Why is delirium so much worse than dementia?

How can anything be worse than dementia? – even Stephen King says that dementia keeps him awake at night. Dementia is a leading cause of death, it is incurable, it robs an individual of their identity, human rights, self-determination; what could be worse?

As a doctor I have long been familiar with the patient who is admitted to hospital, often bed-bound, immobile, unable to feed or toilet themselves, perhaps because of the progression of dementia or a stroke, and, the expression – ‘I’d rather be dead than…’

Now, many of us know that this statement is meaningless as, the only person who can tell you about the experience of immobility, etc., is the person in bed and, yes, some prefer death, but, many are able to redefine life, find meaning in different situations to those that might have been unknown or unrecognised when the person was able-bodied.

I wrote about this last year in relation to people living with Locked-In Syndrome.

So, no, that is not where I am going.

My point relates more to the speed of onset.

Essentially, anyone reading this blog might have dementia. They might have the changes of Alzheimer’s Disease in their brains now. The slow accretion of plaques and neurofibrillary tangles, remorselessly tearing to shreds their self. Yet, this might not manifest for ten or twenty years, when the condition moves from Alzheimer’s Disease to Alzheimer’s Dementia – the point at which the changes affect a person’s ability to function in everyday life.

Delirium however can arise de novo today. I don’t know and, it is impossible to tell who tomorrow will wake delirious. Delirium being a change in perception, orientation, consciousness, mood and behaviour that develops over days and hours, in comparison to dementia which has an progression measured in years and months.

Anyone reading this blog might tonight, on the way home from work or college, develop a fever that leads to delirium with associated loss of capacity and ability to independently function.

Sure, many who become delirious, if treated well, provided the correct specialist treatment will recover, won’t succumb to the underlying disease (e.g. ‘flu), or its consequences (falls, dehydration, brain injury) – yet, some will; a proportion of those who become delirious never recover, sometimes they have been affected by strokes and cerebrovascular disease – we find they have Vascular Dementia (which can only be diagnosed after three months).

Sure, I could wake in the night with a weakness down one side – a stroke; I might have cancer, like I said, I am not comparing like with like. My point is more to demonstrate the relevance of delirium in the spectrum of disease.

Most people have heard and have some sort of mental construct of stroke, cancer, diabetes or asthma, even dementia.

Delirium is different.

It exists in a nebulous realm, not belonging to any specialty – I am probably a deliriumologist, but, what does that mean? I could name a few people, mostly academics who study this field, but they are not as influential or significant a group as those practicing stroke medicine or say, cardiology.

It was World Delirium Day yesterday.

How many of you knew?

Just saying.

hypnopompic hallucination

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