Delirium and Dementia

Question 1

Is delirium reversible ? Is it considered a medical emergency?

Answer 1

Yes and Yes

Question 2

Characteristics of Delirium

Answer 2

Rapid/Sudden Onset
Altered LOC
erratic lucidity and somnolence
disturbed attention 
disorganized thinking 
sleep - wake cycle is affected (may be an early symptom)

Question 3

APA describes delirium as having 4 units

Answer 3

Disturbance of consciousness with reduced ability to focus, sustain or shift attention.

Change in cognition or development of perceptual disturbance that is NOT due to a pre-existing dementia.

The disturbance develops over a short period of time and tends to fluctuate during the course of the day.

Evidence that the disturbance is related to or caused by a medical condition

Question 4

Common symptoms of delirium

Answer 4

Orientation?
Meaningless chatter
Poor judgement
Hallucinations 
Illusions
Agitation or lethargy
Memory Impairment
Wandering
Fluctuating or altered level of consciousness
Uncooperative or unable to follow directions
Inattentiveness 
Somnolent
Stupor

Question 5

What are the different types of delirium?

Answer 5

Hyperactive delirium
Hypoactive delirium
Mixed delirium

Question 6

Risk factors for delirium

Answer 6

Length of stay
Older, aged patients 
fluid and electrolytes imbalances 
oxygen deficiency 
polypharmacy patients 
alcohol withdrawal 
sleep deprived 
dehydration

Question 7

Common causes of delirium

Answer 7

Drug toxicity interaction 
infection process
Metabolic and endocrine disorders
New disease process
Changes in chronic illness

Question 8

There is a _______________ risk of developing delirium in patients with _____________.

Answer 8

greater; dementia

Question 9

CAM

Answer 9

Confusion Assessment Method

Question 10

CAM - what are the 4 features to assess for presence or absence of delirium

Answer 10

1. Mental Status altered from baseline (acute onset or fluctuating)
2. Inattention
3. Disorganized Thinking
4. Altered Level of Consciousness (are they alert, drowsy, stuporous, comatose)

Delirium is identified if there’s evidence of features 1 and 2, and either 3 or 4 (or both).

Question 11

84% of the time clincians fail to recognize _______________ delirium in older adults.

Answer 11

delirium.

It is not always recognized; it is easy to miss.

Question 12

What is sundowning ?

Answer 12

Disruptive, delirium like symptoms seen in older patients in the evening hours
- this is not a medical diagnosis- this is a descriptive term
believed to be caused by changes in the circadian rhythm

Question 13

Is dementia irreversible or reversible ?

Answer 13

Irreversible

Question 14

Onset - rapid or slow?

Answer 14

Slow

Question 15

What is dementia ?

Answer 15

Intellectual deterioration in the presence of a clear state of consciousness

Question 16

Types of Dementia

Answer 16

Alzheimers Disease
Vascular Dementia
Frontotemporal dementia
Lewy body dementia
Creutzfeldt-Jakob disease
Wernicke’s encephalopathy and Parkinson’s (small %)
AIDs (final stage)
Trauma and toxins

Question 17

Potentially reversible causes of dementia symptoms

- these may possibly lead to dementia

Answer 17

Thyroid disease
Vitamin B12 deficiency
Depression
Tumors
Infections
Vasculitis (Inflammation of the vessels)
Normal pressure hydrocephalus

Question 18

True or false …. Alzheimers is the sixth leading cause of death.
True or false…. every 67 seconds someone develops Alzheimers

Answer 18

True. Its the symptoms that cause death

True.