DELIRIUM, DEMENTIA, AND ALZHEIMERS DISEASE NOTES.
DELIRIUM, DEMENTIA, AND ALZHEIMER'S DISEASE
LEARNING OBJECTIVES
Differentiate between delirium and dementia and provide examples of conditions that cause each.
List five etiologic factors linked to Alzheimer disease.
Discuss the pathophysiologic changes associated with Alzheimer disease.
Name the first symptom of Alzheimer disease.
Identify two methods for diagnosing Alzheimer disease.
Explain the mechanism of drug therapy in Alzheimer disease.
Describe the nursing management for patients with Alzheimer disease.
GERONTOLOGIC CONSIDERATIONS
Delirium may present as symptoms for various conditions including UTI, pneumonia, or other infections.
Delirium may manifest as hypoactive or hyperactive behavior.
Document cognitive changes in detail as they can impact assessment and management.
Understand alterations in absorption, metabolism, distribution, and/or elimination of medications due to aging.
Cognitive changes may alter roles and relationships, suggesting the use of photographs to help provide a sense of self.
Caregiver support, coping mechanisms, and respite care are essential in managing patients with cognitive decline.
Be aware of the effects of medications as per the Updated Beers Criteria for Potentially Inappropriate Medication Use in Adults.
DELIRIUM AND DEMENTIA
Changes in mentation can occur at any point in life.
Cognitive functions are subject to change with age, particularly short-term memory and learning ability.
Cognitive impairment can occur at any age;
Older adults are at greater risk, but cognitive decline is not a normal consequence of aging and is not untreatable.
Other disorders, particularly depression, can manifest as mental dysfunction.
DELIRIUM
Symptoms
Difficulty processing information
Disorientation
Impaired judgment
Poor intellectual capacity
Symptoms may include:
Suspicious behavior
Frightened demeanor
Inappropriate behavior
Causes
Conditions that may lead to delirium include:
High fever
Head trauma
Brain tumor
Drug intoxication or withdrawal
Metabolic disorders
Inflammatory disorders of the CNS
Treatment
Treat the underlying medical condition; delirium is reversible.
It is characterized as a sudden and transient state of confusion.
Nursing Considerations
Minimize risk factors associated with delirium.
Use CAM screening for assessment.
Focus on injury prevention, cognitive support, and addressing physical needs.
Ensure effective communication with patients.
Medication management per protocol.
Confusion Assessment Method (CAM)
Diagnosis requirements:
Presence of BOTH features A and B:
A. Acute onset and fluctuating course
B. Inattention
Evidence of acute change in mental status must be observed.
Abnormal behavior must fluctuate throughout the day.
Assess difficulty with attention and tracking conversation.
Presence of EITHER feature C or D:
C. Disorganized thinking
D. Altered level of consciousness
Assess coherence of thinking (e.g., rambling speech, unpredictable subjects, unclear ideas).'
DEMENTIA
General Overview
More commonly affects older adults.
Characterized by a gradual, irreversible decline in memory and other mental functions, affecting daily life.
Disorders characterized by dementia include:
Alzheimer’s disease
Cerebrovascular disorders
Parkinson disease
Risk Factors
Advanced age
Neurovascular disorders
Vascular dementia
Chronic alcoholism
Medications
Signs and Symptoms
Recent memory is usually affected first.
Remote memory declines later on.
Individuals may forget how to perform simple tasks.
Other symptoms can include:
Wandering behavior
Aphasia (speech language difficulties)
Behavioral problems.
ALZHEIMER'S DISEASE
Pathophysiology and Etiology
Two types of Alzheimer’s disease include:
Early onset
Late onset
Etiologic Factors
Increased risk associated with:
Environmental and lifestyle factors
First-degree relatives with Alzheimer’s disease
Inherited genetic abnormalities
Four pathologic changes in the brain include:
Decreased cortex size
Deficient acetylcholine levels
Presence of neuritic plaques
Neurofibrillary tangles.
Stages of Alzheimer’s Disease (according to National Institute on Aging)
Preclinical
Mild Cognitive Impairment
Dementia
Classic Symptoms
Earliest symptom: Memory loss (especially recent memory).
Other symptoms include:
Behavior disturbances
Impaired judgment and problem-solving skills
Personality changes
Signs of depression.
Advanced symptoms can result in:
Deterioration of memory (including long-term memory)
Cognitive impairment affecting self-care
Possible wandering or violent behavior.
Medical Terminology Related to Alzheimer’s Disease
Aphasia: Impairment of language ability.
Alexia: Inability to read.
Agraphia: Inability to write.
Acalculia: Inability to perform arithmetic calculations.
Agnosia: Inability to interpret sensations and recognize things.
Ataxia: Lack of voluntary coordination of muscle movements.
Apraxia: Inability to perform tasks or movement when asked.
Diagnostic Findings
Diagnostic tools include:
Electroencephalography (EEG)
CT scan
MRI
PET scan
Biomarkers: A new diagnostic method being researched.
Medical Management
Currently, no cure exists.
Emphasis on supportive care.
Medications aim to delay progression and/or lessen severity, including:
Folic acid supplements
Antidepressants
Tranquilizers such as donepezil (Aricept) and memantine (Namenda).
Nursing Management
Aim to maintain patient independence for as long as possible.
Provide referrals to extended care facilities when appropriate.
Regularly assess for patient safety.
Monitor for caregiver burden and offer support mechanisms.
Nursing Management in Hospital Settings
Position patient room close to RN's station for safety monitoring.
Use bed alarms as necessary.
Establish a consistent routine for patients.
Ensure adequate nutrition provision.
Caregiver Burnout Management
Assess for caregiver burnout continuously.
Recommend participation in support groups.
Provide information about daycare and other community resources.
Encourage collaboration among members of the health care team to ensure comprehensive care for both patient and caregiver.