Delirium and Dementia

DELIRIUM

Delirium is an abrupt change in the brain that causes mental confusion and emotional
disruption. It makes it difficult to think, remember, sleep, pay attention, and more.

You might experience delirium during alcohol withdrawal, after surgery, or

with dementia.Delirium is usually temporary and can often be treated effectively.
The onset of symptoms with delirium tends to be rapid and can include disturbed
intellectual function, disorientation of time and place but usually not of identity; altered
attention span; worsened memory; labile mood; meaningless chatter; poor judgement; and
altered level of consciousness, including hypervigilance, mild drowsiness and
semi-comatose status
The patient may be suspicious, have personality changes, and experience illusions more
often than delusions. Physical signs, such as shortness of breath, fatigue, and slow
psychomotor activities, may accompany behavioral changes
Note: Delirium alters the level of consciousness, whereas dementia does not.
Nurses can play a significant role by detecting signs of confusion promptly. A good history
and assessment of mental status on initial contact can provide the baseline data with which
changes can be compared.
 Types of delirium

Delirium is categorized by its cause, severity, and characteristics:

● Delirium tremens is a severe form of the condition experienced by people who are trying to
stop drinking. Usually, they’ve been drinking large amounts of alcohol for many years.
● Hyperactive delirium is characterized by being highly alert and uncooperative.
● Hypoactive delirium is more common. With this type, you tend to sleep more and become
inattentive and disorganized with daily tasks. You might miss meals or appointments.

Note: Some people have a combination of both hyperactive and hypoactive delirium (called mixed
delirium), alternating between the two states.
Causes of Delirium

Disruption in the brain function due to medication side effect, circulatory disturbances,
dehydration, low or high blood pressures (taking certain medications (such as blood
pressure medicine) or misusing drugs can disrupt chemicals in the brain, low or high thyroid
activity, low or high blood glucose, surgery, stress,

Diseases that cause inflammation and infection, such as pneumonia, can interfere with brain
function.

Alcohol withdrawal and eating or drinking poisonous substances can also cause delirium.

When you have trouble breathing due to asthma or another condition, your brain doesn’t get
the oxygen it needs and it could cause brain disruption

Note: Older adults over 65 or have numerous health conditions, are at higher risk for
delirium.
Others who have increased risk of delirium include:

● people who’ve had surgery

● people withdrawing from alcohol and drugs
● those who’ve experienced conditions that damage the brain (for example, stroke and
dementia)
● people who are under extreme emotional stress
Onset of Delirium

Its is Rapid, changes noted within a day or days

Mental status Assessment

Short term memory impaired more than long term disoriented, confused, distorted thinking incoherent
speech, may become suspicious of others, see or hear things that are not there (illusions, hallucinations),
Exaggeration of personality features

Level of consciousness (Alertness)

Changed, can be highly agitated or very dull.

Behavior

Can be hyperactive, be less active than normal, or fluctuate between both extremes.

Recovery:

Disease can be reversed and normal, Mental status is restored if cause is treated promptly
DIAGNOSIS

1. Confusion assessment method

Some health practitioners use the Confusion Assessment Method (CAM) to diagnose or rule out delirium.
This helps them observe whether or not:

● your behavior changes throughout the day, especially if you’re hospitalized

● you have a hard time paying attention or following others as they speak
● you’re rambling

1. Test and Exams

Many factors can cause changes in brain chemistry. Your doctor will try to determine the cause of the
delirium by running tests relevant to your symptoms and medical history.
One or more of the following tests may be needed to check for imbalances:

● blood chemistry test

● head scans
● drug and alcohol tests
● thyroid tests
● liver tests
● Chest X-ray
● urine tests
Medications
Your doctor will prescribe medications to treat the underlying cause of your delirium. For example, if your
delirium is caused by a severe asthma attack, you might need an inhaler or breathing machine to restore
your breathing.

If a bacterial infection is causing the delirium symptoms, antibiotics may be prescribed.

In some cases, your doctor may recommend that you stop drinking alcohol or stop taking certain
medications (such as codeine or other drugs that depress your system).

If you’re agitated or depressed, you may be given small doses of one of the following medications:

● antidepressants to relieve depression

● sedatives to ease alcohol withdrawal
● dopamine blockers to help with drug poisoning
● thiamine to help prevent confusion
Dementia
Dementia is an irreversible, progressive impairment in cognitive function affecting memory, orientation,
judgment, reasoning, attention, language, and problem solving. It is caused by damage or injury to the
brain. An estimated 5% older adults suffer from some form of dementia.
•Alzheimer’s disease is the most common form of dementia. The likelihood of developing Alzheimer’s
disease doubles every 5 years after the age of 65 resulting in more than 60% of all cases of dementia.
•Alzheimer’s disease is characterized by two changes in the brain.

- the first is the presence of neuritic plaques, which contain deposits of P-Amyloid protein (excess
amounts of this are found in persons with Alzheimer’s disease and Down’s syndrome).
-The second characteristic brain change is neurofibrillary tangles in the cortex. Microtubules, structures
within healthy neurons, are normally stabilized by a special protein called tau.
Possible Causes
Although environmental factors Play a role, genetic factors do increase the risk of Alzheimer's
disease. Studies have revealed several generations of Alzheimer's disease patients occurring in
the same family. chromosomal abnormalities have been identified. A strong argument for the
genetic formation of the disease stems from its connection with down syndrome. An extra
chromosome 21 exists In person with down syndrome not only to the people with down syndrome
begin to develop symptoms of dementia after age 35 but also the prevalence of Alzheimer's
disease is higher in families with down syndrome and vice versa.

There is some investigation into the role of free radicals in the development of Alzheimer's
disease. free radicals are molecules that can build up in urines resulting in damage ( called
oxidative damage) the damage block substances from flowing in and out of the cell, leading to
brain damage.
Some risks hypothesized associated with Alzheimer's disease include hyperlipidemia,
hypertension, smoking, head injury, and physical and mental inactivity. At present, no one can
explain this complex disease.
Other kinds of dementia
In additional to enzymes disease, a variety of other pathologies can cause dementia.

vascular dementia
results from small cerebral infarctions. It is associated with risk factors such as smoking, hypertension,
hyperlipidemia, in activity, in a history of stroke or cardiovascular disease.
lewy body dementia
also known as cortical body disease, is associated with subcortical pathology in the presence of lewy body
substance in the cerebral cortex. people with this dementia fluctuations in mental status, decompensate rapidly
when they experience a medical condition, and often have idiosyncratic reactions two cholinergic type
medications .( sedatives and antipsychotics)
Creutzfeldt-Jakob Disease
is an extremely rare brain disorder that causes dementia. It has rapid onset and progression and is characterized
by severe neurologic impairment that accompanies the dimension. symptoms psychotic behavior, memory
impairment. etc
Wernicke’s Encephalopathy and Parkinson's disease
are responsible for a small percentage of dementias.
Aids
mary to the development of dementia in the final phase of the disease.

trauma and toxins

are among the other causes of dementia
For more additional infos.
sundowners syndrome
individuals with cognitive impairment experience and nocturnal confusion, name sundowner’s
syndrome due to its presentation “ after the sun goes down.'' Some of the factors that increase
the risk of this condition include unfamiliar environment, disturbed sleep patterns, use of
restraints, excess sensory stimulation, sensory deprivation, or change in circadian rhythms.
prevention and management:

● placing familiar objects in the person's room

● providing physical activity in the afternoon to help the person expend energy
● adjusting lightning in the environment to prevent the room from becoming dark in the
evening
● keeping and night light on throughout the night
● using touch to provide human contact income the person
Symptoms
the symptoms of this progressive, degenerative disease develop gradually and progress at
different rates among affected individuals.

early in the disease, the patient may be aware of changes in the intellectual ability and become
depressed or anxious or attempt to compensate by writing down information, structuring
routines, and simplifying responsibilities. it may take some time for symptoms to be detected
even by those close to the patient

Remember : The greatest risked e of suicide for a person with dementia is in the early stage of the
disease when the individual is aware of the changes experienced.
Treatment:
Currently there is no treatment to prevent or cure Alzheimer's disease. clinical trials are being conducted
in the hope of finding means to improve function and slow the progress of the disease.
because as a acetylcholine falls sharply in people with alzheimer's disease, medication that stop or
slow the enzyme that breaks down acetylcholine have been developed to help people with alzheimer's
disease, these drugs includes donepezil ( aricept) rivastigmine ( exelon) and galantamine ( reminyl).

Promoting therapy in activity

various therapies and activities can be offered to the patient with dementia. depending on the patient's
level of function. occupational therapy in expressive therapies can benefit those with early dementia.

Providing physical care

physical care needs of patients with dementia must not be overlooked. These individuals may not
complain that they are hungry, these patients need close observation and careful attention to their
physical needs. consideration must be given to their potential inability to communicate their needs and
discomforts.
Using complementary and therapy
a variety of alternative medical therapies are being used to treat dementia. nutritional supplements that
have been used include vitamin b6, b12, C and E, folic acid, zinc and selenium. and also the herb ginkgo
biloba has been shown to improve circulation and mental function in several clinical trials.

Caring for persons with dementia

The reversible nature of dementia and its progressive dating course have devastating effects on affected
individuals and their families. a majority of the care required by persons with dementia falls within the
scope of the nursing practice.

Ensuring patient safety

one of the foremost care considerations in the safety of patients with dementia. their poor judgment and
misperceptions can lead to serious behavioral problems, and mishaps. A safe, structured environment
is. essential. the person in components of the environment should be consistent.
Respecting the individual:
Patient regress, their dignity, person worth, freedom, and individuality maybe jeopardize. loved ones
may view the demented family member as a stranger living inside the body that once housed the person
they knew. a person with dementia may be treated in a dehumanizing manner. Special attention must be
paid to maintaining and promoting the following qualities.
individuality
they should learn the personal history and uniqueness of the patient and incorporate this into caregiving
activities.
independence
Even if it takes three times longer to guide patients through dressing then it would take to dress them,
they should be afforded every opportunity for self care.
freedom
As major freedoms become limited, minor choices and control becomes especially important, nurses
must be careful that, in the name of efficiency in safety, such as severe restrictions to freedom are not
imposed that the quality of life becomes minimal.
dignity
to become angry or laugh at the behaviors of a demented person is no less cruel than reacting in a
similar fashion to a stroke victim who falls during ambulation. These patients should be afforded the
respect given to any adult, including attractive clothing, good grooming, adult hairstyles, use of their
names, privacy, and confidentiality.
connection
People with dementia continue to be valued human beings who are members of families, communities,
and the universe. interaction in connection with other people and nature show recognition and respect
for the spiritual beings that live within the altered bodies and minds.
nursing care plan:
the older adult with alzheimer's disease
nursing diagnosis: feeding self care deficit related to altered cognition

Goal
The patient maintains within ideal range is free from signs of malnutrition.

Nursing action
● weigh the patient Twister blush baseline weight and advise the wife to weigh the patient weekly in
report weight loss of 5lb or more.

● review with the patient and family the patient's food like and dislikes; assist family in planning
meals that incorporate the patients' preferences; consult with dietitian as necessary.

● advise the family to provide nutritious snacks, finger foods in soft foods for the patient