Magazine article Clinical Psychiatry News

Exams Differentiate Delirium from Dementia

Magazine article Clinical Psychiatry News

Exams Differentiate Delirium from Dementia

Article excerpt

SAN FRANCISCO -- Two brief mental state exams can reliably differentiate delirium from dementia in the elderly emergency department patient.

Because delirium usually is caused by an organic illness, confusional symptoms may disappear once the underlying problem is treated, said Dr. Allen Yuen, director of emergency medicine at Epworth Hospital, Melbourne. Dementia, the product of a progressive disease, is largely untreatable.

"Poor differentiation between the confusional states is associated with poor outcomes in the patients, with increased morbidity and mortality, longer hospital stays, and functional decline," he said at the 12th International Conference on Emergency Medicine.

There are three types of confusion in the elderly patient, Dr. Yuen said at the meeting, which was hosted by the American College of Emergency Physicians. Delirium is characterized by the sudden onset of symptoms. Patients may appear either drowsy or agitated. They can exhibit variable short-term memory, poor attention, disorganized thoughts, and even hallucinations.

The underlying causes can range from serious cardiovascular disorders--such as cerebral ischemia, myocardial infarction, and pulmonary embolism--to such seemingly innocuous problems as a urinary tract infection, pain, cold, urinary retention, and constipation.

Dementia is a state of chronic confusion induced by a long-term neurologic illness such as Alzheimer's disease. This is progressive and irreversible. Short-term memory is impaired, and the patient may not be able to perform simple tasks when asked. Language may be impaired. Family members may report aggression or personality changes.

Acute or chronic confusion occurs when a treatable illness, such as infection, brings on acute delirium in a patient with dementia.

A combination of the Confusion Assessment Method (CAM) and the Mini-Mental State Exam (MMSE) is highly effective in differentiating the types of confusion, Dr. Yuen said. "A positive CAM and an MMSE score of more than 25 are strongly predictive of delirium," he said.

CAM has sensitivity of 95%-100% and a specificity of up to 95% for diagnosing delirium in the elderly. …

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