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1Clear out junk files and repair common Windows errors2Scan for outdated or missing drivers - takes under a minute3Repair Windows errors before they cause bigger problemsDelirium is a sudden change in attention, awareness, thinking, or behavior that often fluctuates over hours or days. It can signal an urgent medical problem, a medication effect, or another treatable cause. If someone becomes suddenly confused, seek prompt medical care; in the United States, MedlinePlus advises calling emergency services for sudden confusion. Elsewhere, use the appropriate local emergency service.
What delirium is—and why sudden confusion matters
Delirium is a clinical syndrome: a marked change from a person’s usual alertness, attention, thinking, or behavior. It often starts over hours or days, and symptoms may come and go. A family member can notice the change, but cannot confirm the diagnosis at home. A clinician needs to assess the person and look for the cause.
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Sudden confusion can be associated with serious illness, so do not wait to see whether it passes or try to treat it with a home remedy. MedlinePlus provides general information about confusion and advises emergency help for sudden confusion in its urgent-care guidance. The right emergency route depends on where you are and the circumstances.
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What are the signs of delirium?
The defining clue is a recent change from the person’s baseline. Signs can vary, and a person may have some but not all of them:
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- Difficulty concentrating, following a conversation, or engaging with others
- Slower responses, confusion, or altered communication
- Restlessness, agitation, or unusual behavior
- Hallucinations
- Less movement, reduced mobility, withdrawal, or unusual sleepiness
- Changes in mood, attitude, appetite, or sleep
Delirium is not always dramatic. The quieter, or hypoactive, form may look like low energy, slowed responses, reduced movement, or withdrawal, and can be overlooked. NICE identifies these changes among the indicators clinicians should notice and recommends taking reports from relatives and carers seriously.
Three patterns delirium can take
- Hypoactive: The person seems quiet, sleepy, slowed down, or withdrawn.
- Hyperactive: The person is restless or agitated.
- Mixed: The person shifts between quieter and more agitated periods.
Symptoms may fluctuate, so a person seeming clearer at one moment does not rule out delirium.
What causes delirium, and who is at greater risk?
Delirium may have more than one contributor. Possible causes include infection or other acute illness, dehydration or electrolyte imbalance, medication effects or withdrawal, severe pain, sleep deprivation, surgery or anesthesia, organ failure, and metabolic problems. Clinicians assess the individual situation rather than assuming a single cause.
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NICE identifies age 65 or older, cognitive impairment or dementia, a current hip fracture, and severe illness as risk factors in hospital and long-term care. Risk factors do not establish that a person has delirium; a new change still needs assessment. NICE’s guideline covers adults in hospital and long-term residential care, including nursing homes, and its overview says it was last updated on 18 January 2023: NICE guideline CG103.
For context, the Merck Manual Professional Edition reports that at least 10% of patients older than 65 admitted to hospital have delirium, and that 15–50% experience it at some point during hospitalization. These are hospitalization estimates, not community prevalence; Merck’s page was last updated in July 2026 and the cited page excerpt does not identify the original study or its year: Merck Manual: Delirium.
How delirium differs from dementia
Delirium usually begins suddenly and fluctuates; dementia generally develops gradually over a longer period. Delirium particularly affects attention and alertness, while dementia involves a lasting decline in memory and other cognitive abilities. Hallucinations are not required for delirium, and their absence does not rule it out.
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The conditions can coexist: someone with dementia can develop delirium. Because the signs may overlap, distinguishing them is a clinical task. NICE recommends managing delirium first when it is difficult to tell whether a person has delirium, dementia, or delirium superimposed on dementia.
How clinicians assess and diagnose delirium
Assessment starts with identifying a change from the person’s usual state. Information from family or carers can help establish when the change began and how the person normally functions. Clinicians also evaluate possible causes; investigations such as laboratory tests or imaging are selected according to the clinical situation, rather than being the same fixed panel for everyone.
NICE recommends different screening tools by care setting. These are clinical tools, not home self-tests:
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| Care setting | Tool NICE recommends when indicators are present |
|---|---|
| General indicated assessment | 4AT |
| Critical care or the recovery room after surgery | CAM-ICU or the Intensive Care Delirium Screening Checklist (ICDSC) |
A relevantly qualified health professional makes the final diagnosis. NICE also recommends documenting it in the person’s care record and primary care record.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.How delirium is treated and supported
Treatment focuses on identifying and managing the underlying cause or combination of causes. Supportive care is tailored to the person and does not replace that evaluation. NICE recommends clear communication, reassurance, reorientation, and a suitable care environment; familiar family, friends, or carers may help.
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- Reducing disorientation with familiar staff, clear lighting and signage, a visible clock and calendar, and visits from family or friends; avoiding unnecessary transfers where possible
- Addressing hydration and constipation, oxygenation, mobility, pain, and medication effects
- Supporting nutrition and sleep
- Making needed hearing and visual aids available and ensuring they work
Hydration should follow the person’s medical needs and clinical advice, especially when a condition affects fluid balance. A clock or calendar may be a practical orientation aid, but no consumer device, supplement, or home remedy is established here as a way to prevent or cure delirium. NICE’s prevention recommendations are available at NICE CG103: preventing delirium.
If delirium does not resolve, NICE advises reassessing for causes and assessing for possible dementia.
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