What they are
Neurocognitive disorders affect memory, attention, language, orientation and planning. Dementia, such as Alzheimer’s disease, is progressive and reduces independence. Mild cognitive impairment is an intermediate stage, with noticeable decline but no major loss of independence.
Delirium, or acute confusional state, is different: it starts suddenly, over hours or days, with confusion and fluctuating attention, and almost always has a medical cause such as infection, dehydration, a drug effect or surgery. It is a medical emergency.
Signs and symptoms
- Forgetting recent events and repeating questions
- Trouble with money, medications, appointments and household tasks
- Disorientation in time and in familiar places
- Personality changes, apathy, irritability
- Suspiciousness, hallucinations, agitation, especially in the evening
- In delirium: sudden confusion, drowsiness or agitation, incoherent speech
How it is diagnosed
The assessment combines the family’s account, cognitive screening, a medication review and investigation of treatable causes, such as thyroid problems, vitamin B12 deficiency and depression, which can mimic dementia. Blood tests, brain imaging and neuropsychological testing are ordered when indicated, together with the neurologist or geriatrician. For more than ten years, Dr. Petrus led the Psychiatric Consultation-Liaison Service at Hospital Vera Cruz, where assessing delirium in inpatients was frequent.
Treatment
- Treating reversible causes and adjusting medications that worsen cognition
- Medication, when indicated, for cognition and for depression, anxiety, insomnia, agitation and psychosis
- Guidance for family and caregivers, routine, a safe environment and stimulation
- In delirium, treatment of the underlying medical cause, with orientation and safety measures
When to see a psychiatrist
When forgetfulness or behavioral changes worry the family or begin to affect independence. Sudden confusion should be assessed immediately in an emergency room.
Follow-up at the practice
At the practice in Campinas, Dr. Petrus Raulino sees the patient with the family, explains the diagnosis and care plan, and follows progress with regular visits.
Staging: text awaiting medical review by Dr. Petrus before publishing.
This content is for information only and does not replace a medical consultation. Diagnosis and treatment depend on an individual assessment. In crisis or having thoughts of suicide? In Brazil call 188 (CVV, 24 hours, free) or go to the nearest emergency room. In an emergency, call 192 (SAMU).