Delirium in the elderly could signal the presence of underlying life-threatening diseases and is an indicator of quality of care, according to a new report.

Delirium often goes unrecognized by physicians and nurses because of its fluctuating nature, its overlap with dementia, lack of formal cognitive assessment and lack of appreciation for its clinical importance. That’s the view of Dr. Sharon K. Inouye, director of the Aging Brain Center in the Institute for Aging Research at Boston’s Hebrew SeniorLife.

Often, delirium can be the only sign of serious illness, including myocardial infarction, infection and respiratory illness, she notes. Delirium is described as an acute decline in cognitive functioning and attention and is the most frequent complication of hospitalization in older residents and patients.

Delirium worsens cognitive decline of people with dementia, she writes in the March 16 issue of the New England Journal of Medicine.