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Diagnosis of delirium: a practical approach
  1. Sian K Alexander1,
  2. Edward Needham2
  1. 1Department of Neurology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
  2. 2Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  1. Correspondence to Dr Sian K Alexander, Department of Neurology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK; s.alexander2{at}


Delirium is an acute disorder of fluctuating attention and awareness with cardinal features that allow it to be positively distinguished from other causes of an acute confusional state. These features include fluctuations, prominent inattentiveness with other cognitive deficits, a change in awareness and visual hallucinations. We describe a framework for diagnosing delirium, noting the need to consider certain caveats and differential diagnoses. Delirium is a clinical diagnosis where a thorough history and clinical examination are much more helpful diagnostically than any single test or combination of tests.


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  • Correction notice This article has been corrected since it was first published. A sentence in the 'Pathophysiology of delirium' section has been edited for readability.

  • Contributors SKA and EN contributed equally to the writing and revision of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SKA is a co-applicant and receives royalties on patent application WO/2010/046716 ‘Neurological Autoimmune Disorders’, licensed commercially for the development of assays for LGI1 and other VGKC-complex antibodies. EN has no competing interests to declare.

  • Provenance and peer review Commissioned; externally peer reviewed by Martin Sadler, Plymouth, UK, Lucy Pollock, Taunton, UK and Tom Hughes, Cardiff, UK.

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