Recognizing Delirium: A Checklist for Caregivers

Delirium is a sudden change in a person’s mental state that comes and goes over short periods of time. It can cause a person to have a hard time paying attention or following a conversation. Thinking and speech may be confused, illogical, unclear, and unpredictable. A person’s mental state may vary from being restless and alert to sluggish and sleepy.

Delirium can sometimes be mistaken for dementia. Often the 2 conditions occur together. But delirium happens quickly over a short time, such as hours or days. Dementia happens more slowly, over months or years.

Delirium is a medical emergency. If delirium is not diagnosed and treated, it can lead to permanent problems or even death.

A checklist of delirium signs

Below is a checklist of the signs of delirium. It’s important to remember that the signs of delirium happen quickly, over the course of hours or days. They can come and go, and may be worse later in the day. And a person may shift between the signs.

Does the person:

Seem acutely more sleepy and quiet than usual, or more restless and disturbed?

Seem suddenly confused or disoriented?

Act in a violent way?

Have trouble paying attention and focusing on a conversation?

See things that others can’t see?

Hear things that others can’t hear?

Believe things that aren’t known to be true?

Think that people want to harm them?

Change the subject too often while talking?

Talk about things that others find strange?

Have anxiety, be sad or tearful, or have intense feelings of joy and excitement (euphoria) that changes rapidly?

Seem unsteady while walking and not a result of a prior health condition?

Have a hard time focusing on simple tasks?

If you’ve answered yes to any of the signs above, your loved one may have delirium. If you think the person has any of the signs above, you can do two simple tests to check their mental state. One tests their attention. The other tests how clearly they are thinking.

Attention test

Try this test:

  • Say to the person, “I am going to read you a series of 10 letters. Each time you hear the letter A, squeeze my hand.”

  • Read each of these letters, 3 seconds apart: S A V E A H A A R T.

  • Count each time the person does not squeeze your hand when you say the letter A.

  • Count each time he or she squeezes your hand on a letter other than A.

  • If the person has 3 or more errors, he or she may have delirium.

Thinking test

Ask the person these 4 questions:

  1. Will a stone float on water? (Correct answer: No)

  2. Are there fish in the sea? (Correct answer: Yes)

  3. Does 1 pound weigh more than 2? (Correct answer: No)

  4. Can you use a hammer to pound a nail? (Correct answer: Yes)

Count each time he or she gives a wrong answer. If he or she has 2 or more errors, and they could previously answer these questions, the person may have delirium.

When to get medical help

If someone is showing signs of delirium, call his or her healthcare provider right away. Or call 911 or your local emergency number. Tell the healthcare provider or emergency services person about the signs of delirium you have seen.