Delirium Superimposed on Dementia — SCE Neurology MCQ

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EasyNeurodegenerative DiseaseDelirium Superimposed on DementiaSCE Neurology

A 70-year-old man with dementia is admitted to hospital with a hip fracture. He becomes acutely confused with fluctuating consciousness, visual hallucinations, and agitation. This is a change from his baseline. His underlying dementia is Alzheimer disease. What is the most likely acute diagnosis?

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Correct answer: E — Delirium superimposed on dementia

Delirium superimposed on dementia is extremely common in hospitalised elderly patients, particularly after surgery, infection, or metabolic disturbance. It presents with acute onset (hours to days) of fluctuating consciousness, inattention, disorganised thinking, and perceptual disturbances. It is distinguished from the underlying dementia by its acute onset, fluctuating course, and identifiable precipitant (in this case, hip fracture with pain, anaesthesia, and hospital environment). Management involves identifying and treating the underlying cause, ensuring a safe environment, and avoiding deliriogenic medications. A: AD has a gradual course without acute fluctuation. C: DLB develops over months, not acutely. D: Stroke would have focal neurological signs. E: Depression has different features.

Reference: NICE CG103 Delirium (2010); NICE NG97 Dementia