Friday, April 17, 2009

Dementia and delirium

Aside from the natural aging process, dementia and delirium in old age have many identifiable characteristics. Dementia is associated with, but not limited to, Alzheimer’s disease, vascular dementia, alcoholism, toxic reactions to medications (a huge risk in seniors), infections, metabolic disorders, malnutrition, and brain tumours (Pinel, 2006). Dad could have been suffering from any of these things, but no one was able to help us diagnose it. There is some confusion between delirium, dementia, and depression, and these require clarification, as well as early diagnosis by geriatricians. In The Hazards of Health Care (Heckman, 2004), warnings are given for undiagnosed dementia and delirium. The May 2008 issue of BP Blogger explains the difference between delirium and dementia. They say that it is the most common complication of hospital admission--between thirty and sixty-four percent in varying medical issues. One can have both delirium and dementia at the same time. Delirium is preventable and treatable; dementia is not.

Dementia is an abnormal progressive deterioration of neural functioning. It involves:

• Memory impairment
• Diminishing intellectual ability; confusion; forgetfulness
• Poor judgment
• Difficulty with abstract thinking, e.g.,, math, time, thinking skills.
• Personality changes, e.g.,, stubbornness, agitation, poor or inappropriate social skills
• Sleep disturbances

Delirium can occur in response to stressors such as illness, surgery, drug overdoses, interactions of drugs, malnutrition (Cole, 2004) and can change daily. Between 32% and 67% of hospital patients are discharged with undiagnosed delirium (Rudolph and Marcantonio, 2003), and some 16% of seniors are readmitted to hospital (Forster, et al., 2004). It affects up to 50% of elderly hospital patients and can result in:

• Disturbance of consciousness
• Disorientation, wandering attention, confusion, hallucinations
• Increased LTC placements, infections, and increased mortality (Rudolph and Marcantonio, 2003)

Alzheimer’s disease accounts for 70% of dementia cases and affects 5% of the population age 65 and over (Blazer, 1996 and Regier et al., 1988, as cited in Pinel, 2006). It affects 40% of those over age 90 (Williams, 1995, as cited in Pinel, 2006) and patients die, on average, eight to ten years after the onset of dementia symptoms. The number of Alzheimer’s cases is predicted to increase by twenty-five percent by the year 2010 (Cummings and Jeste, 1999). Yet no one had examined Dad for these signs. Not all dementia is Alzheimer’s disease, but the work done by the Alzheimer’s Society has provided much information on the signs that usually develop two to three years before dementia sets in, such as difficulty in learning and remembering verbal material. The first significant sign is memory loss. It affects simple activities: eating, speaking, recognition of family members, and bladder control. Callahan, et al. (1995) found that 23.5 percent of those with moderate to severe dementia were identified as having a dementia syndrome.

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2 comments:

Kelly said...

Ontario 211 can help people find Alzheimer services from information, education, counselling for individuals to group support. We can help find extra support at home and fee assistance for Alzheimer's programs. There is also support out there for transition to specialized long-term care homes, that we can assist you in locating.

Visit Ontario 211's website at http://www.211ontario.ca or follow us on Twitter at: http://www.twitter.com/211ontario

Jenn Jilks said...

The Alzheimer Society is great, too. But tell that the Emergency Room department who discharged my dad with undiagnosed infection causing his delirium!