Ch. 64 Dementia and Delirium

Dementia

Disorder characterized by a decline from the previous level of function in 1 or more cognitive domains: complex attention, executive function, language, learning and memory, perceptual-motor, and social cognition

Manifestations of dementia

Gradual neurologic degeneration

Alzheimer disease

Progresses slowly

Etiology of Alzheimer's Disease

DM, HTN, obesity, smoking, and high cholesterol ↑ risk of CVD and thus ↑ risk of neurologic problems

Mild stage of Alzheimer's

Lost of initiative and interests

May no longer be able to solve simple math problems

Diagnostic for Alzheimer's

Mini-Cog

Drug therapy for Alzheimer's

Rivastigmine: Block cholinesterase, the enzyme that breaks down acetylcholine in the synaptic cleft

Memantine: Protects the brain's nerve cells by blocking the action of glutamate

Drug therapy for Alzheimer associated depression

Selective Serotonin Reuptake Inhibitors (SSRIs)

-fluoxetine, sertraline, and citalopram

Atypical antidepressants

-trazodone, mirtazapine

Drug therapy for behavioral problems associated with Alzheimer's

Antipsychotics

Can be used to manage agitation and aggression

-Should only be used when agitation and psychosis are severe, dangerous, and cause significant distress

-Aripiprazole, haloperidol, olanzapine, quetiapine, risperidone

Benzodiazepines

-Clonazepam, lorazepam

Problems associated with Alzheimer's

Risk for aspiration pneumonia

Urinary and fecal incontinence are common

Constipation may be caused by immobility, and reduced fiber and fluid intake

Delirium

State of confusion that develops over days to hours

Diagnostic study for delirium

The Confusion Assessment Method (CAM): helps differ between delirium and dementia

Nursing management for delirium

Reassure, reorient; clocks and calendars may be helpful

Dementia vs Delirium

Dementia- Chronic

Delirium- Acute