Delirium differential diagnosis: Difference between revisions
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===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> | ||
Revision as of 15:14, 11 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: psychiatric Disorders, dementia, other neurological disorders etc.
Differential Diagnosis
- Shown below the table of differentiating delirium from other psychiatric disorders:
| 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.
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.[2]
Other Neurological Disorders
- Frontal lobe disorders such as tumor can produce deficits in memory, distorted emotional responses, impaired judgment, etc. 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, etc. 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, etc. Imaging studies and focal neurological symptoms may be helpful to differentiate from delirium.
- Parital lobe disorders like Wernicke's aphasia can hinder patient's ability to follow examiner's instructions which is 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. It is a corollary of these differential criteria that a diagnosis of delirium cannot be made without a previous assessment, or knowledge, of the affected person's baseline level of cognitive function. In other words, a mentally disabled or demented person who is operating at their own baseline level of mental ability might appear to be delirious without a baseline functional status against which to compare.
Common Usage of the Term v/s Standard Medical Usage
In common usage, delirium is often used to refer to drowsiness and disorientation. In broader medical terminology, however, a number of other symptoms, including sudden inability of focus attention, and even (occasionally) sleeplessness and severe agitation and irritability, are also defined as "delirium."
Complete List of Differential Diagnoses
References
- ↑ "Delirium in elderly adults: diagnosis, prevention and treatment".
- ↑ 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.