Dementia and Delirium

1. Dementia and Delirium Christine Hatcher

2. Imagine yourself in your mid to late thirties and you have become the primary care provider for a parent or grandparent. Now imagine that parent or grandparent waking up Monday morning and not knowing who you are or why you are with them, or where they are. They try to leave but don’t know where to do go or who to call to pick them up because normally they would call you. Fast forward to later that afternoon. They know exactly who you are and are asking you to make them their favorite lunch. This is just a glimpse of what living with and taking care of a family member who suffers from delirium or dementia can be like. Introduction

3. Dementia is the loss of mental functions such as the thought process, reasoning, and memory. • Dementia develops when the parts of the brain that are involved with learning, memory, decision-making, and language are affected by one or more of a variety of infections or diseases. • The term “dementia” is used to describe a collection of symptoms ranging from memory impairment, loss of communication skills, and a gradual deterioration in a persons ability to carry out daily tasks and activities of living. Dementia

4. Alzheimer’s • Alzheimer’s Dementia is a progressive cortical dementia, which causes problems with language, memory, social behavior and cognitive functioning. • Clumps of protein knows as plaques and tangles develop around brain cells which causes them to malfunction. • AD accounts for 60% of dementia and has a 7-10 year average lifespan after diagnosis. • Gradually brain function will decline and most deaths occur in the latest stages from aspiration pneumonia. Dementia can be classified according to the part of the brain affected, its cause, and its degree of progression. The most common types of dementia are Alzheimer's disease, Vascular Dementia, and Dementia with Lewy Bodies. Types of Dementia

5. Vascular Dementia • VD accounts for 20% of dementias and is caused by brain damage as a result of cerebrovascular or cardiovascular problems such as a stroke. • Vascular Dementia is also linked to genetic diseases such as endocarditis, or amyloid angiopathy. • Patients may have a history of high blood pressure, vascular disease, or previous stroke or heart attacks. • People with Vascular dementia often wander at night and often have other problems similar to people who have had a stroke such as depression and incontinence. • Dementia with Lewy Bodies • DLB is a progressive forms of dementia that can occur in patients with no family history. • It does however have a familiar pattern associated with Alzheimer's and Parkinson's disease. • There are plaques similar to the ones found in Alzheimer’s patients and a protein present that is associated with Parkinson's. • Depression and hallucinations are very common in DLB. Types of Dementia (continued)

6. Sometimes Dementia can be treated and cured because the cause is treatable and in some cases, self-induced. • long term substance abuse (drugs and alcohol) • Combinations of prescription drugs • Hormones or vitamin imbalances. • Causes of Dementia: • Diseases that cause deterioration or loss of nerve cells in the brain. (Alzheimer’s, Parkinson’s, Huntington’s) • Diseases that affect blood vessels such as a stroke. • Types of hydrocephalus which is an accumulation of fluid in the brain that can result from developmental abnormalities, injections, injuries, or brain tumors. • Infections that affect the brain and spinal cord. • Toxic reactions, head injuries, nutritional deficiencies, and other illnesses. Causes of Dementia

7. Delirium is a common acute and suddenchange in a person’s attention and overall cognitive state that can occur over hours or days. • Classification according to the DSM-IV: • Disturbance of conscientiousness with reduced ability to focus, sustain, or shift attention. • A change in cognition or the perceptual disturbance that is not better accounted for by a pre-existing, established ,or evolving dementia. • Develops over a short period of time and tends to fluctuate throughout the day. • There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct psychological consequence of a general medical condition. Delirium

8. So what causes Delirium? • Delirium occurs when the sending and receiving of signals in the brain become impaired. It can be caused by a combination of factors that make the brain vulnerable and trigger a malfunction. This is what the agitation and confusion stem from. • Delirium can also be caused by: • Infection • constipation, • Dehydration • Trauma • Anaesthesia • Or anything that interferes with homeostasis • Delirium may also indicate the presence of a life threatening condition such as pneumonia, sepsis, or myocardial infarction. Causes of Delirium

9. Advanced Age • Male Gender • Pre-existing dementia and depression • Visual and hearing impairment • Functional dependence • Poly-pharmacy • Alcohol Abuse • Multiple medical co-morbidities Risk Factors for the development of Delirium

10. Dementia Delirium Very quiet or alternatively agitated and disorientated Quick onset Hallucinations Rambling disjointed speech May talk to people that are not physically present Unaware of others May be semi comatose, mistaken for sleeping or withdrawal Agitation Fluctuations of feelings at any time of day Risk of Dehydration Risk of sudden disorientation in physical health • Poor short term memory • Usually gradual onset • Problems with self-care • Difficulties with sequencing • Usually distractible • Disorientation with time • Repetitive conversations • Feeling the need to connect with others • Sometimes withdrawn, sometimes forthcoming • Agitation • Diurnal Variation usually feeling worse in the afternoon or evening Signs of common Mental Health Problems in Older People

11. Dementia vs. Delirium • What is Delirium? • What is Dementia? • Click here to view this chart that shows the difference between Delirium, Dementia, and Depression. • These three short videos are brief but give a simple but accurate description of Delirium and Dementia and the difference between the two. Check out these videos!

12. Bibliography • Griffiths, E. S., Tandon, U., Treml, J., & Jackson, T. (2014). Delirium in trauma. Trauma, 87-92. • Keenan, B., Jenkins, C., Denner, L., Harris, M., Fawcett, K., Magill, L., et al. (2011). Promoting mental health in older people admitted to hospitals. Nursing Standard, 46-56. • Thomas, C., Kreisel, S. H., Oster, P., Driessen, M., Arolt, V., & Inouye, S. K. (2012). Diagnosing Delirium in Older Hospitalized Adults with Dementia: Adapting the Confusion Assessment Method to International Classification of Diseases, Tenth Revision, Diagnostic Criteria. Journal of the American Deriatrics Society, 1471-1477. • Westerby, R., & Howard, S. (2011). Early Recognition and Diagnosis. Practice Nurse, 42-47. Citations