Delirium/Alzheimer's Disease PDF

DELIRIUM/ALZHEIMER’S DISEASE Delirium Delirium is an acute syndrome caused by a medical condition, substance, intoxication or withdrawal, or medication side effect causing temporary altered mental status Examples include: Sepsis, sundowning, ETOH withdrawal, opiate withdrawal, su...

DELIRIUM/ALZHEIMER’S DISEASE Delirium Delirium is an acute syndrome caused by a medical condition, substance, intoxication or withdrawal, or medication side effect causing temporary altered mental status Examples include: Sepsis, sundowning, ETOH withdrawal, opiate withdrawal, sunstroke Common in hospitalized elderly patients, is often caused by drugs, dehydration, and infections (eg, UTI) but can have many other causes. Delirium is rapid in onset, short-term and reversible Criteria for the diagnosis of delirium include the following: 1. Disturbed level of consciousness, such as a decreased attention span or lack of environmental awareness 2. Cognitive change, such as a memory deficit, disorientation, or language disturbance, possibly also including visual illusions or hallucination 3. Rapid onset within hours or days with a fluctuating course 4. Evidence of a causal physical condition Delirium vs. Dementia Delirium is an acute syndrome caused by a medical condition versus dementia which is a long-term impaired memory disease process such as Alzheimer’s Delirium Consider delirium in elderly patients, particularly those presenting with impaired memory or attention History taken from family members, caregivers, and friends and mental status examination are key to recognizing delirium. Thoroughly assess patients with delirium for possible neurologic and systemic causes and triggers Testing usually includes CT or MRI, tests for suspected infections (eg, CBC, blood cultures, chest x-ray, urinalysis), and measurement of electrolytes, BUN, creatinine, plasma glucose, blood levels of any drugs suspected to be having toxic effects, and a urine drug screen Treat the cause of delirium and provide supportive care, including sedation when necessary Alzheimer’s Disease Alzheimer's Disease History and examination along with limited laboratory testing and a neuroimaging study are usually sufficient to make a diagnosis of neurocognitive disorders and in most cases to identify a presumptive cause The Mini-Mental Status Examination or the Montreal Cognitive Assessment (MoCA) is often used as a bedside screening test When delirium is absent, the presence of multiple deficits, particularly in patients with an average or a higher level of education, suggests a neurocognitive disorder Neuropsychologic testing should be done when history and bedside mental status testing are not conclusive. It evaluates mood as well as multiple cognitive domains Takes 1 to 3 h to complete and is done or supervised by a neuropsychologist Screen for depression Screen for B12 deficiency and hypothyroidism. Routine CBC and liver function tests Lumbar puncture is rarely needed but should be considered if a chronic infection or neurosyphilis is suspected Biomarkers for Alzheimer's disease can be useful in research settings but are not yet routine in clinical practice Neuroimaging with noncontrast magnetic resonance imaging (MRI) or head computed tomography (CT) should be considered in the initial evaluation of all patients with dementia Alzheimer's Disease Elimination of drugs with sedating or anticholinergic effects The cholinesterase inhibitors donepezil, rivastigmine, and galantamine are somewhat effective in improving cognitive function in patients with Alzheimer's disease or Lewy body dementia and may be useful in other forms of dementia Memantine, an NMDA (N-methyl-d-aspartate) antagonist, may help slow the loss of cognitive function in patients with moderate to severe dementia and may be synergistic when used with a cholinesterase inhibitor Drugs to control behavior disorders (eg, antipsychotics) have been used. Patients with dementia and signs of depression should be treated with non anticholinergic antidepressants, preferably SSRIs Measures to ensure safety and prevent falls Provision of appropriate stimulation, activities, and cues for orientation Assistance for caregivers Arrangements for end-of-life care, durable power of attorney