Wednesday, May 21, 2008

treatment stops: delirium increases

5/21/06
Robin and I decide that we will not take Dad in for more radiation treatments. He is just too ill and cannot sit up. He is urinating every ten minutes. He is leaving the tap on and letting the water run all night - when he remembers to wash his hands. I find out later that this kind of memory loss is indicative of dementia due to the brain tumour in his frontal lobe. Dad is both delirious, having symptoms of dementia, and fighting the brain tumour. Aside from the aging process, dementia and delirium in old age include the following characteristics. Dementia is associated with, but not limited to, Alzheimer’s disease, vascular dementia, alcoholism, toxic reactions to medication, infections, metabolic disorders, malnutrition, and brain tumours (Pinel, 2006). (See week 9)

Dementia (i.e. senility) is an abnormal progressive deterioration of neural functioning. It means
- memory impairment
- diminishing intellectual ability
- poor judgement
- difficulty with abstract thinking i.e. math, thinking skills.
- personality changes

Delirium:
- changes daily
- disturbance of consciousness
- disorientation, wandering attention, confusion, hallucinations
- affects up to 50% elderly hospital patients
- response to stressors: illness, surgery, drug overdoses, interactions of drugs, malnutrition (Cole, 2004)
- high death rate for those undiagnosed and sent home from hospital (Kakuma et al., 2003)

Alzheimer’s disease
- Accounts for 70% of dementia cases
- Affects 5% of the population age 65+ (Blazer, 1996; Regier et al., 1988)
- Affects 40% of those over age 90 (Williams, 1995)
- Patients die on average 8 – 10 years after onset of symptoms
- 2 -3 years before dementia usually difficulty learning and remembering verbal material (Howieson et al., 1997)

These are all signs. Not all dementia is Alzheimer’s disease, but these are the signs to look for. It means Dad’s tumour is progressing.
- first significant sign is memory loss
- develops into dementia
- affects simple activities: eating, speaking, recognition of family members, bladder control
- neural research is focused on predementia Alzeimer’s patients
- memory deficits are more general than medial temporal lobe damage, medial diencephalic damage or Korsakoff’s syndrome (alcoholism) (Butters & Delis, 1995)
- anterograde and retrograde deficits are major in explicit memory tests
- implicit memory for verbal and perceptual material is often deficient (Gabrieli et al., 1993; Postle, Corkin, & Growdon, 1996)
- level of acetylcholine is reduced due to degeneration of basal forebrain
- strokes in this area can cause amnesia.

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