Confusing dementia and delirium is a common pitfall—in practice and on the licensing exam. But knowing how they differ can help you better serve clients and avoid critical test errors.
Let’s break them down:
Delirium
Onset: Sudden (hours to days)
Course: Fluctuates, often worse at night
Consciousness: Impaired—client may be drowsy or agitated
Attention: Severely impaired
Cause: Often medical (e.g., infection, substance withdrawal, medications)
Reversibility: Usually reversible if cause is treated
Dementia (now more often called major neurocognitive disorder)
Onset: Gradual (months to years)
Course: Slowly progressive
Consciousness: Usually alert
Attention: Generally intact until later stages
Cause: Chronic conditions (e.g., Alzheimer’s, Parkinson’s)
Reversibility: Typically not reversible
Delirium is a medical emergency. Think: “This person was fine yesterday and now they’re hallucinating.”
Dementia develops slowly. Family may notice increasing forgetfulness or confusion over time.
Delirium can co-occur with dementia—older adults with cognitive decline are more vulnerable to acute changes.
How this could appear on the ASWB exam:
A hospital social worker meets with an 81-year-old client who is suddenly confused, disoriented, and having trouble focusing. A week ago, the client was alert and oriented. What condition should the social worker suspect?
A. Early-stage Alzheimer’s disease
B. Major depressive disorder
C. Delirium
D. Dementia
Have your answer?
A sudden change in mental status—especially in an older adult—points to delirium, not dementia. Alzheimer’s and other dementias are gradual. Depression can cause cognitive symptoms, but not this abrupt or severe.
Correct Answer: C. Delirium
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