an article of Lucia Pardopsychologist specializing in the field of aging and author of the blog
What has classically been calleddelirium» or «delirium tremens» is what we currently call acute confusional syndrome. It’s about a transient syndrome, which is highly common among older people or people suffering from alcoholism. Its main feature is a clear altered consciousness and of the Cognitive abilitieswhich can alert us and lead to confusion with the onset of dementia or any other neurological pathology. These alterations can be very diverse, highlighting:
- altered consciousness: the person who suffers from this syndrome is not aware of what is happening, that their symptoms are abnormal, showing clear difficulty in paying attention to their surroundings and to those tasks they are trying to perform.
- Memory problems: for example, difficulties to remember a recent event, or to recognize an unfamiliar person.
- Temporal and/or spatial disorientation: for example, difficulty knowing what day of the week or what time it is, problems remembering if you have already eaten or not, if it is in the morning or in the afternoon, etc.; Difficulties to recognize where they are, to know if they are at home or not, in which town or city, etc. are also characteristic.
- hallucinations: erroneous perceptions that are interpreted as real by the person, such as seeing a person who is not really there, misrecognition of certain objects, seeing unreal animals or objects, hearing sounds that are not really taking place, etc.
- delusional ideas: distorted beliefs that are totally real for the person who suffers them, such as believing that an event has occurred that has not really taken place, thinking that other people want to deceive or steal, mistrust others for fear of this deception, etc. .
These cognitive alterations fluctuate throughout the day, showing a worsening at certain times of the day.
In addition to these symptoms, symptoms are also usually present in sleep, as well as at a psychomotor and emotional level:
- sleep disturbances: sleep-wake cycle problems, such as difficulty sleeping at night, extreme sleepiness during the day, waking up early, etc.
- psychomotor alterations: such as psychomotor agitation, erratic wandering, disordered behavior, etc.
- emotional disturbances: for example, great emotional lability or altered emotional expression.
Another characteristic of this syndrome is that it is acute in nature, which means that it occurs in a short period of time (in hours or days). That is to say, it does not have an insidious, progressive onset, but rather appears “suddenly”.
The main causes of confusional syndrome may be a general medical condition, substance intoxication or withdrawal (for example, alcohol), or exposure to toxins (for example, drug side effects or drug overdose). The fact that these are the causes of this syndrome makes it transient and reversible.
In older people, common causes of acute confusional syndrome are medical conditions (for example, urinary or respiratory infections), prolonged hospitalization, or ingestion of certain drugs.
How to differentiate it from the beginning of a dementia?
The symptoms described can make us think about the similarity of this syndrome with the onset of dementia, or with other pathologies at the cognitive level. However, the following defining points can help us differentiate one thing from the other.
- Start
As we have seen, the confusional syndrome is characterized by an acute, sudden onset. That is to say, in a matter of hours or days all this picture of symptoms appears. However, in the case of dementia, its onset is usually progressive, “little by little”, taking even years for such a varied picture of symptoms to appear.
- Duration
Taking into account the possible causes of the confusional syndrome, its duration will tend to be short, as long as the problem that originates it lasts. Therefore, this syndrome is also reversible: once the cause is resolved, the person returns to their usual cognitive and general state. However, dementia is a progressive neurodegenerative disorder, which worsens over time, and which may last for years.
- Cause
The confusional syndrome finds its origin in some of the causes described above, so we must be attentive, given the symptoms, to see if any of the different options may be motivating the condition. In the case of dementia, this cause is found at the brain level, in the substances that handle information in it (neurotransmitters) and, ultimately, in some cases in the genes.
- Attention
The attentional capacity of the person with confusional syndrome is already altered from the outset. She appears distracted, with great difficulties to maintain attention and concentrate on what she is doing, as well as to interact appropriately with her environment. In the case of dementia, on the contrary, the person initially appears well connected with their environment.
- psychomotor restlessness
Restlessness and nervousness are characteristic symptoms of confusional syndrome, even accompanied by tremor and erratic behaviors (such as walking for no apparent reason, carrying out behaviors without purpose, etc.). In the case of dementia, this type of behavior does not usually occur in the initial phases.
- hallucinations
In the early stages of dementia, hallucinations are not common, but rather are characteristic of advanced stages of the disease. In the case of confusional syndrome, they are quite common, especially those of a visual type.
These aspects can help us differentiate between the beginning of a insane process or a acute confusional syndrome. Although some of these symptoms may occur in dementia, they do not in the early stages.
About the author: Lucia Pardo
Lucia Pardo She is a psychologist, graduated from the University of Santiago de Compostela, and specialized in the field of aging with a Master’s Degree in Psychogerontology. She currently continues to train through different courses and is completing the Master’s Degree in General Health Psychology at UNED.
She is the author of the blog a platform through which its author spreads her enthusiasm for topics related to psychology through posts focused on psychology in general, psychology within the field of aging and professional practice.