What Doctors Should Evaluate When Someone With Dementia Becomes Delirious
If you've reported to a doctor or nurse that a loved one with dementia seems more confused than usual or is showing other signs of delirium, the correct next step is to make sure the person is evaluated by a doctor as soon as possible, ideally the same day.
Here's what a thorough medical evaluation will likely cover when delirium is suspected in someone with dementia.
Remember that you're a key participant in the process, because you can supply important information that the doctor won't know and your loved one may not be able to convey. If some of the following points are overlooked in a medical evaluation, don't be shy about asking the doctor why.
1. The doctor should assess for underlying illnesses.
Why: In some people with dementia, delirium may be the only outward sign of an underlying illness. Just about any physical problem that stresses the body can cause delirium in a person with dementia.
To check for illness, the doctor will take a medical history and do a basic physical -- and will also usually:
Check for signs of infection, such a urinary tract infection (UTI) or pneumonia.
Assess blood pressure, pulse, breathing rate, and blood oxygen level, which can help determine whether a problem with the heart or lungs is at the root of things. Blood pressure and pulse rate can also provide clues to whether dehydration might be present.
Possibly order an EKG and/or chest X-rays. This step depends on whether the clinician thinks it's medically indicated and whether another likely cause of delirium has been found (such as signs of UTI on a urine dipstick).
What can be done: If an illness is the main cause of delirium, treatment of the problem usually helps improve the sick person's mental state. (Even after successful treatment of an illness, however, it can still take days or even longer for the person's mental state to get back to what's normal for him or her.)
2. The doctor should assess for excessive pain or other discomfort.
Why: Unresolved pain is another reason the body can be stressed to the point of delirium. The doctor will explore for possible causes of pain:
Was there a fall? Are there signs of injury? Falling down sometimes causes unrecognized fractures that cause pain. Dementia may cause the person to forget the incident and -- except when moving a certain way -- the pain, which means he or she doesn't mention it and suffers unnecessarily.
Could the person be constipated? Constipation, too, can create pain that a person with dementia is unable to connect to bowel habits, or even articulate. In older men with enlarged prostates, urinary retention can lead to severe pain.
What can be done: Many causes of pain, such as fractures and constipation, can be treated, easing some of the pain over time. Meanwhile, carefully prescribed painkillers can ease the physical stress of pain and help resolve the delirium.
