Question

A person brings a parent, who is an older adult, to the doctor. During the past two days, the parent has been overheard speaking to a spouse who has been deceased for four years. Prior to that, the parent was completely normal. The parent most likely has:

Short answer

The parent most likely has delirium.

Step-by-step solution

Identify symptoms

Review the symptoms described: speaking to a deceased spouse over the past two days, and prior to this, the parent was completely normal.

Consider mental health conditions

Consider mental health conditions that might explain this sudden change in behavior. Common conditions to consider include dementia or delirium.

Evaluate for Delirium

Delirium often presents suddenly and can cause severe confusion and hallucinations. Assess whether the symptoms align with these characteristics: sudden onset and hallucinations (seeing or hearing the deceased spouse).

Evaluate for Dementia

Dementia typically develops more gradually and wouldn't usually present with sudden onset of symptoms. Since the parent was completely normal prior to two days ago, this is less likely.

Conclusion

Based on the sudden onset and hallucinations, the most likely diagnosis is delirium.

Key concepts

delirium

Delirium is an acute and sudden change in attention and cognition. It often manifests with severe confusion and hallucinations.

The symptoms can appear rapidly, as seen in the exercise where the parent suddenly began speaking to a deceased spouse.

Causes of delirium can include:

• Infections
• Medications
• Dehydration
• Metabolic imbalances

Healthcare professionals often use clinical tools, such as the Confusion Assessment Method (CAM), to diagnose delirium.

Treatment focuses on addressing the underlying cause and providing supportive care.

dementia

Dementia is a chronic and progressive decline in cognitive function, affecting memory, thinking, and behavior. Unlike delirium, its onset is gradual.

Common symptoms of dementia include:

• Memory loss
• Difficulty in problem-solving
• Changes in mood and behavior
• Language difficulties

Alzheimer's disease is the most common form of dementia, but there are others, such as vascular dementia and Lewy body dementia.
Treatment for dementia often involves medications to manage symptoms and support from caregivers to assist with daily activities.

mental health conditions

Mental health conditions encompass a wide range of disorders affecting mood, thinking, and behavior.

Common conditions include:

• Anxiety disorders
• Depressive disorders
• Bipolar disorder
• Schizophrenia

These conditions can significantly impact daily functioning and quality of life.

For the elderly, it’s crucial to differentiate between mental health conditions and cognitive disorders like delirium and dementia.

Treatment often involves a combination of medication, therapy, and lifestyle changes to manage and improve symptoms.