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Presentation: Demographics, onset of symptoms, history of present illness,
associated risk factors
Dementia and delirium are both conditions that present a challenge to a person’s
functional capacity, however, they contrast in their pathophysiology, presentation,
duration, and treatment methods. It is important to note that both conditions have the
possibility of overlapping symptoms which can present a diDiculty in diagnosing. Delirium
is acute and temporary that can be triggered by an underlying condition such as a urinary
tract infection, medication eDects, or an electrolyte imbalance. Whereas dementia is an
irreversible chronic progressive disorder that presents with degeneration of cognitive
decline including memory, functional reasoning, and communication. Those with
underlying dementia are at an increased risk of delirium. Additional risk factors include
age, gender, and socioeconomic status. Looking at the history of present illness for both
conditions, it is most important to gain understanding in the timeline for presenting
symptoms. Delirium typically is an acute presentation of lack of attention and awareness
over days to weeks, whereas dementia is a progressive overall cognitive decline over
months to years (Jandu et al., 2025).
Pathophysiology: Similarities and di9erences in pathophysiology
Dementia and delirium are the most common causes for presenting altered mental status
within emergency departments. However, their etiologies diDer greatly. Delirium is likely an
eDect from precipitating factors such as medication, acute illness, infections, and
exacerbation of chronic medical conditions (Jandu et al., 2025). Conversely, dementia is a
neurodegenerative process that is characterized by the accumulation of misfolded
proteins, cerebrovascular disease, and other neuropathology (Chin, 2023). Similarities as
previously mentioned include a person with underlying dementia having a delirium episode
due to possible multifactorial causes.
Assessment: Physical assessment techniques, appropriate diagnostic testing
Physical assessment including a full neurological exam from the patient alone can provide
symptoms that may present in both disorders supporting in a nonspecific diagnosis as
symptoms of both disorders can coexist. This accentuates the importance of gaining
history from the patient’s family members or caretakers. Assessments for delirium include
the Memorial Delirium Assessment Scale, and the Delirium Rating Scale (DRS/DRS-98)
(Buttaro et al., 2020). For dementia evaluation, cognitive testing such as Mini Mental State
Examination (MMSE), Mini-Cog, and the Katz Index of Independence in Activities of Daily
Living can provide insight to aid in exclusion. Additionally, labs including a CBC, TSH,
vitamin B12, folate, and a metabolic screening help to exclude other potential causes of
cognitive issues. If the patient has a history of taking medications such as digoxin,
carbamazepine, theophylline, Depakote, a measurable level should be ordered (Buttaro et
al., 2020). Imaging necessary to aid in diagnosis include a non-contrast CT scan or an MRI.
Diagnosis: Additional di9erential diagnoses to consider, positive findings for each
diagnosis
Alcoholic dementia, liver disease, hypothyroidism, hypoglycemia, adrenal insuDiciency,
Cushing disease, vitamin deficiencies including thiamine, b12, and folic acid, traumatic
injury, infectious disease such as viral encephalopathy, Alzheimer dementia, vascular
dementia, neurosyphilis, Creutzfeldt-Jakob disease, and Parkinson’s disease are all
potential diDerentials for both conditions.
Management: Similarities and di9erences in pharmacologic and nonpharmacologic
treatments, client education, referral, and follow-up care
For both dementia and delirium, depending on the stage of development helps facilitates
the treatment protocol. The goal of management is to treat all correctable factors that may
inhibit cognition, promote activities that enhance cognition, address safety concerns, and
look into potential pharmacological management. Dementia diagnoses require more
interprofessional collaborative management since there is no cure of the disease process
and is a degenerative disorder that worsens with age. Pharmacological treatment for
dementia may include cholinesterase inhibitors, and NMDA (N-methyl-D-aspartate)
receptor antagonists. Non-pharmacologic treatment include cognitive behavioral therapy
(CBT).
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