Confusion in Older Adults: How to Tell the Difference Between Delirium vs. Dementia
Key takeaways:
Delirium and dementia are a common cause of confusion in older adults. But confusion from delirium comes on much faster than dementia.
Delirium is a symptom of another medical problem, and is often temporary. Dementia is its own permanent condition that worsens over time.
Delirium can resolve with treatment of the underlying condition. Dementia can be treated but not cured.
Confusion in older people is a sign of a medical problem that needs attention. For family and caregivers, the cause of the confusion isn’t always obvious.
The two most common conditions causing confusion in older adults are delirium and dementia. It’s also possible for someone to have both of these conditions at the same time. Even though they both cause confusion, delirium and dementia are very different from each other. Knowing these differences and what to do can help if you notice confusion in someone close to you.
The difference between delirium and dementia
Dementia and delirium can look a lot like each other, since both can cause confusion. But these two conditions are actually quite different. A look at the definition and descriptions of each can help explain these differences.
Search and compare options
Delirium definition
Delirium isn’t a disease itself. Delirium is a change in thinking, alertness, and attention caused by an underlying medical problem. One common example of delirium is when someone becomes confused as a symptom of a urinary tract infection (UTI). Identifying and treating the cause of the delirium is key to curing it.
Dementia definition
Dementia is a general term that refers to several different diseases of the brain. All types of dementia cause progressive breakdown of brain tissue. These changes result in the typical symptoms of dementia, including confusion and changes in behavior and personality. Alzheimer’s disease is the most common type of dementia, and accounts for about 70% of all cases. Currently, dementia is treatable but not curable.
How to tell the difference between delirium and dementia
Several clues can help determine if someone’s confusion is due to delirium or dementia. Healthcare providers use someone’s symptoms, when they started, and additional testing to determine the cause of confusion.
There are some key differences that may give a clue to which situation is more likely:
Timing: Dementia usually starts very gradually, and worsens over the course of months to years. In contrast, an episode of delirium starts much more abruptly, in a matter of hours to days.
Fluctuation of symptoms: A person with delirium often has a noticeable fluctuation in their symptoms. They’ll become more and less confused throughout the course of a day, or even from moment to moment. Symptoms don’t vary as widely in people with dementia.
Comparison to usual state: People with delirium can quickly change from their usual mental state to dramatically confused. Dementia doesn’t usually cause such a noticeable change over a short period of time.
Presence of other symptoms: Since delirium is caused by another medical problem, there are usually other symptoms related to the underlying problem. This may include symptoms like fever, weakness, pain, or new bowel and bladder problems.
Resolution: Once the underlying cause is treated, delirium will improve. This isn’t always immediate. It can take days or months for a delirium episode to completely improve. Dementia isn’t currently curable, so the confusion won’t go away.
Can a person with dementia also have delirium?
A person with dementia can develop delirium like anyone else. In fact, people with dementia are at a higher risk for delirium than those without dementia. And people who had an episode of delirium have increased risk for developing dementia later on in life. Because of this, medical providers try hard to prevent delirium when possible.
Read more like this
Explore these related articles, suggested for readers like you.
The difference in treatment for delirium and dementia
Treatments exist to help people with both delirium and dementia. Since these two conditions are different, so are the treatments.
Delirium treatment
Delirium is due to some kind of underlying medical problem, such as:
Infection
Constipation
Dehydration or electrolyte changes
Uncontrolled pain
Certain medications
This means that the treatment for delirium is tailored to the cause. So it can be anything from antibiotics to medications for pain and IV fluids for dehydration.
Dementia treatments
Although there isn’t currently a cure for dementia, there’s treatment. Medication can potentially help with the symptoms of dementia and slow its progression. These include:
What to do when an older adult is confused
Even though the treatment for delirium and dementia are very different, the approach as a caregiver is similar.
Here are some tips to help someone with dementia or delirium who may be distressed or agitated. Following these can help calm them down and make communication go a little more smoothly.
Keep the environment calm. Avoid overstimulation. If the TV is on, make sure the volume is appropriate and that the subject matter is soothing. Use natural lighting when possible.
Use a soothing voice. Speak both clearly and loud enough to be heard and understood. Avoid speaking in a hurry or presenting multiple choices at once, which can worsen confusion.
Follow nonverbal cues. Look for signs of discomfort, which could be causing the agitation or confusion. Pain, hunger, or something about the environment could be a factor.
Try reorienting. It can sometimes be helpful to provide gentle reminders about the date and the current setting or situation. For someone with delirium, these gentle reminders can be especially helpful. Only continue this approach if it seems to be soothing.
When to seek medical help quickly
Some symptoms can suggest that something more serious is happening, and urgent medical attention is necessary. When in doubt, reach out to your healthcare provider or seek care in an emergency room. If the following symptoms are present, seek help immediately:
Fever
Severe headache or other pain
Drooping facial features
Sudden weakness or numbness
Loss of consciousness or inability to stay awake
Head injury
Difficulty breathing
Extreme agitation
The bottom line
It’s a scary time when a loved one has confusion. Knowing what to do and how to help when this happens can be stressful for caregivers. When in doubt, seek medical attention at the first sign of a concern. Finding out the cause and getting help is critical, since an underlying and treatable medical problem may be the cause. Medical providers can help to figure out what’s going on. While connecting with local medical help is important, there are also online resources to support caregivers when delirium happens.
Why trust our experts?
References
Davis, D. H. J., et al. (2012). Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain.
Fong, T. G., et al. (2022). The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews Neurology.
Ford, A. H. (2016). Preventing delirium in dementia: Managing risk factors. Maturitas.
