Medical Surgical Dementia vs Delirium #4


A long-term elderly resident is experiencing some confusion. The nurse suspects delirium instead of dementia by which of these observations?


  1. The client cannot remember her children's name and her vital signs are normal.
    • Rationale:

      This answer is not correct because it is common for some older clients to have memory loss with dementia. This client’s normal vital signs show there is no reason to suspect an infection, which could cause delirium.

  2. The confusion has come on abruptly and the client has decreased urinary output.
    • Rationale:

      This answer is correct because with delirium, the onset of confusion is rapid or abrupt. The confusion that comes with dementia is progressive or gradual. Also, the client has decreased urinary output along with the abrupt onset of confusion which indicates a UTI. There is an underlying cause for delirium which usually can be treated, whereas dementia does not have a cause which can be treated.

  3. The client gets upset when she does not know the answer to a question.
    • Rationale:

      This answer is not correct because although a client can become angry or upset during an episode of delirium, it is not usual for a client with dementia to become upset or fretful if a question is not understood. Aphasia is common with clients who have dementia.

  4. Client having difficulty buttoning her blouse and brushing her hair.
    • Rationale:

      This answer is not correct because one of the symptoms associated with dementia is apraxia. Apraxia is the inability to carry out a skilled movement.


Delirium has a rapid onset, whereas dementia is progressive. Delirium has an underlying cause usually that can be treated.


Learning Outcomes

Delirium comes on quickly as a result of an infection or another underlying cause. Delirium is treatable, by treating the cause of the delirium. Due to the specific cause, the nurse may notice objective signs such as abnormal vital signs or lab values. Dementia on the other hand has a gradual onset with no underlying cause. There is no treatment that can completely resolve dementia. Medications can be used to enhance memory and cognitive function. Occupational therapy can treat the symptoms of dementia, such as apraxia.

Test Taking Tip

Remember with delirium, there will be objective signs, whereas with dementia, there will not.

Video Rationale