Differential points from other processes and syndromes that cause cognitive dysfunction:
- Delirium may be distinguished from psychosis, in which consciousness and cognition may not be impaired (however, there may be overlap, as some acute psychosis, especially with mania, is capable of producing delirium-like states).
- Delirium is distinguished from dementia (chronic organic brain syndrome) which describes an "acquired" (non-congenital) and usually irreversible cognitive and psychosocial decline in function. Dementia usually results from an identifiable degenerative brain disease (for example Alzheimer disease or Huntington's disease). Dementia is usually not associated with a change in level of consciousness, and a diagnosis of dementia requires a chronic impairment.
- Delirium is distinguished from depression.
- Delirium is distinguished by time-course from the confusion and lack of attention which result from long term learning disorders and varieties of congenital brain dysfunction. Delirium has also been referred to as 'acute confusional state' or 'acute brain syndrome'. The key word in both of these descriptions is "acute" (meaning: of ''recent onset''), since delirium may share many of the clinical (i.e., symptomatic) features of dementia, developmental disability, or attention-deficit hyperactivity disorder, with the important ''exception'' of symptom duration.
- Delirium is not the same as confusion, although the two syndromes may overlap and be present at the same time. However, a confused patient may not be delirious (an example would be a stable, demented person who is disoriented to time and place), and a delirious person may not be confused (for example. a person in severe pain may not be able to focus attention, but may be completely oriented and not at all confused).
It is a corollary of the above differential criteria that a diagnosis of delirium ''cannot'' be made without a previous assessment or knowledge of the affected person's ''baseline'' level of cognitive function.
Several valid and reliable rating scales now exist which can be used to accurately diagnose delirium by trained individuals. www.icudelirium.org
Further Reading
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