The comments of Dr Gluck on the interrelationship between fever, pain, and mental status of the elderly is well taken. In fact, geriatric literature stresses that mental confusion is as much a common manifestation of systemic infection in the elderly as convulsions in children.1 Doctor Gluck correctly pointed out that this manifestation of the infectious process is seen regardless of the degree of the associated fever. Other important physical conditions that may lead to the acute dementia or, using the psychiatric glossary, delirium are presented by Dr Gluck in the form of diagnostic tips and are valuable notes for any practitioner in daily practice. My intention, however, was not so much to enumerate all of the diagnostic dilemmas encountered in the practice with the elderly but rather to systematize and conceptualize the knowledge that is empirically derived by many skillful clinicians dedicated to the care for the elderly.
Portnoi VA. The Psychological Consequences of Physical Illness-Reply. Arch Intern Med. 1981;141(12):1722-1723. doi:10.1001/archinte.1981.00340130160044