Dementia And Delirium Not the Same Thing

Dear Dr. Roach: My father, 79, used to play 18 holes of golf three times a week, but after a recent gallbladder removal, he started showing some unusual symptoms. He appeared to be a totally different person: helpless and unable to walk. The doctors diagnosed him as having dementia.

I kept telling the doctors and nurses that his washroom smelled horrible and that there was a bad odor after he passed urine. Finally, after several weeks of going in and out of the hospital, he’s been on antibiotics for five days, and is his same old self again, as mentally agile as before. Please tell caregivers to watch for unusual behavior in their clients and peculiar odors. — L.B.

Answer: Dementia and delirium are similar-sounding terms, often confused by both doctors and patients. Dementia is a slow, progressive loss of memory and other higher brain functions, often accompanied by changes in personality and decision-making. Dementia can begin so slowly that it can be months or years before it is finally recognized, even if there are periods when the decline seems to progress more quickly. Alzheimer’s disease and multi-infarct or vascular dementias are classic types of dementia.

Delirium is a sudden, dramatic change in brain function. Memory, personality and language may be affected, but it is the speed of change that is the hallmark of delirium. I had a professor remark that we should think of delirium as “chest pain of the brain.” The most common causes of delirium are routine illnesses of the body — urine infection, as described here, is common, but so are pneumonia, low oxygen levels, medications and changes in blood sodium levels. Just having a surgery, such as gallbladder removal, can cause delirium. Hospital doctors should be on the lookout for these.

Delirium is more likely in someone with dementia. Sometimes the delirium is the first time the confusion and memory changes are noticed. It can take months for delirium to resolve completely. The fact that your father went back to normal so quickly is a good sign.

Dear Dr. Roach: My family doctor told me I have a right bundle branch block after a routine EKG. How serious is this condition, and how should it be treated? — Anon.

Answer: The heart has an electrical system that enables it to coordinate its movement and respond to the body’s needs. The most important parts of the electrical system are, in the order the electrical impulse travels: the sinoatrial node, the atrioventricular node, the bundle of His (pronounced “hiss”) and the left and right bundle branches. Disease or blockages at any of these will cause electrical changes that can be seen on an electrocardiogram.

In general, the higher up the problem, like the SA node, the greater the likelihood of the need to do something about it. Since a right bundle branch block is fairly far down, nothing usually needs to be done about it.

Bundle branch blocks are more commonly seen in people with ischemic heart disease (the word “ischemic” means “holding back blood,” so ischemic heart disease is the kind where cholesterol-laden blockages can cause heart attacks). When a right BBB is combined with other conditions, such as a left BBB or an AV node block, then the outlook isn’t so good, and a pacemaker is usually necessary.

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