• Main symptoms

• Clouding of consciousness

• Difficulty maintaining or shifting attention

   

• Disorientation

• Illusions

• Hallucinations

   

• Fluctuating levels of consciousness

• Symptoms tend to fluctuate over the course of the day, with some improvement in the daytime and maximum disturbance at night. Reversal of the sleep-wake cycle is common.

• Neurological symptoms

• Dysphasia

   

• Dysarthria

• Tremor

• Asterixis in hepatic encephalopathy and uremia

• Motor abnormalities

• Patients with delirium who are hyperactive have an increased state of arousal, psychomotor abnormalities, and hypervigilance. In contrast, patients with delirium who are hypoactive are withdrawn, less active, and sleepy.

• Hypoactive delirium sometimes is misdiagnosed as dementia or depression. Mixed states also occur.

• In patients who are elderly, delirium often is the presenting symptom of an underlying illness.

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