an article of Lucia Pardo Ramilo
Health psychologist specializing in the field of aging
What we now know as Acute Confusion Syndrome (ACS) is what until recently was called delirium tremens. Although this term has been associated with the symptoms that appear after alcohol withdrawal, its causes may be other, and it should be differentiated from the presence of a neurodegenerative disease like dementia.
Dementia refers to a set of symptoms caused by brain dysfunction, which leads to impaired cognition and emotion, altering the affected person’s social and occupational functioning. Within this label we can fit different types of dementia, depending on the cause that originates it. This will determine the presence of one or the other symptoms.
The SCA is a picture of symptoms that begin suddenly, in a matter of hours or days, and that can fluctuate throughout the day. This syndrome is characterized by an acute disturbance of attention. This means that the ability to pay attention to the environment has suddenly been affected.
In addition, in the ACS an alteration of the cognitive functions can be produced. Symptoms such as disorientation (temporary, spatial or personal), memory deficits or language alterations may appear. Along with these are hallucinations (for example, visual hallucinations, which can cause the person to see objects or people that are not actually present) or delusions (for example, extravagant thoughts or memories about situations that have not occurred).
Along with the symptoms described, ACS is usually accompanied by other disorders. Characteristics of this syndrome are sleep disturbances such as insomnia – manifested as difficulty falling asleep or waking up markedly early -, motor disturbances such as wandering -walking without a specific objective- and emotional disturbances such as lability.
What is the cause of ACS?
The SCA can be motivated by different causes, such as intoxication or withdrawal of substances (for example, alcohol), medical illnesses or exposure to toxins (for example, the over-ingestion of a drug or its side effects). Once the cause is adequately treated, the symptoms disappear in a short space of time, making it a defining characteristic of ACS that it is reversible.
This syndrome is very common among older people. Among this population group, the causes that give rise to this syndrome are usually medical conditions (for example, urinary or respiratory infections), the side effects of a drug or prolonged hospitalizations.
How can we differentiate it from the onset of dementia?
It is important to know how we can differentiate the appearance of an Acute Confusional Syndrome from the onset of a neurodegenerative disease such as dementia. Paying attention to different aspects of the appearance and evolution of symptoms can help us.
1. Appearance of symptoms
The onset of an ACS will always be sudden, that is, its appearance is sudden. In a matter of hours or days the entire picture of symptoms described will appear. However, in the case of dementia, the onset of symptoms will be progressive and insidious; it may take months or even years for such a variety of symptoms to occur. In this way, the symptoms will appear little by little, never all at the same time.
2. Duration
As stated above, in the case of ACS the symptoms are reversible. In other words, once their cause is addressed, they will progressively disappear. If we were in the presence of a neurodegenerative disease, this would not be the case.
3. Cause
The origin of a dementia is found in a dysfunction at the brain level, of different types and locations depending on the disease in question. This will be what gives rise to the appearance of symptoms. However, as indicated above, the origin of ACS can be found in a general medical condition such as an infection, substance use or withdrawal, or medication side effects. As we said, these causes are reversible.
4. Attention and concentration
In ACS, attention span is suddenly and markedly affected; the person has great difficulty paying attention to her surroundings, noting that he cannot concentrate on the same task or follow the thread of a conversation. In the case of dementia, this can also occur but its onset is not sudden and occurs in more advanced stages of the disease.
5. Language
ACS can give rise to language disorders such as dysarthria, causing great difficulty in articulating words. Neurodegenerative diseases can also give rise to linguistic difficulties, but these will be of another type, such as aphasia (difficulties expressing a complex linguistic construction, understanding or naming objects).
6. Hallucinations
Visual hallucinations (seeing an object or person that is not really there) or auditory (hearing non-existent voices or noises) are very common and striking in a picture of SCA. Like the rest of the symptoms, they will appear suddenly, in a matter of hours or days. In the case of dementias, hallucinations can also occur, but generally they will do so in later stages of the disease and their onset will be insidious.
These guidelines can help differentiate ACS from dementia. The same symptoms can occur in one box or another, but their appearance, evolution and cause will be very different. In this sense, it is of vital importance perform a thorough scan of the person suffering from symptoms such as those described by a multidisciplinary team.
Within this team, the psychogerontologist, expert psychologist in the area of aging. Their role will be to interview family members and the patient in order to clarify the appearance and evolution of the symptoms, as well as possible events or circumstances related to them, and to evaluate the different cognitive areas in order to establish the profile of symptoms that the person presents. elderly.
About the author: Lucía Pardo Ramilo
Lucia Pardo Ramilo is a Health Psychologist, collegiate M-32383 and specialized in the field of aging through the Master in Psychogerontology. She is a member of the Spanish Association of Psychogerontology – and she carries out her work as a psychogerontologist in a center for the prevention and treatment of Alzheimer’s.
She is the author of the blog a platform through which he spreads his enthusiasm for topics related to psychology and aging, through posts focused on psychology in general, psychogerontology and professional practice.