Useful facts on Alzheimer's Disease. Note especially the huge contribution that carers make.

A delirium tool that also finds dementia? New study: n=75,221 older adult admissions ↳ 4AT score ≥1: • 87% sensitive for clinical dementia diagnosis ↳ The 4AT isn't just for delirium anymore. #Delirium #Dementia #4Ms Penfold et al, Age Ageing 2025

"He saw visions of ships sailing through the air, and heard voices calling his name." Notes from Underground, Dostoevsky #delirium

Clinical tip on #delirium: symptoms of delirium can fluctuate. A person might have lucid periods and then, an hour later, be obviously confused again. This coming and going is characterisic of delirium.

Myth: Only people with dementia get delirium. Fact: While dementia increases risk, anyone can develop delirium. In hospitals, about 60% of people with #delirium also have dementia.

Pain is very common in hospital patients. As is delirium. As is distress associated with delirium. Pain is also commonly present in patients with delirium. So: always assess for pain in delirium, including using observation as well as directly asking the patient.

Family: "I've known him 60 years. This is not him." Chart: "Confused." One of these is clinical data. One is lay description masquerading as a diagnosis. → Calling delirium "confusion" is poor practice ← #delirium

Let's look at delirium and dementia: Episodes of delirium: more rapid progression of dementia. Delirium survivors: x3-fold higher risk of future dementia. ➡️ We really need the support of dementia charities in helping improve delirium care. #delirium #dementia #medtwitter

"Although I have no doubts whatsoever that the care I received was of the highest order, I still feel today that my #delirium was seen as an acceptable side effect of my illness and treatment."

Mrs Smith, 78, hip fracture patient, described as "confused & aggressive" Ward round note: "?UTI. Start antibiotics." No mention of "delirium" My reaction: What about her distress - untreated pain? Dehydration? Medication review? Telling the family the diagnosis? Etc. Why we need Delirium 8 👇

Shocking reality: 1 in 4 older hospital patients develop #delirium, yet most families have never heard the word. We need to do much better in improving public awareness of delirium.

🧠 Delirium is the only dedicated delirium journals 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium

Very few other acute conditions are as strongly predictive of mortality as #delirium.

Delirium isn't always preventable. But this cascade? Early recognition likely changes the trajectory. #delirium

"You can't properly assess for delirium when someone already has dementia." Wrong. New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations. 5 studies. 1,304 patients. International data. #delirium #dementia

Made the 4AT #delirium assessment tool with 2 colleagues in 2011 to help improve the rates of detection in my hospital at the time. Also made a website - www.the4AT.com - to help with dissemination. Pleased to say it has now been widely adopted & has a large evidence base.

The Nursing Delirium Screening Scale (NuDESC). Designed for inpatient monitoring for new #delirium.

#Delirium-aware hospital care

"The hate and anger that was coming out of him. I'd be quite honest, I was scared stiff."  - Wife describing her husband's #delirium.

❗️NHS ENGLAND POLICY ↳ "Patients aged over 65 presenting to hospital as an emergency should be assessed by a competent clinical decision-maker within 30 minutes of arrival using the Clinical Frailty Scale (CFS) & the 4AT tool for delirium." #delirium #frailty

Let's look at delirium and dementia: Episodes of delirium: more rapid progression of dementia. Delirium survivors: x3-fold higher risk of future dementia. ➡️ We really need the support of dementia charities in helping improve delirium care. #delirium #dementia #medtwitter

When a person in hospital is restless then it often means they are experiencing #delirium. → Look carefully at their facial expressions - see if they might be seeing things that are not real. → Sometimes asking them - "are you seeing anything strange or frightening?" can help.

Delirium has a visibility problem, not just a diagnostic one. How many cases of delirium are you missing day to day by not looking proactively?

A delirium tool that also finds dementia? New study: n=75,221 older adult admissions ↳ 4AT score ≥1: • 87% sensitive for clinical dementia diagnosis ↳ The 4AT isn't just for delirium anymore. #Delirium #Dementia #4Ms Penfold et al, Age Ageing 2025

This has taken years - training, culture change, embedding the 4AT into routine practice. But increasingly on our ward rounds, delirium has been detected & management plans in place. All from the ED or the medical admissions unit. Impressive changes - encouraging. #Delirium #PatientSafety

🧠 Delirium = the only dedicated delirium journals. 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium #medtwitter

Causes of distress in people with #delirium. More info: www.the4at.com/deliriumguide

When you're with a patient with #delirium, imagine that you're them. Delirium survivor: 'get down on the eye level with your patient, take a hand if it's appropriate and just say your name and who you are.'

For clinicians working with delirium, Fuseli's painting 'The Nightmare' resonates on multiple levels. The patient's vulnerable position, the intrusion of terrifying figures into what should be a safe space, and the sense of helplessness all reflect common elements of the experience of #delirium.

When speaking to person describing delusional beliefs, listen without interrupting or dismissing their experiences. Instead of immediately correcting them, say something calm and neutral like: “That must be very frightening for you.”' #delirium

"They come at night with needles. They whisper about you. The machines beep codes. You're not a patient - you're a subject. No one believes you." How do you cope when you're certain the doctors are experimenting on you? #delirium

Steps to better bone health. #osteoporosis

"You can't properly assess for delirium when someone already has dementia." Wrong. New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations. 5 studies. 1,304 patients. International data. #delirium #dementia

Let's look at delirium and dementia: Episodes of delirium: more rapid progression of dementia. Delirium survivors: x3-fold higher risk of future dementia. ➡️ We really need the support of dementia charities in helping improve delirium care. #delirium #dementia #medtwitter

“When in acute fevers ... the hands are waved before the face, hunting through empty space, as if gathering bits of straw, picking the nap from the coverlet, or tearing chaff from the wall - 𝐚𝐥𝐥 𝐬𝐮𝐜𝐡 𝐬𝐲𝐦𝐩𝐭𝐨𝐦𝐬 𝐚𝐫𝐞 𝐛𝐚𝐝 𝐚𝐧𝐝 𝐝𝐞𝐚𝐝𝐥𝐲.” Hippocrates on #delirium.

Myth: Sedatives (like benzos) are mostly helpful in calming delirium. Fact: Sedatives often worsen delirium. Non-drug approaches (reorientation, hydration, mobility) are first-line treatments.

How many of your last 50 older acute patients were screened for delirium? #delirium

Myth: If a patient knows their name and their date both, they are not delirious. Fact: People with #delirium can often correctly answer simple orientation questions. This does not exclude delirium. Use a proper assessment tool like the 4AT.

"It's just the dementia progressing." A very dangerous phrase in clinical care. Acute change in someone with dementia? That's #delirium until proven otherwise. ↳ Don't put the stick in the patient's wheel. #Delirium

“Nobody used the word delirium. I thought I’d lost my mind.” — Delirium survivor ➡️ Always provide clear information, including telling the patient they have delirium, during the episode. Then explain & de-brief afterwards.

🧠 Delirium is the only dedicated delirium journals 👍100% open access. 👍Ultra-low fees ($20 submission, $280 publication). 👍All study types welcome & rapid 4-week peer review. #delirium

Does your patient need you to provide reassurance? Kindness goes a long way in #delirium.

2 millenia & counting. Hippocrates knew #delirium was a medical emergency. Why is it still so often missed, misdiagnosed, or undertreated? What are the barriers? What are the solutions?

A delirium tool that also finds dementia? New study: n=75,221 older adult admissions ↳ 4AT score ≥1: • 87% sensitive for clinical dementia diagnosis ↳ The 4AT isn't just for delirium anymore. #Delirium #Dementia #4Ms Penfold et al, Age Ageing 2025

Useful infographic from the US National Institute on Aging. #dementia #medtwitter

The word "delirium" comes from Latin: *de-lira* — "out of the furrow." Like a plough going off track. Delirium is an abrupt departure from the person's normal path. To recognise it, you need to know what their path was before. #delirium

This image captures what many patients actually experience. Delusions - false beliefs that feel completely real - affect up to 1 in 3 older hospital patients with delirium. A gentle question that can help: "Can you tell me where you think you are right now?" #Delirium

The person in the visitor's chair might be your best diagnostic tool. Families know what "normal" looks like. They notice the subtle changes we can miss. They can tell you if this confusion is new - the key question in #delirium. They're not visitors. They're informants.  ↳ Talk to them.

HYPOACTIVE DELIRIUM: The one we miss Many people picture delirium as agitation and confusion. But 75% of delirium is HYPOACTIVE: - Quiet - Withdrawn - Easy to miss It has WORSE outcomes than hyperactive delirium. What's your experience with hypoactive delirium?

"The nurse smiles as she brings your dinner. But you KNOW something's wrong with it. You can't explain why, but you're certain." What does it feel like to believe the food on your hospital tray is poisoned? #delirium