Overview
Causes of Delirium
Effects of Delirium on the Patient, Family, and Healthcare Providers
Diagnosis of Delirium
Treatment of Delirium

Treatment of the Symptoms of Delirium by Changing the Patient's Surroundings Treatment of the Causes of Delirium Treatment of the Symptoms of Delirium with Medication Delirium and Sedation

Changes to This Summary (06/22/2004)
Questions or Comments About This Summary
To Learn More
About PDQ

Overview

Delirium is a cognitive (mental) disorder.

Delirium often occurs suddenly and the patient's symptoms may come and go throughout the day. People experiencing delirium may fall in and out of consciousness and may have problems with the following:

• Attention.
• Thinking.
• Awareness.
• Emotion.
• Memory.
• Muscle control.
• Sleeping and waking.

Delirium occurs frequently in cancer patients, especially in patients with advanced cancer.

Delirium is often reversible, even in people with advanced illness. In the last 24 to 48 hours of life, however, delirium may not be reversible due to problems such as organ failure.

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Causes of Delirium

Delirium may be a complication of cancer and cancer treatment, especially in people with advanced cancer.

Delirium may be due to the direct effects that cancer has on the brain, such as the pressure of a growing tumor. Delirium may also be caused by indirect effects of cancer or its treatment, including the following:

• Organ failure.
• Electrolyte imbalances: Electrolytes are important minerals (including salt, potassium, calcium, and phosphorous) that are needed to keep the heart, kidneys, nerves, and muscles working correctly.
• Infection.
• Medication side effects: Patients with cancer usually take many medications. Some drugs have side effects that include delirium and confusion. The effects of these drugs usually go away after the drug is stopped.
• Withdrawal from drugs that depress (slow down) the central nervous system (brain and spinal cord).

Risk factors for delirium include having a serious disease and having more than one disease.

Risk factors include the following:

• Advanced cancer or other serious illness.
• Having more than one disease.
• Older age.
• Previous mental disorder, such as dementia.
• Low levels of albumin (protein) in the blood.
• Infection.
• Taking medications that affect the mind or behavior.
• Taking high doses of pain medication.

Early identification of risk factors may help prevent the onset of delirium or may reduce the length of time it takes to correct it.

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Effects of Delirium on the Patient, Family, and Healthcare Providers

Delirium can be upsetting to the patient's family and caregivers.

Delirium can be upsetting to the family and caregivers, and may be dangerous to the patient if judgment is affected. Delirium can cause the patient to act unpredictably and sometimes violently. Even a quiet or calm patient can suddenly experience a change in mood or become agitated, requiring increased care. The safety of the patient, family, and caregivers is most important.

Delirium may affect physical health and communication.

Patients with delirium are more likely to fall, be incontinent (unable to control bladder and/or bowels), and become dehydrated (drink too little water to maintain health). They often require a longer hospital stay than patients without delirium.

Delirium may hinder communication between the patient and the family, and between the patient and the healthcare providers. Assessment of the patient's symptoms becomes difficult and the patient may be unable to make decisions regarding care. Agitation in the delirious patient may be mistaken as an expression of pain. Conflict can arise among the patient, family, and staff concerning the level of pain medication needed.

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Diagnosis of Delirium

Possible signs of delirium include sudden personality changes, impaired thinking, or unusual anxiety or depression.

A patient who suddenly becomes agitated or uncooperative, experiences personality or behavior changes, has impaired thinking, decreased attention span, or intense, unusual anxiety or depression, may be experiencing delirium. Patients with early-stage cancer who develop symptoms of delirium need to be assessed completely. Delirium in early-stage cancer may indicate that the cancer is affecting the brain.

The symptoms of delirium are similar to symptoms of depression and dementia.

Early symptoms of delirium are similar to symptoms of anxiety, anger, depression, and dementia. Delirium that causes the patient to be very inactive may appear to be depression. Delirium and dementia are difficult to tell apart, since both may cause disorientation and impair memory, thinking, and judgment. Dementia may be caused by a number of medical conditions, including Alzheimer's disease. Some differences in the symptoms of delirium and dementia include the following:

• Patients with delirium often go in and out of consciousness. Patients who have dementia usually remain alert.
• Delirium may occur suddenly. Dementia appears gradually and gets worse over time.
• Sleeping and waking problems are more common with delirium than with dementia.

In elderly patients who have cancer, dementia is often present along with delirium, making diagnosis difficult. The diagnosis is more likely dementia if symptoms continue after treatment for delirium is given.

Regular screening of the patient and monitoring of the patient's symptoms can help in the diagnosis of delirium.

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Treatment of Delirium

Patient and family concerns are addressed when deciding the treatment of delirium. Deciding if, when, and how to treat a person with delirium depends on the setting, how advanced the cancer is, the wishes of the patient and family, and how the delirium symptoms are affecting the patient.

Monitoring alone may be all that is necessary for patients who are not dangerous to themselves. In other cases, symptoms may be treated or causes of the delirium may be identified and treated.

Controlling the patient's surroundings may help reduce mild symptoms of delirium. The following changes may be effective:

• Putting the patient in a quiet, well-lit room with familiar objects.
• Placing a clock or calendar where the patient can see it.
• Reducing noise.
• Having family present.
• Limiting changes in caregivers.

To prevent a patient from harming himself or herself or others, physical restraints also may be necessary.

The standard approach to managing delirium is to find and treat the causes. Symptoms may be treated at the same time. Identifying the causes of delirium will include a physical examination to check general signs of health, including checking for signs of disease. A medical history of the patient’s past illnesses and treatments will also be taken. In a terminally ill delirious patient being cared for at home, the doctor may do a limited assessment to determine the cause or may treat just the symptoms.

Treatment may include the following:

• Stopping or reducing medications that cause delirium.
• Giving fluids into the bloodstream to correct dehydration.
• Giving drugs to correct hypercalcemia (too much calcium in the blood).
• Giving antibiotics for infections.

Drugs called antipsychotics may be used to treat the symptoms of delirium. Drugs that sedate (calm) the patient may also be used, especially if the patient is near death. All of these drugs have side effects and the patient will be monitored closely by a doctor. The decision to use drugs that sedate the patient will be made in cooperation with family members after efforts have been made to reverse the delirium.

The decision to use drugs to sedate the patient who is near death and has symptoms of delirium, pain, and difficult breathing presents ethical and legal issues for both the doctor and the family. When the symptoms of delirium are not relieved with standard treatment approaches and the patient is experiencing severe distress and suffering, the doctor may discuss the option to give drugs that will sedate the patient. This decision is guided by the following principles:

• Healthcare professionals who have experience in palliative care make repeated assessments of the patient’s response to treatments. The family is always included.
• The need to use drugs that sedate the patient is evaluated by a multidisciplinary team of healthcare professionals.
• Temporary sedation should be considered.
• A multidisciplinary team of healthcare professionals will work with the family to ensure that the family's views are assessed and understood.

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Changes to This Summary (06/22/2004)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.

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To Learn More

Call

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Web sites and Organizations

The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LiveHelp

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

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About PDQ

PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

Some patients have symptoms caused by cancer treatment or by the cancer itself. Patients who have symptoms related to cancer treatment may want to take part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During supportive care clinical trials, information is collected about new treatment methods, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

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