Delirium Superimposed on Dementia DSD

DSD is when someone with dementia develops a delirium on top of their dementia. Delirium is an acute, transient disorder of attention and cognition.

The trigger for the delirium might be an infection, an acute illness, surgery, hospitalisation, constipation, drug side effects, sudden withdrawal of some medications.

Physical changes that contribute to delirium are low blood oxygen, high blood carbon dioxide, high or low sodium, high calcium, low glucose, neurotransmitter changes in the brain.

It’s a common condition, affecting as much as 50% of older adults with dementia on hospital wards.

Because of diminished cognitive reserve, people with dementia are more prone to having a delirium. They can also take longer than adults without dementia to recover. It may take days, weeks or even up to six months to recover. People with dementia may not recover back to their previous level of cognition and functioning after the delirium.

Treating delirium:
Identify and treat the cause. It may be more than one cause.
Are there metabolic abnormalities?
Are medications or medication withdrawal implicated?
Are there any psychological predisposing factors?
Adequate hydration and a good balanced diet are critical to recovery.
Address any constipation.
Nutritional deficiencies such as vitamin D, B6, B12.
Provide reassurance, reorientation, involve family.
Prioritise sleep.