Delirium: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate delirium:

Leading symptoms

  • Cognitive disturbance (memory impairment) with impaired perception (disorientation), fluctuating over hours/days
  • Attention deficit
  • Restriction of perception, speech, etc. to varying degrees.
  • Altered sleep-wake rhythm, ie reversal of the day-night rhythm.
  • (Optical) hallucinations, delusions.
  • Affective disorders

Signs of hypoactive delirium

  • Withdrawn into himself
  • Apathy (apathy)
  • Psychomotor slowed
  • Change to the hyperactive form at any time

Signs of hyperactive delirium

  • Agitation (pathological restlessness)
  • Increased wakefulness
  • Hallucinations
  • Often with autonomic instability
  • Switch to the hypoactive form at any time

Confusion Assessment Method (CAM; version: Short)

If items 1, 2, and additionally 3 or 4 are affirmed, delirium is present:

  1. Acute onset, fluctuating course.
  2. Disturbance of attention
  3. Thinking disorders
  4. Quantitative disorder of consciousness.

Warning signs (red flags)

  • Anamnestic information:
    • Age <65 years of age (delirium is extremely rare at this age!).
    • Neurological pre-existing conditions (e.g. dementia).
    • Psychiatric pre-existing conditions (eg, psychosis).
    • Trauma, especially traumatic brain injury (TBI).
    • Alcohol dependence
    • Drug use
    • Polypharmacy (> 6 prescribed medications).
  • Hyper- and hypoglycemia
  • Central cyanosis → emergency!

Differential diagnosis: senile delirium versus dementia

Symptoms Age delir Dementia
Psychiatric history Mostly unremarkable often inconspicuous
Symptom onset subacute insidious
Short-term symptom progression, with the following symptoms: Fluctuating stable
  • Attention Deficit Disorder
 frequent initially not
  • Awareness
 Modified clear
  • Memory disorder / orientation disorder
 frequent depending on severity
  • Psychomotor disorders
 Acting or hypoactive possible
  • Perceptual disturbances / hallucinations
 Frequent possible
  • Insomnia (sleep disturbance)
 Frequent possible

Symptoms of delirium tremens (alcohol withdrawal delirium)

  • Predelir – transient hallucinations or startle, sleep disturbances, sweating, tremor.
  • Full delirium – impaired consciousness, hyperarousal, hallucinations, vegetative symptoms (hypertension/high blood pressure, tachycardia (heartbeat too fast: > 100 beats per minute), sweating, tremor/shaking)
  • Life-threatening delirium – additional severe disturbances of consciousness, cardiac arrhythmias, shock, pneumonia (pneumonia), hepatic/renal insufficiency (liver/kidney weakness), multiple organ failure (MODS, multiple organ dysfunction syndrome; MOF: multiple organ failure; simultaneous or sequential failure or severe functional impairment of various vital organ systems of the body)