Delirium, Dementia and Neurodevelopmental Disorders
Telling them apart, and caring for cognition
| Delirium | Dementia | Depression | |
|---|---|---|---|
| Onset | Sudden (hours to days) | Gradual (months to years) | Weeks to months |
| Course | Fluctuates, often worse at night | Slowly progressive | Can improve with treatment |
| Attention | Impaired | Normal early | Poor effort ("I don't know") |
| Reversible? | Usually, if the cause is treated | No | Yes |
Delirium is a medical emergency. Screen with the CAM (Confusion Assessment Method).
Delirium: find the cause
- Infection (UTI, pneumonia), medications (anticholinergics, benzodiazepines, opioids), dehydration, low oxygen, pain, urinary retention, constipation, sleep loss, alcohol withdrawal, electrolyte imbalance.
- Prevent and manage: reorientation, glasses and hearing aids, day–night routine, early mobility, family presence, hydration, avoid restraints and benzodiazepines (except alcohol withdrawal).
- Antipsychotics only for severe agitation or danger, short-term.
Dementia care (e.g., Alzheimer's)
- Consistent routine and caregivers; simple one-step instructions; limited choices.
- Don't argue or "quiz"; validate feelings and redirect.
- Wandering: door alarms, ID bracelet, secure unit. Sundowning: light during the day, activity, calm evenings.
- Label rooms; remove hazards; supervise meals and medications.
- Support caregivers (respite, resources).
- Antipsychotics carry a boxed warning: higher risk of death in older adults with dementia.
ADHD
Inattention and/or hyperactivity-impulsivity starting before age 12, in 2 or more settings (home, school). Behavior therapy (first for preschoolers), classroom supports, stimulants or non-stimulants (see Part 1). Consistent rules, short instructions, praise.
Autism spectrum disorder
Differences in social communication + restricted, repetitive behaviors or interests. Screen at 18 and 24 months (M-CHAT). In the hospital: keep routines, warn ahead of changes, reduce noise and light, use visual supports, involve parents, minimize waiting.