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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 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia— (cont.) • CAM therapies – Nutritional supplements •Vitamins •Minerals •Herbs • Therapeutic exercise – Qigong Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia— (cont.) • Respecting the individual – Know the person’s unique life history – Need to promote: • Individuality • Independence • Freedom • Dignity • Connection Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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