Tuesday, January 3, 2012

Is It Dementia or Delirium?

Photo by Susan NYC
When I first started interacting with older adults with greater frequency as a student of gerontology, I was conflating a number of terms.

Senility, cognitive slowing, confusion, dementia, and Alzheimer’s are not interchangeable phenomena.

Senility is a dated term employed before contemporary medicine was able to diagnose more specific forms of cognitive changes.

Senility is a general term, one that lumps too many situations into one group. Using the label “senility” limits the observers’ understanding of the affected person’s limitations, capabilities and needs. Therefore, “senility” is a harmful term.

[Note: The purpose of this post is to raise awareness not to offer medical advice. If you have a concern about your health or the health of a loved one, please see a licensed medical professional.]

Cognitive slowing is a natural, age-related process. Everyone who ages will need more time and fewer distractions to perform various mental functions. If a person temporarily forgets the name of the lead actor in Gone with the Wind, this does not mean that person has Alzheimer’s Disease. In my 30s, I used to give three hour lectures in college literature courses without using lecture notes. Now I need to review names, dates and places that I used to recall immediately. This is especially true if I feel stress, if I am tired, or if I have distractions competing for my attention. Age-related cognitive changes include a degree of short-term memory problems, problems with word retrieval, word substitutions and slowing of executive planning and working memory.

Casual observers might mistake confusion, depression or age-related cognitive decline for dementia. Most mental confusion or delirium is temporary and due to treatable conditions such as low blood sugar, infections, or polypharmacy (side effects from taking multiple prescription medications). These problems need immediate attention.  Family members may be startled to see a loved one struggling to focus while hospitalized.  Studies show that about 20% of patients on general wards have delirium, rising to 60% in those who are critically ill.

Since writing this, I have found a 9/9/13 post by Carole Larkin that presents more research about delirium, which you can read here

Many older adults suffer from depression, which can affect the ability to concentrate. For a proper diagnosis, people displaying changes to their cognition should consult a physician, who after excluding other causes treatable by a general physician might make a referral to a neurologist or psychiatrist in order to undergo additional testing.

If other causes for cognitive changes are excluded, a doctor will then explore the possibility that dementia is the root cause. There are multiple causes for dementia, some of them reversible or at least static. However, the types of dementia that require the most intervention are those that are irreversible and progressive. The most common causes of dementia are as follows: Alzheimer’s disease (by a wide margin), Parkinson’s disease, vascular dementia, and Diffuse Lewy body disease. Note that Alzheimer’s Disease and dementia are not interchangeable; Alzheimer’s Disease is a subset of the category dementia.

Whatever the cause for changes to mental function, older adults benefit from others who treat them with respect, compassion and dignity. They don’t need anyone to infantilize them. In my volunteer work with residents who suffer from dementia, I have observed how keen they are in reading tone and body language. Even people with very compromised cognitive abilities know when they are being treated in a dismissive way.

Family members and friends can help older adults gain access to resources in order to address these changes. They may need help with paperwork or transportation. If you do not know where to start, contact your local Area Agency on Aging office. People who are experiencing changes to cognition may just need someone to serve as a sounding board while they use their own resources to address these changes. And you may learn a great deal in the process of helping others.

Have you had a "senior moment" that made you wonder what was going on with your mind? Do you have a friend or relative struggling with any one of these situations described above? Jump in and leave a comment so that we can share the journey of the aging process together.


Register with API for Information on Alzheimer's
Age-Related Changes to How We Write
Prevalence of Dementia and Diagnostic Tools
Modify Conversation with Older Adults as Needed
Hospital-induced Delirium
Cognitive Changes: The Usual Suspects


  1. My grandmother was diagnosed with hydrocephalus in the mid-90s. Her symptoms were like dementia in that she seemed to lose all filtering. We got to find out how angry she was at my grandfather for not letting her work and how much she hated my now-ex-husband. And when they put a shunt in, she had no recollection of what she had said -- or at least she wouldn't admit it.

    My mother-in-law has repeated her stories to me over and over since I've known her, so since her mid-70s. Even when I tell her that I've heard it already, she tells it anyway. I've found it easiest and most respectful to simply let her tell me again.

    I'm really enjoying your blog so far, Karen. I think this is a valuable resource.

  2. Wow, your grandmother's change in manner probably threw the whole family system into shock. I am glad to read that she enjoyed a return to her former personality with a shunt. I hope everyone could get back to normal after those outbursts. What an ordeal!

    You are very kind to listen to your MIL retell the same stories. I have listened to residents retell me about the dust bowl, about a husband who met Gen. McArthur, etc. I sometimes think about what these stories are expressing about their identities--their view of self. That helps me listen repeatedly. If I lived with a person who did this, it might be harder to demonstrate patience and to act as though the stories are new to me. Cognitive changes (to memory and to personality, etc.) seem very challenging for immediate family members. My heart goes out to them.

    Thanks for the comments, Trish. I am fairly obsessed with all issues related to aging, so I decided that I need to share my thoughts and invite others to participate. Thanks for the comment!

  3. I know you wrote this awhile ago, but I have to respond. Delirium is a very serious condition. It should never be considered "just" delirium. A large percentage of older adults who experience hospital delirium die within a year. http://www.health.harvard.edu/blog/the-dangers-of-hospital-delirium-in-older-people-201111163810

  4. Thanks for sharing! Very informative and useful.