Diagnosis

A health care provider can diagnose delirium based on medical history and tests of mental status. The provider also will consider factors that may have caused the disorder. An exam may include:

  • Medical history. The provider will ask what changed in the last few days. Is there a new infection? Did the person begin a new medicine? Was there an injury or new pain such as chest pain? Did headaches or weakness occur? Did the person use alcohol or a legal or illegal drug?
  • Mental status review. The provider starts by testing awareness, attention and thinking. This may be done by talking with the person. Or it may be done with tests or screenings. Information from family members or caregivers can be helpful.
  • Physical and neurological exams. A physical exam checks for signs of health problems or disease. A neurological exam checks vision, balance, coordination and reflexes. This can help determine if a stroke or another disease is causing the delirium.
  • Other tests. The health care provider may order blood, urine and other tests. Brain-imaging tests may be used when a diagnosis can't be made with other information.

Treatment

The first goal of delirium treatment is to address any causes or triggers. That may include stopping certain medicines, treating an infection or treating an imbalance in the body. Treatment then focuses on creating the best setting for healing the body and calming the brain.

Supportive care

Supportive care aims to prevent complications. Here are steps to take:

  • Protect the airway
  • Provide fluids and nutrition
  • Assist with movement
  • Treat pain
  • Address a lack of bladder control
  • Avoid the use of physical restraints and bladder tubes
  • Avoid changes in surroundings and caregivers when possible
  • Include family members or familiar people in care

Medications

If you're a family member or caregiver of someone who has delirium, talk with the health care provider about medicines that may trigger the symptoms. The provider may suggest that the person avoid taking those medicines or that a lower dose is given. Certain medicines may be needed to control pain that's causing delirium.

Other types of medicines may help calm a person who is agitated or confused. Or medicines may be needed if the person is showing distrust of others, is fearful or is seeing things that others don't see. These medicines may be needed when symptoms:

  • Make it hard to perform a medical exam or provide treatment
  • Put the person in danger or threaten the safety of others
  • Don't lessen with other treatments

When symptoms resolve, the medicines are usually stopped or are given in lower doses.

Coping and support

If you're a relative or caregiver of someone who is at risk of delirium, you can take steps to prevent an episode. If you take care of someone who is recovering from delirium, these steps can help improve the person's health and prevent another episode.

Promote good sleep habits

To promote good sleep habits:

  • Provide a calm, quiet setting
  • Use inside lighting that reflects the time of day
  • Help the person keep a regular daytime schedule
  • Encourage self-care and activity during the day
  • Allow for restful sleep at night

Promote calmness and orientation

To help the person remain calm and aware of their surroundings:

  • Provide a clock and calendar and refer to them during the day
  • Communicate simply about any change in activity, such as time for lunch or time for bed
  • Keep familiar and favorite objects and pictures around, but avoid a cluttered space
  • Approach the person calmly
  • Identify yourself or other people
  • Avoid arguments
  • Use comfort measures, such as touch, if they help
  • Reduce noise levels and other distractions
  • Provide eyeglasses and hearing aids

Prevent complicating problems

To help prevent medical problems:

  • Give the person the proper medicines on schedule
  • Provide plenty of fluids and a healthy diet
  • Encourage regular physical activity
  • Get prompt treatment for potential problems, such as infections

Caring for the caregiver

Caring for a person with delirium can be scary and exhausting. Take care of yourself too.

  • Consider joining a support group for caregivers.
  • Learn more about the condition.
  • Ask for pamphlets or other resources from a health care provider, nonprofit organizations, community health services or government agencies.
  • Share caregiving with family and friends who are familiar to the person so you get a break.

Organizations that may provide helpful information include the Caregiver Action Network and the National Institute on Aging.

Preparing for your appointment

If you're the relative or primary caregiver of a person with delirium, you'll likely play a role in making an appointment or providing information to the health care provider. Here's some information to help you get ready for the appointment and know what to expect.

What you can do

Before the appointment, make a list of:

  • All medicines the person takes. That includes all prescriptions, medicines available without a prescription and supplements. Include the doses and note any recent medicine changes.
  • Names and contact information of any person who provides care for the person with delirium.
  • The symptoms and when they started. Describe all symptoms and any changes in behavior that began before the delirium symptoms. They might include pain, fever or coughing.
  • Questions you want to ask the care provider.

What to expect from the doctor

A health care provider is likely to ask several questions about the person with delirium. These may include:

  • What are the symptoms and when did they begin?
  • Is there or was there a recent fever, cough, urinary tract infection or sign of pain?
  • Was there a recent head injury or other trauma?
  • What were the person's memory and other thinking skills like before the symptoms started?
  • How well did the person perform everyday activities before the onset of symptoms?
  • Can the person usually function independently?
  • What other medical conditions have been diagnosed?
  • Are prescription medicines taken as directed? When did the person take the most recent dose of each?
  • Are there any new medicines?
  • Do you know if the person recently used drugs or alcohol? Does the person have a history of alcohol or drug misuse? Is there any change in the pattern of use, such as increasing or stopping use?
  • Has the person recently appeared depressed, extremely sad or withdrawn?
  • Has the person shown signs of not feeling safe?
  • Are there any signs of paranoia?
  • Has the person seen or heard things that no one else does?
  • Are there any new physical symptoms — for example, chest or stomach pain?

The provider may ask additional questions based on your responses and the person's symptoms and needs. Preparing for these questions helps you make the most of your time with a provider.

By Mayo Clinic Staff