Overview
Delirium and dementia are distinct but related cognitive disorders that often affect older adults. Delirium is an acute and reversible change in mental status, while dementia is a chronic and progressive decline in cognitive function. In Korea, early diagnosis and management at hospitals like Seoul National University Hospital, Asan Medical Center, and Samsung Medical Center are critical for improving outcomes, preventing complications, and supporting patients and families.
What is Delirium and Dementia?
- Delirium is an acute syndrome marked by confusion, reduced awareness, and fluctuating cognitive function, often triggered by medical illness, medications, or surgery.
- Dementia is a chronic, progressive decline in memory, thinking, and reasoning skills, affecting daily life. Common types include Alzheimer’s disease, vascular dementia, and Lewy body dementia.
While both conditions can coexist, delirium is often reversible, whereas dementia generally requires long-term management.
Symptoms
- Sudden confusion or disorientation (delirium)
- Memory loss and difficulty remembering recent events (dementia)
- Difficulty focusing or paying attention
- Fluctuating levels of consciousness (delirium)
- Impaired judgment and reasoning
- Behavioral changes, agitation, or aggression
- Hallucinations or delusions in advanced stages
- Sleep disturbances
Causes
- Delirium: infections, metabolic imbalances, medications, surgery, dehydration
- Dementia: neurodegenerative diseases (Alzheimer’s, Parkinson’s), vascular damage, brain injury, chronic illness
- Shared risk factors: advanced age, polypharmacy, sensory impairments, and chronic health conditions
Risk Factors
- Age over 65 years
- Pre-existing cognitive impairment or dementia
- Hospitalization or ICU admission
- Multiple medications or sedatives
- Chronic illnesses such as heart disease, diabetes, or kidney disease
- Sensory impairments (hearing or vision loss)
Complications
- Increased risk of falls and injuries
- Extended hospital stays and higher healthcare costs
- Emotional distress for patients and caregivers
- Accelerated cognitive decline if delirium episodes occur in dementia patients
- Loss of independence and functional decline
Prevention
- Regular cognitive screenings in older adults
- Maintaining hydration, nutrition, and proper sleep
- Minimizing unnecessary medications and sedatives
- Early treatment of infections and medical illnesses
- Providing orientation aids and supportive environments
- Physical activity and social engagement
Treatment Options in Korea
Management focuses on treating underlying causes, supportive care, and slowing cognitive decline.
- Diagnosis
- Clinical assessment and history taking
- Cognitive tests such as MMSE (Mini-Mental State Examination) or MoCA (Montreal Cognitive Assessment)
- Blood tests, imaging (CT/MRI), and medication review
- Screening for reversible causes of cognitive impairment
- Medical Treatments
- Delirium: addressing infections, correcting metabolic imbalances, adjusting medications
- Dementia: cholinesterase inhibitors, memantine, and management of behavioral symptoms
- Pain management and treatment of coexisting medical conditions
- Supportive Care
- Orientation tools (clocks, calendars, familiar objects)
- Structured routines and cognitive stimulation
- Physical therapy to maintain mobility
- Counseling and support for caregivers
- Specialized Hospitals in Korea
- Seoul National University Hospital – Geriatric and neuropsychiatry care
- Asan Medical Center – Cognitive disorder clinics and rehabilitation
- Samsung Medical Center – Multidisciplinary care for delirium and dementia
- Community centers and day-care programs for long-term cognitive support
- Long-Term Follow-Up
- Regular cognitive assessments and monitoring
- Management of comorbidities to prevent delirium episodes
- Ongoing caregiver education and support
- Adaptation of living environments to ensure safety and independence
