Delirium Superimposed on Dementia

Abstract

Delirium and dementia, two common geriatric syndromes, can present with similar symptoms and can share some physiopathological and clinical interrelationship. Delirium superimposed on dementia (DSD) is considered as an acute change in mental status, such as a fluctuating course, inattention, and either disorganized thinking or changes in consciousness that is observed in elderly patients with dementia. DSD tends to have significantly higher mortality risk, more institutionalization, rehospitalization, and cognitive and functional decline than delirium without dementia. DSD is usually underrecognized, misdiagnosed, and undertreated, most generally due to it natural course and behavioral and psychological symptoms. Prevention and treatment of DSD is similar to delirium without dementia, but it is much more important to develop primary and secondary prevention; therefore, keeping close contact with the patient; providing adequate vision, hearing, nutrition, hydration, and sleep; informing the caregivers about delirium to recognize early symptoms; mobilizing the patient as early as possible; and managing the pain are strongly recommended, as well as identifying all underlying medical conditions. If non-pharmacological interventions are considered insufficient, pharmacologic therapy should be implemented.