Delirium differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]; Vishal Khurana, M.B.B.S., M.D. [3]


Delirium is differentiated from other causes cognitive dysfunction such as psychiatric Disorders, dementia. Unlike dementia, the course of delirium is reversible with fluctuation in level of consciousness.

Differential Diagnosis

The difference between delirium and similar psychiatric illness
Attributes Delirium Alzheimer disease Depression Psychotic Disorders
Onset Sudden/acute/subacute Gradual Gradual Acute or gradual
Progression Shifts in severity, likely to resolve in days to weeks. Worsens over a period of time Acute or chronic with acute exacerbation Chronic with acute exacerbation
Hallucinations May be present, mostly visual Mostly absent (exceptions: Lewi body dementia) May be present if associated with psychotic features Present
Delusions Fleeting Mostly not present May be present Present
Psychomotar activity Increased or decreased, may shift from increased to decreased states. May or may not change Change Change
Attention Poor attention span and impaired short-term memory Progressive worsening short-term memory. Attention span is likely to be affected in severe cases May be altered May be altered
Consciousness Altered, rapidly shifts Mostly intact until severe stages Normal Normal
Attention Altered, rapidly shifts Mostly intact until severe stages May be altered May be altered
Orientation Altered, rapidly shifts Mostly intact until severe stages Not altered Not altered
Speech Not coherent Errors Slow Normal or pressured
Thought Disorganized Impoverished Normal Disorganized
Perceptions Altered, rapidly shifts Mostly intact until severe stages Normal May be altered
EEG Moderate to severe background slowing Normal or mild diffuse slowing Normal Normal
Reversibility Mostly Very rarely Yes Rarely


Psychiatric Disorders


Other Neurological Disorders

Complete List of Differential Diagnoses


  1. Fong TG, Vasunilashorn SM, Libermann T, Marcantonio ER, Inouye SK (June 2019). "Delirium and Alzheimer disease: A proposed model for shared pathophysiology". Int J Geriatr Psychiatry. 34 (6): 781–789. doi:10.1002/gps.5088. PMC 6830540 Check |pmc= value (help). PMID 30773695.
  2. O'Sullivan R, Inouye SK, Meagher D (September 2014). "Delirium and depression: inter-relationship and clinical overlap in elderly people". Lancet Psychiatry. 1 (4): 303–11. doi:10.1016/S2215-0366(14)70281-0. PMC 5338740. PMID 26360863.
  3. Charlton, B.G; Kavanau, J.L (2002). "Delirium and psychotic symptoms – an integrative model". Medical Hypotheses. 58 (1): 24–27. doi:10.1054/mehy.2001.1436. ISSN 0306-9877.
  4. "Delirium in elderly adults: diagnosis, prevention and treatment".
  5. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK (August 2015). "The interface between delirium and dementia in elderly adults". Lancet Neurol. 14 (8): 823–832. doi:10.1016/S1474-4422(15)00101-5. PMC 4535349. PMID 26139023.
  6. Canevelli M, Valletta M, Trebbastoni A, Sarli G, D'Antonio F, Tariciotti L, de Lena C, Bruno G (2016). "Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches". Front Med (Lausanne). 3: 73. doi:10.3389/fmed.2016.00073. PMC 5187352. PMID 28083535.

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