Heman-Ackah Y, Roses AD. Unfortunately, focal changes are not associated exclusively with delirium or dementia.A full examination should be carried out including in particular the following areas:The following investigations are almost always indicated in patients with acute confusion in order to identify the underlying cause:Other investigations may be indicated according to the findings from the history and examination:Sedation should be avoided if at all possible. Copyright 1994Information from American Psychiatric Association. Together with the history and the physical examination, standardized instruments (followed by periodic reevaluation) are usually sufficient to determine the severity, but not the nature, of an elderly patient's cognitive impairment.The Mini-Mental State Examination (MMSE) is the most widely used method for grading cognitive status The Mini-Mental State Examination. However, family members, including the patient's spouse and adult children, will have individual interpretations of the severity and impact of the patient's cognitive symptoms. Delirium occurs when the normal sending and receiving of signals in the brain become impaired. Baxter LR, Practice parameter for diagnosis and evaluation of dementia. Evans DA. Advisory Panel on Alzheimer's Disease. Positron-emission tomography and Alzheimer's disease [Letter]. Essentials of clinical geriatrics. Moran MB, Delirium and other cognitive impairment in older adults in an emergency department. Pick up the phone if necessary! Fourth report of the Advisory Panel on Alzheimer's Disease, 1992. Patients who lack alertness or have a clouded consciousness are more likely to have delirium than dementia. Avoid polypharmacy. Thyroid dysfunction, vitamin deficiencies and normal-pressure hydrocephalus are some potentially reversible causes of dementia. Bird TD, Managing confusion is challenging because of several factors that are prevalent in the elderly. In Ham RJ, Sloane PD, eds. Document appropriately in the notes. Apolipoprotein E allele epsilon 4, dementia, and cognitive decline in a population sample. Visit our  Chemotherapy , which uses chemicals to kill cancer cells, often affects healthy cells along with cancerous ones. Confusion is a common problem in persons over 65 years of age. Unlocking the mysteries of Alzheimer's disease. Recent research has attempted to qualify the impact of education and other cultural modifiers on the total score. Eckert SK, N Engl J Med 1989;320:578–82Adapted with permission from Ham RJ. Yurgelun-Todd DA, Only after delirium and psychiatric disorders have been ruled out can dementia be diagnosed in an elderly patient with cognitive impairment. Until proved otherwise, the patient should be assumed to have delirium. Arnold SE, The clinical introduction of genetic testing for Alzheimer disease.

SPECT in dementia: clinical and pathological correlation. The diagnostic features of delirium, dementia and depression are listed in Disturbance in consciousness, with a reduced ability to focus, to sustain focus or to shift attentionChange in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established or evolving dementiaDisturbance in consciousness that develops over a short period of time and fluctuates during the course of the dayEvidence from the history, physical examination or laboratory tests that the disturbance in consciousness is the direct physiologic consequence of a general medical condition, substance intoxication or withdrawal, medication or toxin exposure, or a combination of these factorsRapid, unpredictable shifts from one emotional state to anotherMemory impairment and at least one of the following:Impaired executive functioning (e.g., planning, organizing, abstracting)Significant impairment in social or occupational functioningSignificant decline from previous level of functioningDeficits that do not occur exclusively during the course of deliriumOccurrence of five or more of the following for at least two weeks (a change from prior function; one symptom must be either depressed mood or loss of interest or pleasure):Diminished ability to concentrate or make decisionsRecurrent thoughts of death or suicidal ideation, attempts or plansSymptoms not attributable to substance abuse or general medical conditionDisturbance in consciousness, with a reduced ability to focus, to sustain focus or to shift attentionChange in cognition or the development of a perceptual disturbance that is not better accounted for by preexisting, established or evolving dementiaDisturbance in consciousness that develops over a short period of time and fluctuates during the course of the dayEvidence from the history, physical examination or laboratory tests that the disturbance in consciousness is the direct physiologic consequence of a general medical condition, substance intoxication or withdrawal, medication or toxin exposure, or a combination of these factorsRapid, unpredictable shifts from one emotional state to anotherMemory impairment and at least one of the following:Impaired executive functioning (e.g., planning, organizing, abstracting)Significant impairment in social or occupational functioningSignificant decline from previous level of functioningDeficits that do not occur exclusively during the course of deliriumOccurrence of five or more of the following for at least two weeks (a change from prior function; one symptom must be either depressed mood or loss of interest or pleasure):Diminished ability to concentrate or make decisionsRecurrent thoughts of death or suicidal ideation, attempts or plansSymptoms not attributable to substance abuse or general medical conditionDelirium is a transient global disorder of cognition and consciousness.


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