Delirium vs Dementia on the NCLEX

Two confused patients, two different problems. Delirium is acute and usually reversible. Dementia is not.

Onset

Delirium: hours to days, often with an identifiable trigger (infection, new med, hypoxia, surgery). Dementia: months to years, insidious. Family says 'gradually worse' vs 'fine last week'.

Course

Delirium fluctuates, often worse at night (sundowning can occur in both, but hour-to-hour swings point to delirium). Dementia is progressive and relatively stable day to day.

Attention and consciousness

Delirium: attention is impaired first. Patient cannot follow conversation, drifts, may be hyperalert or drowsy. Dementia: attention intact until late. Memory fails first, alertness is normal.

Reversibility

Delirium is usually reversible once the cause is treated. Hunt the cause: UTI in older adults, medications (anticholinergics, benzos, opioids), hypoxia, electrolytes, withdrawal, pain, retention, constipation. Dementia is irreversible and chronic. New confusion in a patient with dementia is delirium until proven otherwise.

Nursing care for delirium

Treat the cause. Reorient frequently, clock and calendar in view, glasses and hearing aids on, family at bedside, cluster care to protect sleep, early mobility. Avoid restraints and minimize sedatives, both worsen delirium.

Frequently asked

Best screening tool for delirium?

CAM (Confusion Assessment Method): acute onset and fluctuating course, plus inattention, plus disorganized thinking or altered consciousness.

Depression mimicking dementia?

Pseudodementia. Older adult with depression performs poorly but answers 'I don't know' rather than confabulating. Treat the depression.

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