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Delirium versus dementia — MCCQE Part 1 MCQ

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EasyDeliriumDelirium versus dementiaMCCQE Part 1

An 80-year-old man becomes acutely disoriented after starting oxybutynin for urinary urgency. His attention fluctuates during the interview and he is worse at night. Which of the following is the most likely diagnosis?

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Correct answer: D — Medication-associated delirium

Acute fluctuating attention and cognition after an anticholinergic medication strongly suggests delirium. Dementia is chronic and progressive, although it predisposes to delirium. Management includes stopping offending drugs, treating triggers and using non-pharmacologic delirium measures.

Reference: Canadian Coalition for Seniors' Mental Health delirium guidance; Choosing Wisely Canada geriatrics