1 DISTINGUISHING DELIRIUM AND DEMENTIA

Delirium (acute confusional state) presents as one or a mixture of the following two forms:
1. Hyperactive form rapid onset severe confusion and disorientation with fluctuating intensity
of symptoms
2. Hypoactive form sudden withdrawal from interaction with outside world
Dementia is a syndrome of acquired persistent impairment of mental function involving at least 3 of
the following domains:
1.
2.
3.
4.
5.

Memory
Language
Visuospatial skills
Personality or mood
Cognition

Clinical Feature
Onset
Course

Duration
Orientation

Behaviour
Alertness
Perceptions
Speech
Memory

Delirium
Sudden, abrupt
Short, diurnal fluctuations of
symptoms
Worse at night, in darkness and upon
awakening
Hours to less than 1 month
Longer if unrecognised and untreated
Usually impaired
Disoriented to time and place
Disorientated to person
Agitated, withdrawn or depressed
Impaired
Hallucinates/illusions
Incoherent, rapid/slowed
Recent and immediate impairment
Unable to recall events of
hospitalisation and current illness
Forgetful
Unable to recall instructions

Dementia
Insidious/slow and often unrecognised
Long, no diurnal effects
Symptoms progressive but stable over
time
Months to years
Intact early; impaired late

Intact early
Normal
Intact early
Word-finding problems
Recent and remote impairment