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Chapter 33
Delirium and Dementia
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Introduction
• Fear of loss of normal cognition
• Losses that result from impaired cognition
• With aging there is increased risk of
– Delirium: generally reversible
– Dementia: irreversible
• Differences between delirium and dementia
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Delirium
• Causes
• Signs and symptoms
– Rapid; altered level of consciousness
• Nursing assessment
• Prompt treatment may reverse condition and
prevent permanent damage
• Treatment/management
– Depends on the cause
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Delirium—(cont.)
• Consider coexisting factors
• Interventions during the initial acute stage
– Establishing medical stability
– Minimizing stimulation
– Consistency in care
– Prevention of harm to self and others
– Support and realistic expectations
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement True or False?
Several coexisting factors can be
responsible for a delirium.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
As older adults often have multiple health
conditions, it is important to remember that
several coexisting factors can be responsible
for a delirium.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dementia
• Irreversible
• Progressive
• Impairment in cognitive function affects
– Memory, orientation, reasoning,
attention, language, and problem solving
• Caused by damage or injury to the brain
• 4.5 million older adults are affected
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Alzheimer’s Disease (AD)
• Most common form of dementia
• Incidence/prevalence
• Changes in the brain:
– Neuritic plaques containing beta-amyloid
protein
– Neurofibrillary tangles in the cortex
– Loss or degeneration of neurons and
synapses
– Changes in neurotransmitter systems
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AD—(cont.)
• Possible causes
– Genetics
– Environmental factors
– Chromosomal abnormalities
– Free radicals
– Levels of aluminum and mercury in brain
– Slow-acting virus
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
AD—(cont.)
• Symptoms develop gradually and progress at
different rates among individuals
• Staging
– Global Deterioration Scale/Functional
Assessment Staging (GDS/FAST)
• Early disease changes
• Diagnosis
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AD—(cont.)
• Treatment/management
– No current treatment to prevent/cure AD
– Clinical trials in place to improve function and
slow disease progression
– Research on estrogen–conflicting results
– Antioxidants, anti-inflammatory agents, folic
acid, vitamins B6 and B12, and gene therapy
– Medications that slow acetylcholinesterase
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Other Dementias
• Vascular dementia
• Frontotemporal dementia
• Lewy body dementia
• Creutzfeldt-Jakob disease
• Wernicke encephalopathy
• Parkinson’s disease
• AIDS
• Trauma and toxins
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following statements best describes
Creutzfeldt-Jakob disease?
a. Neuronal atrophy of the frontal lobes of the
brain
b. Rare disease with a rapid onset and
progression of the disease to death
c. Behavioral rather than cognitive impairments
in the early stages
d. Caused by cerebral infarctions and history of
cardiovascular disease
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
b. Rare disease with a rapid onset and
progression of the disease to death
Creutzfeldt-Jakob disease is an extremely
rare brain disorder that causes dementia. It
has a rapid onset and progression and is
characterized by severe neurological
impairment that accompanies the dementia.
The disease progresses rapidly, and death
typically occurs within 1 year of diagnosis.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Caring for Persons with Dementia
• Ensuring patient safety
– Problems related to poor judgment and
misperceptions
– Consistent, structured environment
– Items to trigger memory
– Controlled environment
– Wandering behavior
– Prevention of abuse
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Caring for Persons with Dementia —
(cont.)
• Promoting therapy and activity
– Occupational and expressive therapy
– Varying degrees of reality orientation
– Stimulation through other activities
– Touch
– Modified communication techniques
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Caring for Persons with Dementia—
(cont.)
• Providing physical care
– Close observation and attention to
physical needs
•Eating and drinking
•Bathing and skin care
•Consideration of inability to
communicate needs and discomforts
•Consistency in caregivers
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Is the following statement True or False?
The onset of behavioral problems in a
person with dementia indicates the need for
medications to suppress the behavior
problem identified.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
Consideration must be given to the potential
inability of the older adult with dementia to
communicate their needs and discomforts. A
subtle change in behavior or function, a
facial grimace, or repeated touching of a
body part may give clues that a problem
exists. The underlying cause must be
determined.
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Caring for Persons with Dementia—
(cont.)
• CAM therapies
– Nutritional supplements
•Vitamins
•Minerals
•Herbs
• Therapeutic exercise
– Qigong
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Caring for Persons with Dementia—
(cont.)
• Respecting the individual
– Know the person’s unique life history
– Need to promote:
• Individuality
• Independence
• Freedom
• Dignity
• Connection
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Caring for Persons with Dementia—
(cont.)
• Supporting the patient’s family
– Consideration of physical, emotional, and
socioeconomic burdens of caregiving
– Review/educate basic care techniques
– Help prepare for feelings that may
accompany the role of caregiver
– Community resources
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins