Saturday, October 5, 2013

Differentiating between dementia and delirium

This is a difficult issues for many healthcare professionals. I believe that family members are the ones best able to determine erratic behaviours that are the tell-tale signs of delirium. This is a major shift in behaviour, not the slow creeping changes that a patient with dementia exhibit over time.
I recognize it now, but at the time my late father was admitted to hospital, he had both dementia and delirium.
The dementia arose from his brain tumour. The delirium, from the urinary tract infection he acquired after having radiation. Sitting in the ER with my brother, they did not identify it. Both Dad and my brother missed my late mother's funeral, sitting in the ER. He was sent home, with no relief for his symptoms.
Nat Rev Neurol. 2009 April; 5(4): 210–220.

Delirium is a curable issue, resolved by antibiotics. It can mean incontinence, interfere with sleep, and result in strange behaviour.
My father was no where near as disoriented as the actor in the video. Nights were terrible for several days, though. He lit a fire in the fireplace at 2 in the morning. He left taps running. He didn't make it to the bath room several times. This was a new behaviour, but he didn't recognize what he was doing.

A simple test:
Can you count backwards from 20, by 2's?
I'm not sure my dad could have done this, due to his dementia. Or, as they further suggest, counting from 1 to 10.

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)
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 in elderly adults: diagnosis, prevention and treatment


Clinical experience and recent research have shown that delirium can become chronic or result in permanent sequelae. In elderly individuals, delirium can initiate or otherwise be a key component in a cascade of events that lead to a downward spiral of functional decline, loss of independence, institutionalization, and, ultimately, death. Delirium affects an estimated 14–56% of all hospitalized elderly patients. At least 20% of the 12.5 million patients over 65 years of age hospitalized each year in the US experience complications during hospitalization because of delirium.

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