GERIATRICS

Delirium - the textbook definition of this disorder is a “waxing and waning fluctuation of arousal.” I don’t love that definition though. My definition of delirium is “an old person who becomes acutely crazy inside a hospital.” There’s a weird phenomenon where old people  will suddenly become confused, aggressive or sleepy a few days into their admission to the hospital, and it’s even more likely to occur if the patient has an acute medical problem like a UTI or a broken hip. Drugs can also worsen the situation. It doesn’t happen to every old person in the hospital, but it is common. It happened to my grandmother a few months ago, and I helped out on a research project on delirium a few years ago. Their EEGs are abnormal, in a nonspecific kind of way. Aggressive patients must be chemically sedated before they hurt themselves or others using Antipsychotics (often Haloperidol). Steroids, benzos, opioids and anticholinergics (Benadryl) are some of the most common causes of drug-induced Delirium.

Dementia is an old person who slowly loses their intelligence and/or memory. In the DSM-5, all the different flavors of dementia are bundled together into a label called Neurocognitive Disorder (NCD). By definition, someone with a NCD has a MOCA score of 25 or below. EEGs in dementia are normal. See the 

Minor NCD - MOCA <25, independent and normal ADLs 

Major NCD - MOCA <25, not independent and subnormal ADLs