Information for Patients
What is delirium?
Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.
There are three types of delirium:
- Hypoactive, where you are not active and seem sleepy, tired, or depressed
- Hyperactive, where you are restless or agitated
- Mixed, where you change back and forth between being hypoactive and hyperactive
What causes delirium?
There are many different problems that can cause delirium. Some of the more common causes include:
- Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol abuse.
- Dehydration and electrolyte imbalances
- Hospitalization, especially in intensive care
- Infections, such as urinary tract infections, pneumonia, and the flu
- Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be withdrawal after stopping a medicine.
- Metabolic disorders
- Organ failure, such as kidney or liver failure
- Serious illnesses
- Severe pain
- Sleep deprivation
- Surgeries, including reactions to anesthesia
Who is at risk for delirium?
Certain factors put you at risk for delirium, including:
- Being in a hospital or nursing home
- Having a serious illness or more than one illness
- Having an infection
- Older age
- Taking medicines that affect the mind or behavior
- Taking high doses of pain medicines, such as opioids
What are the symptoms of delirium?
The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include:
- Changes in alertness (usually more alert in the morning, less at night)
- Changing levels of consciousness
- Disorganized thinking, talking in a way that doesn't make sense
- Disrupted sleep patterns, sleepiness
- Emotional changes: anger, agitation, depression, irritability, overexcitement
- Hallucinations and delusions
- Memory problems, especially with short-term memory
- Trouble concentrating
How is delirium diagnosed?
Your health care provider may use many tools to make a diagnosis:
- A medical history, which includes asking about your symptoms
- Physical and neurological exams
- Mental status testing
- Lab and diagnostic imaging tests
Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse and can last for hours or weeks. On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable and may last for months or years.
What are the treatments for delirium?
Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:
- Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
- Medicines, including those that control aggression or agitation and pain relievers if there is pain
- If needed, making sure that the person has a hearing aid, glasses, or other devices for communication
Can delirium be prevented?
Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person.
What is dementia?
Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include:
- Language skills
- Visual perception (your ability to make sense of what you see)
- Problem solving
- Trouble with everyday tasks
- The ability to focus and pay attention
It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder which interferes with your daily life.
What are the types of dementia?
The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include:
- Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
- Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
- Frontotemporal disorders, which cause changes to certain parts of the brain:
- Changes in the frontal lobe lead to behavioral symptoms
- Changes in the temporal lobe lead to language and emotional disorders
- Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
- Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.
Other conditions can cause dementia or dementia-like symptoms, including:
- Creutzfeldt-Jakob disease, a rare brain disorder
- Huntington's disease, an inherited, progressive brain disease
- Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
- HIV-associated dementia (HAD)
Who is at risk for dementia?
Certain factors can raise your risk for developing dementia, including:
- Aging. This is the biggest risk factor for dementia.
- Uncontrolled diabetes
- High blood pressure
- Drinking too much alcohol
- Having close family members who have dementia
What are the symptoms of dementia?
The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may:
- Get lost in a familiar neighborhood
- Use unusual words to refer to familiar objects
- Forget the name of a close family member or friend
- Forget old memories
- Need help doing tasks that they used to do by themselves
Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.
Certain types of dementia can also cause problems with balance and movement.
The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.
How is dementia diagnosed?
Your health care provider may use many tools to make a diagnosis:
- A medical history, which includes asking about your symptoms
- A physical exam
- Tests of your thinking, memory, and language abilities
- Other tests, such as blood tests, genetic tests, and brain scans
- A mental health evaluation to see whether a mental disorder is contributing to your symptoms
What are the treatments for dementia?
There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include:
- Medicines may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
- Occupational therapy to help find ways to more easily do everyday activities
- Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
- Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
- Music or art therapy to reduce anxiety and improve well-being
Can dementia be prevented?
Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.