Delirium, Dementias, and Related Disorders

Delirium, Dementias, and Related Disorders

Key Concepts
* Cognition
o System of interrelated abilities, such as perception, reasoning, judgment, intuition and memory
o Allows one to be aware of oneself
* Memory
o Facet of cognition, retaining and recalling past experiences
* Delirium
o Acute cognitive impairment caused by medical condition
* Dementia
o Chronic, cognitive impairment
o Differentiated by cause, not symptoms

Delirium Clinical Course
* Disturbance in consciousness and a change in cognition
* Develops over a short period of time
* Usually reversible if underlying cause identified
* Serious, should be treated as an emergency

Delirium Diagnostic Criteria
* Impairment in consciousness - key diagnostic criteria
* Children - can be related to medications or fever
* Elderly - most common in this group, often mistaken as dementia

Delirium Epidemiology & Risk Factors
* Prevalence rates from 10-30% of patients
* In nursing homes, prevalence reaching 60% of those older than the age of 75 years
* Occurs in 30% of hospitalized cancer patients
* 30-40% of those hospitalized with AIDS
* Higher for women than men
* Common in elderly, post-surgical patients

Delirium Etiology
Variety of brain alterations
o Imbalance of neurotransmitter
o Raised plasma cortisol level
o Involvement of white matter
Types

* Due to General Medical Condition
* Substance-Induced
* Substance-Intoxication
* Substance-Withdrawal
* Multiple Etiologies

Medications
Physiological
* Fluid/kidney
o Dehydration, Hypocalcemia, Hypokalemia, Abnormal sodium, Low serum albumin, Elevated BUN, Elevated creatinine, Azotemia, Proteinuria, CRD
* Cardiac/Respiratory
o Hypotension, CVD, CHF, AA, Elevated PT, Low hematocrit, Respiratory insufficiency, Noncardiac thoracic surgery
LABS

* BUN
* Creatinine Clearance
* Serum Albumin
* Hyponatremia
* Hypocalcemia
* Hypokalemia
* Elevated PT

Physiological
* Metabolism/Temperature
* Age, gender

PhysiologicalInfection and Trauma
o Symptomatic infection
o Urinary tract infection
o Respiratory infection
o Elevated WBC
o Emergency Admission
o Fracture
o Falls
o Orthopedic surgery
o Combination illnesses
Physiological
* More than 4 medications
* Drugs with anticholinergic or CNS effects
* Hypoxia/Ischemia
Interdisciplinary Treatment & Priorities
Nursing Management Biologic Domain Assessment
Nursing Management Pharmacologic Assessment
Delirium: Biologic Domain Nursing Diagnosis
Delirium Biologic Nursing Interventions
Delirium Psychological Domain Assessment
Delirium: Psychologic Domain Nursing Diagnosis
Delirium Psychological Nursing Interventions
Delirium Social Domain Assessment
Delirium: Social Domain Nursing Diagnosis
Delirium Social Nursing Interventions
Evaluation Delirium Dementia
Dementia Alzheimer’s Type
Personality changes
Language difficulties
Dementia/Alzheimers Progression
Diagnosis of AD
Epidemiology
Risk Factors
Etiology
Interdisciplinary Treatment
Priority Care Issues
Family Response to AD
Nursing Management Biologic Domain Assessment
Dementia: Biologic Domain Nursing Diagnosis
Dementia Biologic Nursing Interventions
Pharmacologic Interventions
Dementia Psychological Domain Assessment
Dementia: Psychological Domain Nursing Diagnosis
Dementia Psychological Nursing Interventions
Dementia Psychological Nursing Interventions
Dementia Psychological Nursing Interventions
Dementia Social Domain Assessment & Nursing Diagnosis
Dementia Social Nursing Interventions
Family Interventions
Other Dementias
Amnestic Disorder

Delirium, Dementias, and Related Disorders.ppt

Read more...

Geropsychiatry: Delirium and Dementia

Geropsychiatry: Delirium and Dementia
By:Robert Averbuch, MD
Assistant Professor, Department of Psychiatry

Disorders of Cognition
* DSM-IV devotes an entire section to a subset of “organic” disorders that primarily affect cognition: “Delirium, Dementia, and Amnestic and other Cognitive Disorders”
What is “organic”?
* Previous differentiation between mental disorders with a clear “physical or biological” etiology (Organic) and those without (“Functional” or “Primary”)
* Falsely implied that Functional (or primary) disorders have no underlying pathophysiological basis
* Primary mental disorder- not due to a GMC or substance
Disorders of Cognition
* Delirium-disturbance in consciousness and cognition that develops rapidly
* Dementia- multiple cognitive deficits that include memory disturbance
* Amnestic Disorder- primarily memory impairment
Delirium: defined

* Disturbance of consciousness (awareness of the environment) and attention,
* PLUS…
o Changes in cognition (ie, “thinking”-memory, orientation, language, etc) OR
o Perceptual disturbances
The Course of Delirium
Delirium: Associated Features
* Disturbance in sleep-wake cycle
* Easily distracted by irrelevant stimuli
* Changes in activity level
o Restlessness, hyperactivity
o Picking at clothes, getting out of bed
o OR hypoactivity (lethargy)
* Emotional disturbances- mood lability, anger, irritability, euphoria, apathy
* Speech or language disturbances
* Perceptual abnormalities- common:
o Illusions, hallucinations, delusions
* Neurological deficits/dysfunction

What Are the Causes?
* DIRECT: Brain pathology: head injury, seizures (during and after), strokes, infections
* INDIRECT: Systemic Illness: electrolyte abnormalities, dehydration, uremia, hepatic encephalopathy, cardiovascular compromise
* Sensory deprivation
* After surgery (post-operative state)- ie. “ICU Psychosis”
* Side effects of medications or toxins or with abused recreational drugs:
Treating Delirium
* Considered a Medical Emergency
* Supportive care in an ICU setting
* Safety- close monitoring
* Remove offending agent, treat underlying cause
Dementia
Hallmark is Memory Impairment
Dementia- defined
Details: Aphasia
Disturbances in Executive Functioning
Associated Features
More associated features
Course of Dementia
What causes Dementia?
More causes:
Alzheimer’s Dementia of the Alzheimer’s Type (DAT)
Vascular Dementia
Aka Multi-Infarct Dementia
Treatment of Dementia
Medications

Geropsychiatry: Delirium and Dementia.ppt

Read more...

Delirium in the Elderly: Evaluation and Management

Delirium in the Elderly: Evaluation and Management
By:M. Andrew Greganti, MD

Outline of Discussion
* Case Presentation
* Characteristics of Delirium
* Etiology/Pathogenesis
* Risk Factors
* Prevalence
* Clinical Presentation
* Diagnosis
* Evaluation
* Prevention and Treatment
Case Presentation
Hospital Course
Post Hospital Course
Characteristics of Delirium
Other Characteristics
Etiology
Pathogenesis
How common is delirium?
Risk Factors
Other Risk Factors
Prodrome
Clinical Presentation
Diagnosis
Differential Diagnosis
Prognosis
Evaluation
Preventive Measures Perioperatively
Treatment
Treatment of “Yelling Out”
Summary of Key Points

Delirium in the Elderly: Evaluation and Management.ppt

Read more...