Delirium (confusion): Definition, causes, symptoms, treatment
Mental confusion is defined by the College of Teachers of Neurology (CEN) as the “acute disorganization of all cognitive and behavioral functions.”
What is delirium? Definition
Characteristics of delirium are that it is reversible, unlike dementia, and that it begins quickly, leading to an acute form within hours or days, when dementia begins gradually.
It does not result from structural damage to the brain but results in global nervous system dysfunction and altered cognitive function. Delirium is not an illness in itself.
Recognizing mental confusion: What are the symptoms?
Symptoms of delirium are numerous and mostly nonspecific. However, they are sudden in onset and may fluctuate.
These symptoms cannot be explained by the presence of pre-existing dementia. Some are immediately visible: the face is haggard, the patient seems dazed or on the contrary very agitated, the speech is disconnected and unrelated to the situation, the patient is as disconnected, disoriented, he can be disinhibited.
Other symptoms that emerge during the neurologic examination include lack of attention, disorientation with time and space, memory problems, verbal inconsistency, difficulty or inability to do simple calculation operations, and difficulty writing correctly. People may also have difficulty sleeping, hallucinations, or headaches.
Diagnosis of delirium
Diagnosis of delirium is clinical only. There are no tests or tests to diagnose it. However, health care workers have at their disposal one tool: the CAM (Confusion assessment method).
Developed in 1990 by a U.S. geriatrician in 1990, this method is used to evaluate patients with confusion. The doctor or nurse does a cognitive test in which they look for several physical signs: sudden onset and fluctuation of symptoms, inattention, disorganized thinking, altered consciousness, disorientation, memory impairment, abnormal perception, psychomotor restlessness or slowness, disturbance of the sleep-wake rhythm. The presence of the first two criteria (sudden onset and fluctuation of symptoms, inattention) plus disorganized thinking or altered consciousness suggests a diagnosis of delirium.
Causes of Delirium
There are some risk factors for delirium: male sex, age over 65/70, history of delirium, depression, psychiatric disorders, hospitalization, life in ephad, history of stroke, dementia.
Causes of confusion vary greatly. It may be caused by a mental illness, have a neurologic cause, or confusion may result from intoxication or even a vascular problem.
The main causes are intoxication, withdrawal from alcohol or drugs after prolonged use, and use of certain drugs (particularly those with anticholinergic effects—that is, those that act on acetylcholine, a neurotransmitter that plays an important role in the central and peripheral nervous systems). Delirium may also be caused by severe infection, viral involvement, increased intracranial pressure, meningeal syndrome, diabetic acidosis, kidney failure, liver failure, a vascular cause (meningeal hemorrhage, etc.), puerperal psychosis, or a brain tumor.
Treatment of delirium
Treatment of delirium is obviously directed at the cause, beginning immediately when the cause has been identified. It is associated with psychiatric and somatic management and measures to relieve symptoms.
