When Delirium Is Mistaken for Dementia

We hope you had a chance to read “No Country for Old Women,” yesterday’s moving post by AJN associate editor Amy Collins, in which she described the failure of multiple providers to assess and treat the underlying cause of her grandmother’s rapid acceleration of already existent dementia symptoms (or what were assumed to be dementia symptoms).

It so happens that several years ago we ran an article on a frequently undiagnosed condition in older adults; the article was called “Delirium Superimposed on Dementia.” Maybe this is why two of our nurse editors were able to point Amy in the right diagnostic direction as to possible hidden causes of her grandmother’s crisis. Here’s an excerpt from that article:

A systematic review . . . found that prevalence rates of delirium in people with dementia ranged from 22% among older adults who lived in the community to 89% in hospitalized patients . . .  It’s more difficult to recognize delirium in people with dementia than in those without because of overlapping symptoms, difficulty in ascertaining baseline mental status and the acuteness of symptoms, and the tendency to attribute symptoms of delirium to a worsening of dementia symptoms.⁴ Yet early recognition is essential in order to determine and treat underlying causes; institute interventions to maintain safety;

[and] restore prior cognitive function and improve short- and long-term outcomes.

The article gives a useful algorithm for recognizing as well as managing this condition. There’s also a video which discusses the condition and shows a nurse working with an actual patient (you have to enter your e-mail address to get to it). Reading Amy’s account of her grandmother’s experience, one can’t help wondering if any of the physicians who assessed her had ever even heard of this condition, or knew to look for it. With older patients more and more the norm in hospitals, it’s time for nurses to lead the way in educating others about this condition so it no longer goes unnoticed. As the authors point out, “acuteness, fluctuation, inattention, and altered level of consciousness are not normal in people with dementia, and their presence should trigger further assessment and treatment.”—JM, senior editor/blog editor