differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Delirium is differentiated from other causes cognitive dysfunction | [[Delirium]] is differentiated from other causes [[cognitive]] dysfunction such as [[psychiatric Disorders]], [[dementia]]. Unlike [[dementia]], the course of [[delirium]] is reversible with fluctuation in level of [[consciousness]]. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Shown below the table of differentiating [[delirium]] from other [[psychiatric]] disorders: | *Shown below the table of differentiating [[delirium]] from other [[psychiatric]] disorders:<ref name="pmid30773695">{{cite journal |vauthors=Fong TG, Vasunilashorn SM, Libermann T, Marcantonio ER, Inouye SK |title=Delirium and Alzheimer disease: A proposed model for shared pathophysiology |journal=Int J Geriatr Psychiatry |volume=34 |issue=6 |pages=781–789 |date=June 2019 |pmid=30773695 |pmc=6830540 |doi=10.1002/gps.5088 |url=}}</ref><ref name="pmid26360863">{{cite journal |vauthors=O'Sullivan R, Inouye SK, Meagher D |title=Delirium and depression: inter-relationship and clinical overlap in elderly people |journal=Lancet Psychiatry |volume=1 |issue=4 |pages=303–11 |date=September 2014 |pmid=26360863 |pmc=5338740 |doi=10.1016/S2215-0366(14)70281-0 |url=}}</ref><ref name="CharltonKavanau2002">{{cite journal|last1=Charlton|first1=B.G|last2=Kavanau|first2=J.L|title=Delirium and psychotic symptoms – an integrative model|journal=Medical Hypotheses|volume=58|issue=1|year=2002|pages=24–27|issn=03069877|doi=10.1054/mehy.2001.1436}}</ref> | ||
{| border="3" | {| border="3" | ||
|+ '''The difference between [[delirium]] and similar [[psychiatric]] illness''' | |+ '''The difference between [[delirium]] and similar [[psychiatric]] illness''' | ||
! Attributes !! Delirium !![[ Alzheimer]] disease!![[Depression]]!![[Psychotic]] Disorders | ! Attributes !! [[Delirium ]] !![[ Alzheimer]] disease!![[Depression]]!![[Psychotic]] Disorders | ||
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! Onset | ! Onset | ||
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|}<ref>{{Cite web | last = | first = | title = Delirium in elderly adults: diagnosis, prevention and treatment | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/ | publisher = | date = | accessdate = }}</ref> | |}<ref>{{Cite web | last = | first = | title = Delirium in elderly adults: diagnosis, prevention and treatment | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065676/ | publisher = | date = | accessdate = }}</ref> | ||
===Psychiatric Disorders=== | ===[[Psychiatric]] Disorders=== | ||
*'''Psychotic disorders''': Delirium may be distinguished from [[psychosis]], in which consciousness and cognition may not be impaired (however, there may be overlap, in acute psychosis, especially with [[mania]], is capable of producing delirium-like states). | *'''[[Psychotic]] disorders''': [[Delirium]] may be distinguished from [[psychosis]], in which [[consciousness]] and cognition may not be impaired (however, there may be overlap, in acute [[psychosis]], especially with [[mania]], is capable of producing [[delirium]]-like states). | ||
* [[Delirium]] must be differentiated from following [[psychiatric]] disorders which have [[psychotic]] features. | |||
:*[[Brief psychotic disorder]] | :*[[Brief psychotic disorder]] | ||
:*[[Schizophrenia]] | :*[[Schizophrenia]] | ||
:*[[Schizophreniform disorder]] | :*[[Schizophreniform disorder]] | ||
:*[[Bipolar Disorder|Bipolar]] and [[depression|depressive disorders with psychotic features]]. | :*[[Bipolar Disorder|Bipolar]] and [[depression|depressive disorders with psychotic features]]. | ||
*'''Acute stress disorder''': Delirium accompanied by [[fear]], [[anxiety]], and [[dissociative]] symptoms must be differentiated from [[acute stress disorder]]s. | * [[Mania]] should be differentiated from hyperactive [[delirium]]. | ||
* Previous history of [[bipolar disorder]] is useful in distinguishing [[delirium]] from [[mania]]. | |||
*'''Acute [[stress disorder]]''': [[Delirium]] accompanied by [[fear]], [[anxiety]], and [[dissociative]] symptoms must be differentiated from [[acute stress disorder]]s. | |||
*'''[[Malingering]] and [[factitious disorder]]'''. | *'''[[Malingering]] and [[factitious disorder]]'''. | ||
*'''Confusional states''': Delirium is distinguished by time-course from the confusion and lack of attention which result from long term learning disorders and varieties of | *'''[[Confusional]] states''': [[Delirium ]] is distinguished by time-course from the [[confusion]] and lack of [[attention]] which result from long term learning disorders and varieties of [[congenital]] [[brain]] dysfunction. | ||
*Delirium is not the same as confusion, although the two syndromes may overlap and be present at the same time. | *Delirium is not the same as [[confusion]], although the two syndromes may overlap and be present at the same time. | ||
*'''Other neurocognitive disorders''': Sometimes delirium is superimposed on underling | * However, a confused [[patient]] may not be [[delirious]] (an example would be a stable, demented person who is [[disoriented]] to [[time]] and [[place]]), and a [[delirious]] person may not be [[confused]] (for example, a person in severe [[pain]] may not be able to focus because of the [[pain]], and thus be by definition delirious, but may be completely [[oriented]] and not at all [[confused]]). | ||
*'''Other neurocognitive disorders''': Sometimes [[delirium]] is superimposed on underling [[neurocognitive]] disorders such as [[dementia]].<ref name="pmid26139023">{{cite journal |vauthors=Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK |title=The interface between delirium and dementia in elderly adults |journal=Lancet Neurol |volume=14 |issue=8 |pages=823–832 |date=August 2015 |pmid=26139023 |pmc=4535349 |doi=10.1016/S1474-4422(15)00101-5 |url=}}</ref> | |||
===Dementia=== | ===Dementia=== | ||
* [[Delirium]] is distinguished from [[dementia]] ([[chronic organic brain syndrome]]) which describes an "acquired" (non-congenital) and usually irreversible [[cognitive]] and [[psychosocial]] decline in function. | * [[Delirium]] is distinguished from [[dementia]] ([[chronic organic brain syndrome]]) which describes an "acquired" (non-congenital) and usually irreversible [[cognitive]] and [[psychosocial]] decline in function. | ||
* [[Dementia]] usually results from an identifiable [[degenerative]] [[brain ]] disease (for example [[Alzheimer disease]] or [[Huntington disease]]). | |||
* [[Dementia]] is usually not associated with a change in the level of [[consciousness]], and a diagnosis of [[dementia]] requires a chronic impairment. | * [[Dementia]] is usually not associated with a change in the level of [[consciousness]], and a diagnosis of [[dementia]] requires a chronic impairment. | ||
* Sundowning: In [[patients] suffering from [[dementia]] or [[delirium]] which is an impairment in [[behavioral]] patterns in the evening hours.<ref name="pmid28083535">{{cite journal |vauthors=Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G |title=Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches |journal=Front Med (Lausanne) |volume=3 |issue= |pages=73 |date=2016 |pmid=28083535 |pmc=5187352 |doi=10.3389/fmed.2016.00073 |url=}}</ref> | * Sundowning: In [[patients] suffering from [[dementia]] or [[delirium]] which is an impairment in [[behavioral]] patterns in the evening hours.<ref name="pmid28083535">{{cite journal |vauthors=Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G |title=Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches |journal=Front Med (Lausanne) |volume=3 |issue= |pages=73 |date=2016 |pmid=28083535 |pmc=5187352 |doi=10.3389/fmed.2016.00073 |url=}}</ref> | ||
===Other Neurological Disorders=== | ===Other Neurological Disorders=== | ||
*Frontal lobe disorders such as | *[[Frontal lobe disorders]] such as [[tumors]] can produce deficits in [[memory]], distorted [[emotional]] responses, impaired [[judgment]]. | ||
*Temporal lobe disorders may lead to memory deficits, cortical deafness, visual [[agnosia]] | * Imaging studies and focal [[neurological]] symptoms may be helpful to differentiate from [[delirium]]. | ||
*Occipital lobe disorders can demonstrate various symptoms such as [[confabulation]], [[cortical blindness]] | *[[Temporal lobe]] disorders may lead to [[memory]] deficits, [[cortical]] deafness, [[visual]] [[agnosia]]. | ||
* | * Imaging studies and focal [[neurological]] symptoms may be helpful to differentiate from [[delirium]]. | ||
*Nonconvulsive epileptic episodes should also be considered as a differential diagnosis of delirium. | * [[Occipital lobe]] disorders can demonstrate various symptoms such as [[confabulation]], [[cortical blindness]]. | ||
Delirium represents an organically caused decline from a previously | * Imaging studies and focal [[neurological]] symptoms may be helpful to differentiate from [[delirium]]. | ||
* [[Parietal]] lobe disorders like [[Wernicke's aphasia]] can hinder a patient's ability to follow examiner's instructions which are often misinterpreted as a state of [[confusion]]. | |||
* [[Nonconvulsive]] [[epileptic]] episodes should also be considered as a differential diagnosis of [[delirium]]. | |||
**[[Delirium]] represents an organically caused decline from a previously [[attained]] level of [[cognitive]] functioning. | |||
===Complete List of Differential Diagnoses=== | ===Complete List of Differential Diagnoses=== | ||
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Latest revision as of 08:06, 22 April 2021
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Delirium Microchapters |
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Diagnosis |
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Treatment |
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]; Vishal Khurana, M.B.B.S., M.D. [3]
Overview
Delirium is differentiated from other causes cognitive dysfunction such as psychiatric Disorders, dementia. Unlike dementia, the course of delirium is reversible with fluctuation in level of consciousness.
Differential Diagnosis
- Shown below the table of differentiating delirium from other psychiatric disorders:[1][2][3]
| Attributes | Delirium | Alzheimer disease | Depression | Psychotic Disorders |
|---|---|---|---|---|
| Onset | Sudden/acute/subacute | Gradual | Gradual | Acute or gradual |
| Progression | Shifts in severity, likely to resolve in days to weeks. | Worsens over a period of time | Acute or chronic with acute exacerbation | Chronic with acute exacerbation |
| Hallucinations | May be present, mostly visual | Mostly absent (exceptions: Lewi body dementia) | May be present if associated with psychotic features | Present |
| Delusions | Fleeting | Mostly not present | May be present | Present |
| Psychomotar activity | Increased or decreased, may shift from increased to decreased states. | May or may not change | Change | Change |
| Attention | Poor attention span and impaired short-term memory | Progressive worsening short-term memory. Attention span is likely to be affected in severe cases | May be altered | May be altered |
| Consciousness | Altered, rapidly shifts | Mostly intact until severe stages | Normal | Normal |
| Attention | Altered, rapidly shifts | Mostly intact until severe stages | May be altered | May be altered |
| Orientation | Altered, rapidly shifts | Mostly intact until severe stages | Not altered | Not altered |
| Speech | Not coherent | Errors | Slow | Normal or pressured |
| Thought | Disorganized | Impoverished | Normal | Disorganized |
| Perceptions | Altered, rapidly shifts | Mostly intact until severe stages | Normal | May be altered |
| EEG | Moderate to severe background slowing | Normal or mild diffuse slowing | Normal | Normal |
| Reversibility | Mostly | Very rarely | Yes | Rarely |
Psychiatric Disorders
- Psychotic disorders: Delirium may be distinguished from psychosis, in which consciousness and cognition may not be impaired (however, there may be overlap, in acute psychosis, especially with mania, is capable of producing delirium-like states).
- Delirium must be differentiated from following psychiatric disorders which have psychotic features.
- Mania should be differentiated from hyperactive delirium.
- Previous history of bipolar disorder is useful in distinguishing delirium from mania.
- Acute stress disorder: Delirium accompanied by fear, anxiety, and dissociative symptoms must be differentiated from acute stress disorders.
- Malingering and factitious disorder.
- Confusional states: Delirium is distinguished by time-course from the confusion and lack of attention which result from long term learning disorders and varieties of congenital brain dysfunction.
- Delirium is not the same as confusion, although the two syndromes may overlap and be present at the same time.
- However, a confused patient may not be delirious (an example would be a stable, demented person who is disoriented to time and place), and a delirious person may not be confused (for example, a person in severe pain may not be able to focus because of the pain, and thus be by definition delirious, but may be completely oriented and not at all confused).
- Other neurocognitive disorders: Sometimes delirium is superimposed on underling neurocognitive disorders such as dementia.[5]
Dementia
- Delirium is distinguished from dementia (chronic organic brain syndrome) which describes an "acquired" (non-congenital) and usually irreversible cognitive and psychosocial decline in function.
- Dementia usually results from an identifiable degenerative brain disease (for example Alzheimer disease or Huntington disease).
- Dementia is usually not associated with a change in the level of consciousness, and a diagnosis of dementia requires a chronic impairment.
- Sundowning: In [[patients] suffering from dementia or delirium which is an impairment in behavioral patterns in the evening hours.[6]
Other Neurological Disorders
- Frontal lobe disorders such as tumors can produce deficits in memory, distorted emotional responses, impaired judgment.
- Imaging studies and focal neurological symptoms may be helpful to differentiate from delirium.
- Temporal lobe disorders may lead to memory deficits, cortical deafness, visual agnosia.
- Imaging studies and focal neurological symptoms may be helpful to differentiate from delirium.
- Occipital lobe disorders can demonstrate various symptoms such as confabulation, cortical blindness.
- Imaging studies and focal neurological symptoms may be helpful to differentiate from delirium.
- Parietal lobe disorders like Wernicke's aphasia can hinder a patient's ability to follow examiner's instructions which are often misinterpreted as a state of confusion.
- Nonconvulsive epileptic episodes should also be considered as a differential diagnosis of delirium.
Complete List of Differential Diagnoses
References
- ↑ Fong TG, Vasunilashorn SM, Libermann T, Marcantonio ER, Inouye SK (June 2019). "Delirium and Alzheimer disease: A proposed model for shared pathophysiology". Int J Geriatr Psychiatry. 34 (6): 781–789. doi:10.1002/gps.5088. PMC 6830540 Check
|pmc=value (help). PMID 30773695. - ↑ O'Sullivan R, Inouye SK, Meagher D (September 2014). "Delirium and depression: inter-relationship and clinical overlap in elderly people". Lancet Psychiatry. 1 (4): 303–11. doi:10.1016/S2215-0366(14)70281-0. PMC 5338740. PMID 26360863.
- ↑ Charlton, B.G; Kavanau, J.L (2002). "Delirium and psychotic symptoms – an integrative model". Medical Hypotheses. 58 (1): 24–27. doi:10.1054/mehy.2001.1436. ISSN 0306-9877.
- ↑ "Delirium in elderly adults: diagnosis, prevention and treatment".
- ↑ Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK (August 2015). "The interface between delirium and dementia in elderly adults". Lancet Neurol. 14 (8): 823–832. doi:10.1016/S1474-4422(15)00101-5. PMC 4535349. PMID 26139023.
- ↑ Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G (2016). "Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches". Front Med (Lausanne). 3: 73. doi:10.3389/fmed.2016.00073. PMC 5187352. PMID 28083535.