[Health in the 100-Year Life Era] 'Delirium' Often Mistaken for Dementia... Recovery is Good if Causes are Improved

Professor Hye-Yeon Park, Department of Psychiatry, Bundang Seoul National University Hospital.

#An elderly mother fell on an icy road during winter. Although she underwent surgery, fortunately, she recovered. However, suddenly, the mother could not recognize her family members and became restless, insisting that she needed to go home. Her daughter, Ms. A, was startled and stayed up all night caring for her mother. The mother had trouble sleeping at night and during the day, she waved her hands in the air, saying she saw bugs on the ceiling. Ms. A shared this with her family and became worried that her mother might have dementia.

"Delirium" is derived from the words meaning nonsense (섬) and falsehood (망), referring to a general brain dysfunction caused by physical illness or medication. The main symptoms include a sudden decline in awareness of surroundings, judgment, and concentration, along with intermittent language and memory impairments that cause the person to say strange things or ramble incoherently. Additionally, insomnia or reversal of day and night cycles may occur, and the person may become excessively agitated or, conversely, show dull or sluggish responses. In severe cases, hallucinations such as seeing or hearing things that are not there may accompany the condition.

Delirium is dangerous because it develops suddenly within hours to days and the condition frequently fluctuates. For example, a patient who is very alert and normal during the day may become incoherent and restless at night. Delirium is especially risky for hospitalized patients because a patient who appears normal during the day may experience accidents such as falls or remove catheters at night, leading to dangerous situations. Therefore, when delirium occurs, hospital stays tend to be prolonged, and the risk of medical complications and mortality increases significantly.

Delirium generally occurs due to various triggering factors such as ▲old age ▲medical conditions like high fever or intoxication ▲internal or surgical diseases such as infections or operations ▲alcohol use disorder ▲and the use of multiple medications. It is reported that about 20% of elderly hospitalized patients and about 30% of intensive care unit patients experience delirium. Unlike dementia, delirium appears acutely and is a reversible brain dysfunction that improves once the cause is corrected. However, if delirium recurs or persists for several months, as mentioned earlier, the patient is exposed to multiple risks and has an increased likelihood of developing neurocognitive disorders such as dementia.

The fundamental treatment and prevention of delirium involve improving the causes or risk factors. For example, reducing pain through appropriate treatment, correcting constipation and electrolyte imbalances, and gradually reducing medications that may trigger delirium can prevent or improve the condition. If symptoms such as insomnia, anxiety, agitation, or hallucinations occur, antipsychotic medications may be used to alleviate these symptoms. Additionally, for hospitalized patients at risk of delirium, preventive measures include identifying and managing risk factors in advance, and if delirium occurs, regularly monitoring the patient to detect and intervene early can effectively treat delirium.

Besides medical treatment, the role of caregivers is crucial. As mentioned earlier, patients with delirium have a high risk of accidents such as falls, so intensive observation and caution to prevent such incidents are necessary. Furthermore, emotionally stabilizing the patient and maintaining their sense of reality by frequently providing information about the date, place, and other details through conversation can be helpful. It is also advisable to promptly resume the use of glasses or hearing aids if the patient normally uses them, and if possible, encourage some level of movement or activity during the day. Delirium generally recovers well without significant aftereffects, but since symptoms may recur after discharge, regular monitoring is essential, and if delirium reappears, medical professionals should be consulted promptly.

Professor Hye-Yeon Park, Department of Psychiatry, Bundang Seoul National University Hospital