Delirium and Dementia in the Elderly: Sometimes Associated or Always Together?

Abstract

Background – In the elderly, the association of delirium and dementia can cause diagnostic problems because they share the same symptom of confusion. Delirium is often misdiagnosed as dementia and treated inappropriately, ignoring that it could be successfully addressed, which can lead to increased health risks up to death. Summary – Confusion indicates that functional reserve fails to compensate for the action of stressors. The decline in reserve is linked to aging-related changes in blood flow, mitochondria, cerebrospinal fluid, and immune function, as well as the appearance of structural precursors of disease. It is greater in dementia that adds a large burden of pathology, especially degenerative and vascular. Key Messages – Based on their common background linking normal and pathological brain aging, it can be argued that delirium and dementia are always associated to some extent and can aggravate each other. The clinical approach to their association, which currently relies on the preliminary diagnosis of delirium according to ad hoc protocols, could be simplified by taking delirium for granted so that its causative stressors, usually the most common diseases of old age and/or drug abuse, could be addressed immediately. This approach would benefit all demented patients: not only those who are in such a serious condition that they need to be hospitalized due to the risk of death, but also those with clouded delirium.

Hospital Hallucinosis - where to look for the cause of the delirious syndrome in a geriatric patient and what management to implement

“…In addition, the cholinergic system is also influenced by norepinephrine and serotonin, which together with dopamine regulate the sleep-wake cycle [4,15].…”

“…Symptoms in the case of dementia are long-lasting, more than 6 months, the build-up of symptoms is slower than in delirium. In the case of delirium syndrome, we expect a rather acute course, with suddenly developed symptoms of high intensity [15].…”

Association of peripheral B cells and delirium: combined single-cell sequencing and Mendelian randomization analysis

“…Delirium is a neurocognitive impairment characterized by attentional deficits, cognitive impairment, and dysfunction of consciousness, which is manifested by a diminished ability to maintain and focus attention, damaged cognition, and disorientation of the environment ( 1 ). The prevalence of delirium is significantly higher in older, debilitated populations with comorbid chronic illnesses and those experiencing intense stressful events such as trauma, surgery, and infections ( 2–4 ). In contrast to chronic, ongoing neurocognitive impairments (e.g., aging-related and neurodegenerative diseases), the onset of delirium is usually characterized by acute and subacute features ( 1 ).…”