Dementia, unlike delirium, is characterized by:
A. Slurred speech
B. Insidious onset
C. Clouding of consciousness
D. Sensory perceptual change
Correct Answer: B. Insidious onset
Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances. Dementia is a disorder that is characterized by cognitive decline involving memory and at least 1 of the other domains, including personality, praxis, abstract thinking, language, executive functioning, complex attention, social and visuospatial skills. In addition to the noted decline, the severity must be significant enough to interfere with daily functionality. It is often a progressive disorder, and individuals often do not have insight into their deficits.
Option A: Production of spontaneous speech, word quantity, speech content, and verbal and written language comprehension are impaired in delirious patients compared to cognitively unimpaired patients. Additionally, patients with delirium produced significantly less fluent speech than those with dementia. Language dysfunction is explicitly included within the DSM-5 criteria for delirium (under Criterion C: other cognitive disturbance).
Option C: Delirium is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention. It develops over a short period and fluctuates during the day. The clinical presentation can vary, but usually, it flourishes with psychomotor behavioral disturbances such as hyperactivity or hypoactivity with increased sympathetic activity and impairment in sleep duration and architecture.
Option D: Acetylcholine is a very important neurotransmitter in attention and consciousness. It is known, acetylcholine acts as a modulator in sensory and cognitive input, so an impairment in the route leads to developing symptoms of hypoactive or hyperactive delirium, including inattention, disorganized thinking, and perceptual disturbances.