Week 13: Dementia
1. Discuss current issues, trends and research related to delirium, dementia, or
Alzheimer’s Disease.
Cognition
o Activities of the mind involved in thinking and thought processes
o Involves different domains
o Includes intelligence, learning, judgement, reasoning, knowledge,
understanding and memory (higher levels)
o Attention and orientation (lower level domain).
o Interrelates with the key aspects of the individual (physical, psychological,
social, and spiritual).
Confusion
o Cognitive impairment is a disruption in higher brain functions that results
in confusion (Morrison Valfre, 2021, p.192)
o Means a disorder, bewilderment or uncertainty.
o Confusion is not normal.
o Is an indication of an underlying problem that requires immediate
attention.
o Can be acute, subacute, chronic, reversible or irreversible.
o Sources of confusion: The 6 D’s = damage, delirium, deprivation,
dementia, depression, and drugs.
Delirium
o It is acute confusion, and a change of consciousness
that occurs quickly
o Is a medical emergency that requires immediate
attention to prevent serious damage.
o Reversible, if treated early.
o Can result in further complications and prolonged
hospital stay.
o Occurs primarily in the elderly population but can
also occur in younger adults.
o A disturbance in Attention and Level of Consciousness
o A disturbance in Awareness-reduced orientation to the environment .
o There is an acute (hours-weeks) change in the persons baseline attention,
o awareness, memory and/or language .
o Fluctuates during the day
o Risk Factors: Delirium
Older than 65 yrs. old
Pre-existing dementia
Male
Poor vision/hearing
, Mild cognitive impairment
Depression
Polypharmacy
Poor ADL function
Multiple comorbidities
o Causes
Rapid onset hours to days, evidence of physical condition,
cognitive changes decrease/increase attention to environmental
stimuli
It is multifactorial. It can result from an infection such as UTI,
Pneumonia, or Sepsis
Subdural hematoma intoxication CVA, CHF, Medications (Ativan),
poly-pharmacy, dehydration, electrolyte imbalance, MI,
hypoglycemia, hypoxia TIA, Stroke
o Precipitating Factors of Delirium
o Signs and Symptoms of Delirium
Cardinal signs based on the Confusion Assessment Method (CAM)
Inattention and changes in awareness (of their environment)
Acute onset and fluctuation (lucid during the day, delirious at
evening = sundowning)
Disorganized thinking
Disturbance of cognition/consciousness
o Types of Delirium and Symptoms
Includes three sub-types:
Hyperactive delirium: hypervigilance (very alert, constantly
scanning the room), restlessness, and psychomotor agitation
(climbing out of bed, hitting etc.)
Hypoactive delirium: more common in older adults, include
drowsiness, lethargy, and decreased motor activity. Client may be
quieter apathetic and withdrawn.
Combined/Mixed delirium: involves symptoms of both hyper and
hypo.
Other symptoms = hallucinations, disturbed sleep-wake
cycle, and illusions
o Diagnosis of Delirium
1. Discuss current issues, trends and research related to delirium, dementia, or
Alzheimer’s Disease.
Cognition
o Activities of the mind involved in thinking and thought processes
o Involves different domains
o Includes intelligence, learning, judgement, reasoning, knowledge,
understanding and memory (higher levels)
o Attention and orientation (lower level domain).
o Interrelates with the key aspects of the individual (physical, psychological,
social, and spiritual).
Confusion
o Cognitive impairment is a disruption in higher brain functions that results
in confusion (Morrison Valfre, 2021, p.192)
o Means a disorder, bewilderment or uncertainty.
o Confusion is not normal.
o Is an indication of an underlying problem that requires immediate
attention.
o Can be acute, subacute, chronic, reversible or irreversible.
o Sources of confusion: The 6 D’s = damage, delirium, deprivation,
dementia, depression, and drugs.
Delirium
o It is acute confusion, and a change of consciousness
that occurs quickly
o Is a medical emergency that requires immediate
attention to prevent serious damage.
o Reversible, if treated early.
o Can result in further complications and prolonged
hospital stay.
o Occurs primarily in the elderly population but can
also occur in younger adults.
o A disturbance in Attention and Level of Consciousness
o A disturbance in Awareness-reduced orientation to the environment .
o There is an acute (hours-weeks) change in the persons baseline attention,
o awareness, memory and/or language .
o Fluctuates during the day
o Risk Factors: Delirium
Older than 65 yrs. old
Pre-existing dementia
Male
Poor vision/hearing
, Mild cognitive impairment
Depression
Polypharmacy
Poor ADL function
Multiple comorbidities
o Causes
Rapid onset hours to days, evidence of physical condition,
cognitive changes decrease/increase attention to environmental
stimuli
It is multifactorial. It can result from an infection such as UTI,
Pneumonia, or Sepsis
Subdural hematoma intoxication CVA, CHF, Medications (Ativan),
poly-pharmacy, dehydration, electrolyte imbalance, MI,
hypoglycemia, hypoxia TIA, Stroke
o Precipitating Factors of Delirium
o Signs and Symptoms of Delirium
Cardinal signs based on the Confusion Assessment Method (CAM)
Inattention and changes in awareness (of their environment)
Acute onset and fluctuation (lucid during the day, delirious at
evening = sundowning)
Disorganized thinking
Disturbance of cognition/consciousness
o Types of Delirium and Symptoms
Includes three sub-types:
Hyperactive delirium: hypervigilance (very alert, constantly
scanning the room), restlessness, and psychomotor agitation
(climbing out of bed, hitting etc.)
Hypoactive delirium: more common in older adults, include
drowsiness, lethargy, and decreased motor activity. Client may be
quieter apathetic and withdrawn.
Combined/Mixed delirium: involves symptoms of both hyper and
hypo.
Other symptoms = hallucinations, disturbed sleep-wake
cycle, and illusions
o Diagnosis of Delirium
