1: Dementia and Delirium

Flashcards for reviewing key concepts related to dementia and delirium, including definitions, causes, and management.

What are acute confusional states, such as delirium, characterized by?

A patient’s loss of orientation to time, place, and person, potentially with intense autonomic nervous system hyperactivity.

List potential causes (Aetiology) of Delirium?

General anaesthetic, hypoxia, sepsis, infections, medication toxicity/interaction, low blood sugar, hepatic/renal dysfunction, non-prescription illegal drugs, and numerous other causes.

What neural network disruption is thought to cause Delirium?

Disruption of a widely distributed neural network involving the reticular activating system of the upper brainstem and its projections into the cerebral cortex and limbic areas, typically affecting both cerebral hemispheres.

List some typical signs and symptoms of Delirium.

Slurred speech, altered level of consciousness, restlessness, inattentiveness, grossly altered perceptions of reality, misperception, misinterpretation, incoherent conversation, agitation, hallucinations, and sometimes violence.

What routine care is involved in the management of delirium?

Vital sign observations, full neurological observations (FNO), monitor input and output, maintain a fluid balance chart (FBC), maintain patient and others' safety, administer prescribed antipsychotics and other medications.

List potential complications that may occur with a patient experiencing Delirium.

Potential for harm to self or others, and risk of falls and injury.

Why is Delirium considered a medical emergency?

Due to the acute and potentially life-threatening nature of the underlying causes and associated complications.

How is Dementia defined?

A progressive failure of many cerebral functions not caused by impaired level of consciousness, affecting the ability of the person to function normally.

What functions are decreased with Dementia?

Orientation, memory, language, and executive attentional networks (decision making and judgment).

What percentage of dementia cases does Alzheimer’s disease account for in Australia?

Approximately 50-70%.

What physical changes occur in the brain due to Alzheimer’s disease?

Loss of neurons, shrinkage of the cerebral cortex, and reduction in brain size.

What are the common clinical manifestations of Alzheimer's disease?

Increasing memory loss, reduced concentration, disorientation, mood alterations, and motor changes.

What is involved in the diagnosis of Alzheimer's disease?

History and course of the illness, mental status examination, and brain imaging.

What is prescribed to relieve behavioral disturbances in dementia?

Antipsychotics and antidepressants.

What is the action of centrally acting anticholinesterases (e.g. donepezil)?

Slow cognitive decline by enhancing ACh functions.

What classes of antidepressant drugs exist?

The tricyclic antidepressants, the selective serotonin reuptake inhibitors, and the monoamine oxidase inhibitors.

How do antipsychotics work?

A primary effect is dopamine blockade in specific areas of the CNS. Receptors for many other neurotransmitters are also likely to be blocked.

What are some major adverse effects related to psychotherapeutic medications?

Sedation, hypotension, behavior changes, dystonias and parkinsonian effects, and akathisia.

What are some serious adverse effects related to psychotherapeutic medications?

Tardive dyskinesia and neuroleptic malignant syndrome.

What drugs can be used to manage delirium?

Haloperidol and Chlorpromazine.

What are some side effects of Chlorpromazine.

Drowsiness and patient not rousable, have altered respirations, tachycardia and reduced blood pressure.

What steps are taken when managing a patient experiencing delirium?

Close nursing observation e.g. frequent full neurological observations, frequent vital sign observations or a nurse special (one nurse to one patient) care.

Define Alzheimer's disease.

A disease that accounts for approximately 50-70% of all cases of Dementia characterized by a loss of neurons, the cerebral cortex shrinks and brain size reduces. The loss of neuronal synapses, cause memory loss.

Define Antipsychotics.

Drugs used to treat clinical psychosis. Typical antipsychotics like haloperidol antagonize (block) dopamine receptors.

Define Antidepressants.

Drugs used to treat clinical depression. Antidepressant drug groups include the tricyclic antidepressants, the selective serotonin reuptake inhibitors and the monoamine oxidase inhibitors.

Define Confusion.

The person does not have the ability to be clear on their thoughts and the confusion is related to cognitive function.

Define Delirium.

A major type of acute confusion state, and may manifest as slurred speech, altered level of consciousness, restlessness, inattentive (not obeying commands), grossly altered perceptions of reality, misperception, misinterpretation, incoherent conversation, agitation, hallucinations, and sometimes violence. This is a medical emergency.

Define Dementia.

Progressive failure of many cerebral functions, not caused by impaired level of consciousness. Decrease in orientation to time, place and person, decrease in memory function, language and higher executive attentional networks (decision making and judgment).

Define Disorientation.

The person is not oriented to either time, place and person.

Define Orientation.

Persons ability to describe the correct time, place and person.

What is the brand name of the drug Donepezil Hydrochloride?

Aricept

What is the drug class of Donepezil Hydrochloride?

Other central nervous system agents

What is the action of Donepezil Hydrochloride?

Acetylcholinesterase inhibitor

What are some common side effects of Donepezil Hydrochloride?

Diarrhoea, muscle cramps, fatigue, nausea, vomiting and insomnia

What is the brand name of the drug Chlorpromazine?

Largactil

What is the drug class of Chlorpromazine?

Central Nervous System. Antipsychotic agents

What are some common side effects of Chlorpromazine?

Postural hypotension, ECG changes

What is the brand name of the drug Haloperidol?

Serenace

What is the drug class of Haloperidol?

Central Nervous System - Antipsychotic agents

What are some common side effects of Haloperidol?

Hypotension, Tachycardia, Dystonia

What are the nursing considerations when administering centrally acting anticholinesterases (e.g. donepezil)?

Monitor cognitive decline, report side effects, and ensure patient safety.

What are the nursing considerations when administering antidepressant medications?

Monitor mood changes, assess for suicidal ideation, and educate patients about potential side effects and drug interactions.

What are the nursing considerations when administering antipsychotic medications?

Monitor for extrapyramidal symptoms (EPS) such as dystonia, akathisia, and tardive dyskinesia, as well as neuroleptic malignant syndrome (NMS). Regularly assess vital signs and observe for any adverse effects.

What education should be provided to patients and families regarding delirium?

Explain the potential causes, signs and symptoms, and management strategies for delirium. Educate on the importance of maintaining a safe environment and preventing falls. Stress the need for close monitoring and reporting any changes in the patient's condition.

What education should be provided to patients and families regarding dementia?

Discuss the progressive nature of dementia and its impact on cognitive functions. Provide information on available resources, support groups, and strategies to manage behavioral changes. Educate on medication management and the importance of regular medical follow-ups.

What are the key differences between delirium and dementia?

Delirium is an acute confusional state with a sudden onset and fluctuating course, whereas dementia is a progressive decline in cognitive functions with a gradual onset. Delirium is often reversible, while dementia is typically irreversible.

What are some non-pharmacological interventions for managing delirium?

Maintain a calm and quiet environment, provide frequent reorientation, ensure adequate hydration and nutrition, promote sleep hygiene, and involve family members in providing support and comfort.

What are some non-pharmacological interventions for managing dementia?

Provide a structured and predictable routine, engage in cognitive stimulation activities, encourage social interaction, promote physical exercise, and create a safe and supportive environment.

What is the role of cholinesterase inhibitors in managing Alzheimer's disease?

Cholinesterase inhibitors, such as donepezil, help to slow the cognitive decline in Alzheimer's disease by enhancing acetylcholine function in the brain.

Describe the pathophysiology of vascular dementia.

Vascular dementia results from reduced blood flow to the brain, often due to stroke or other vascular lesions. This can lead to brain damage and cognitive impairment.