Delirium (Acute Confusional State) is an acute, fluctuating neurocognitive disorder characterized by disturbances in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness, accompanied by a change in baseline cognition (memory deficit, disorientation, perceptual disturbances). Unlike dementia (which develops insidiously over years), delirium develops acutely over hours to days and is a medical emergency indicating systemic physiological decompensation—such as sepsis, electrolyte imbalance, medication toxicity, hypoxia, or anticholinergic overload. Grounded in the Confusion Assessment Method (CAM) and Sharon Inouye’s Hospital Elder Life Program (HELP), the Delirium and Acute Confusion Psychoeducation Module provides 19 structured video lessons on etiology, motor subtypes, and multicomponent environmental prevention.
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The Confusion Assessment Method (CAM) Diagnostic Algorithm
Diagnosis requires the presence of features 1 and 2, plus either 3 or 4:
- Acute Onset and Fluctuating Course: Sudden mental status change that waxes and wanes throughout the day.
- Inattention: Inability to maintain focus during conversation or digit-span tests.
- Disorganized Thinking: Rambling, irrelevant, or illogical flow of ideas.
- Altered Level of Consciousness: Hyperalert, drowsy, stuporous, or comatose.
Motor Subtypes: The Danger of Hypoactive Delirium
- Hyperactive Delirium: Agitation, hallucinations, attempting to pull out IV lines; easily recognized by nursing staff.
- Hypoactive Delirium: Lethargy, quiet withdrawal, psychomotor slowing; frequently misdiagnosed as depression or fatigue, carrying significantly higher mortality rates due to delayed medical intervention.
- Mixed Delirium: Alternating between hyperactive and hypoactive states across 24-hour cycles.
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