TABLE 2214 The Brief Mental Status Examination

Independent of these tests, the acute onset of attention deficits and cognitive abnormalities with fluctuating severity through the day and worsening at night is practically diagnostic of delirium.7 Specific Issues

The diagnosis of delirium prompts the search for an underlying disease process. The point that must be remembered is that delirium is secondary to another process that might or might not be related to the central nervous system. Making the diagnostic task more difficult is that chronic cognitive impairment may also be present in the individual patient, therefore making the assessment of the acuity of the mental status change difficult. The main features differentiating delirium from dementia and psychiatric conditions are the relative acute onset of the process (not a feature of dementia) and its fluctuating nature (not a feature of either dementia or psychosis).

Depression can resemble a hypoactive delirium with withdrawal, slowed speech, and poor results in cognitive testing being present in both conditions. Rapid fluctuation of the symptoms, however, is common in delirium but absent in depression. Additionally, clouding of consciousness is absent in patients with depression; usually testing finds them oriented and able to perform commands.3 Table221-5 lists common etiologies of altered sensorium (although not all cause delirium).

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