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Last Stage of Delirium

Delirium is a condition similar to dementia, but unlike dementia it is usually reversible. Delirium occurs when a combination of factors impairs the sending and receiving of signals in the brain. It is an altered mental state, not a disease, and causes loss of attention, concentration and memory. There are two sub-types of delirium: hyperactive, which is an advanced state of agitation, and hypo active where the patient seems confused. During the last stage of delirium the patient becomes sleepy and unresponsive.

  1. Causes

    • Delirium is common among the elderly and in nursing home residents. When delirium occurs in younger patients it is usually as a result of alcohol or drug use. Other causes are dehydration, infection, vitamin deficiency and withdrawal symptoms from drugs or alcohol. Patients in the last stages of terminal illnesses, such as AIDS or cancer often suffer delirium. Several other factors can trigger delirium including stress, sleeping pills, narcotic pain relievers and antidepressants.

    Diagnosis

    • The patient may be unaware of his altered state so a family member or caregiver is usually called on to give a reliable history of symptoms. Unlike dementia, which is a gradual decline, the onset of delirium is swift, taking only a few days or even hours. Symptoms fluctuate through the day but are usually much worse at night and may involve hallucinations and delusions. Physical symptoms include rambling speech and apathy, but with enhanced reflexes. In the last stages of delirium patients become drowsy and unresponsive.

    Treatment

    • When the cause of delirium has been identified it is easy to treat. If the delirium is the result of dehydration, for example, fluids and an electrolyte drip can be administered. Most patients can leave hospital within a few hours but if admitted, general measures such as a calm environment, personal possessions and reassurance, are all helpful. In the last stages of delirium, vigorous stimulation is used to stop the patient slipping into coma.

    Prognosis

    • The sooner delirium is identified, the better the outcome. If the disease is allowed to persist until the final stages a full recovery is less likely and symptoms may persist for weeks or months. In some cases delirium may evolve into dementia or chronic confusion. The healthier a person is at the onset of delirium, the better his chances of complete recovery.

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