Study Worksheet: Alzheimer’s Disease vs Dementia vs Delirium

Part 1: Definitions

Fill in the blanks with the correct terms: Alzheimer’s disease, Dementia, or Delirium

1. _________ is a general term describing a decline in memory and other thinking

skills severe enough to interfere with daily life.
2. _________ is the most common cause of progressive dementia characterized by
gradual memory loss and cognitive decline.
3. _________ is an acute, sudden onset of confusion and changes in attention,
usually caused by an underlying medical condition or medication effect.

Part 2: Key Features

Match the following features to Alzheimer’s disease (AD), Dementia (general), or

Delirium by writing A, D, or L next to each statement:

Feature A/D/L
Onset is usually sudden and rapid
Symptoms progress slowly over years
Consciousness is usually clear
Fluctuates throughout the day
Memory loss is an early and prominent
symptom
Hallucinations and illusions are common
Reversible if underlying cause treated
Associated with irreversible brain changes
Disorganized thinking and speech
Part 3: Compare and Contrast

Fill in the table below to compare Alzheimer’s disease, Dementia, and Delirium:

Characteristic Alzheimer’s Disease Dementia (general) Delirium

Typical Onset

Course

Level of Consciousness

Memory Impairment

Attention Span

Reversibility

Common Causes

Answer the following questions:

1. Why is it important to distinguish delirium from dementia in older adults?

2. What nursing interventions are most important when caring for a patient
with delirium?

3. How does the progression of Alzheimer’s disease affect nursing care

planning over time?

4. What are some common triggers or causes of delirium in hospitalized

elderly patients?

Pharmacolocy
Match the medication with the correct condition (Alzheimer’s or Delirium):

Medication Alzheimer’s / Delirium

Donepezil (Aricept)
Haloperidol (Haldol)
Memantine (Namenda)
Anticholinergics (e.g., Diphenhydramine)

Comprehensive Case Study: Neurocognitive Disorders

Patient Profile:

Name: Mrs. Joan Carter

Age: 78
Admission: Emergency Department via family for sudden confusion and agitation

Medical History:

 Diagnosed with Alzheimer’s disease 5 years ago

 Lives at home with spouse
 Hypertension controlled with medication
 Mild osteoarthritis

Presenting Problem:

Mrs. Carter’s husband reports that she has been increasingly forgetful over the last few
years but has managed at home with minimal assistance. However, today she suddenly
became very confused, restless, and was calling out repeatedly, unable to recognize
family members. She was also disoriented to time and place.

Assessment Findings:

 Vital Signs: T 38.3°C (100.9°F), HR 98 bpm, BP 150/85 mmHg, RR 20/min

  Physical Exam: Mild dehydration noted, no focal neurological deficits
 Mental Status Exam:
o Alertness: Fluctuating
o Orientation: Disoriented to time, place, and person intermittently
o Attention: Severely impaired, unable to focus
o Memory: Poor short-term and long-term recall
o Speech: Incoherent at times
o Mood/Affect: Agitated and fearful
o Thought Content: No hallucinations reported, but confused speech

Lab Results:

 CBC: Elevated WBC count

 Electrolytes: Mild sodium imbalance
 Urinalysis: Positive for urinary tract infection

Current Medications:

 Donepezil (Aricept) 10 mg daily

 Lisinopril 20 mg daily
 Acetaminophen PRN for pain

Nursing Notes:

 Patient is restless, attempts to get out of bed despite safety concerns

 Difficulty following simple commands
 Spouse is anxious and requesting guidance

Critical Thinking Questions

1. Based on Mrs. Carter’s presentation, what is the most likely cause of her
sudden change in mental status?
2. How can you differentiate delirium from her baseline Alzheimer’s dementia
in this scenario?

3. What are the priority nursing interventions for Mrs. Carter right now?

4. Why is it important to assess for and treat the underlying cause of

delirium?

5. How would you communicate with Mrs. Carter to reduce her agitation and
confusion?

6. What safety measures should be implemented to prevent injury during her

episode of delirium?

7. How might Mrs. Carter’s medication regimen be evaluated or modified

during this hospitalization?

8. What education would you provide to the spouse regarding delirium and
dementia?

9. What are some long-term care considerations for a patient with progressive
Alzheimer’s disease?
 10. If Mrs. Carter develops hallucinations or paranoid delusions in the future,
how should these symptoms be managed?

Answers:

Part 1: Definitions

1. Dementia is a general term describing a decline in memory and other thinking

skills severe enough to interfere with daily life.
2. Alzheimer’s disease is the most common cause of progressive dementia
characterized by gradual memory loss and cognitive decline.
3. Delirium is an acute, sudden onset of confusion and changes in attention,
usually caused by an underlying medical condition or medication effect.
Part 2: Key Features

Feature A/D/L
Onset is usually sudden and rapid L
Symptoms progress slowly over years A
Consciousness is usually clear A, D
Fluctuates throughout the day L
Memory loss is an early and prominent A, D
symptom
Hallucinations and illusions are common L
Reversible if underlying cause treated L
Associated with irreversible brain changes A, D
Disorganized thinking and speech L

Explanation:

 Delirium has a sudden onset and fluctuates, often reversible if cause is found.
 Alzheimer’s and dementia develop slowly and cause permanent brain changes.
 Consciousness is typically clear in dementia/Alzheimer’s but altered in delirium.

Part 3: Compare and Contrast

Characteristic Alzheimer’s Dementia Delirium

Disease (general)
Typical Onset Gradual (months to Gradual or Sudden (hours to
years) progressive days)
Course Progressive decline Progressive or Fluctuating, usually
static brief
Level of Usually clear Usually clear Altered, fluctuates
Consciousness
Memory Early and Common feature Variable, attention
Impairment prominent more impaired
Attention Span Usually intact early Usually intact early Severely impaired
on on
Reversibility No Depends on cause Often reversible
 Common Causes Alzheimer’s Alzheimer’s, Infection, medication
disease, vascular, vascular, other toxicity, metabolic
Lewy body brain diseases imbalances

Critical Thinking

1. Why is it important to distinguish delirium from dementia in older adults?

Because delirium is often reversible if identified and treated promptly, whereas
dementia is usually progressive and irreversible. Misdiagnosis can delay
treatment of underlying acute medical problems.
2. What nursing interventions are most important when caring for a patient
with delirium?

 Ensure patient safety (prevent falls, injuries)

 Provide orientation aids (clocks, calendars)
 Manage underlying causes (infection, medication review)
 Maintain hydration and nutrition
 Provide calm, low-stimulation environment

3. How does the progression of Alzheimer’s disease affect nursing care

planning over time?
Care plans must evolve from supporting memory and decision-making to full
assistance with ADLs, managing behavior changes, and providing end-of-life
care.
4. What are some common triggers or causes of delirium in hospitalized
elderly patients?

 Infection (e.g., UTI, pneumonia)

 Medication side effects or interactions
 Electrolyte imbalances or dehydration
 Surgery or anesthesia effects
 Pain or uncontrolled chronic illness

Pharmacology

Medication Alzheimer’s / Delirium

Donepezil (Aricept) Alzheimer’s

Haloperidol (Haldol) Delirium
Memantine (Namenda) Alzheimer’s

Anticholinergics (e.g., Diphenhydramine) Can worsen Delirium

 Critical Thinking Answers

1. The sudden onset of confusion, agitation, and fluctuating attention strongly suggests
delirium, likely triggered by the urinary tract infection (confirmed by labs) and
dehydration.

2. Delirium has an acute onset, fluctuating course, and impaired attention, whereas
dementia (including Alzheimer’s) has a gradual onset with relatively intact attention
early on.

3. Priority nursing interventions include:

o Treating the underlying UTI with antibiotics
o Ensuring hydration
o Providing a safe, calm environment
o Frequent orientation and reassurance
o Monitoring vital signs and neurological status

4. Treating the underlying cause can often reverse delirium, preventing complications such
as falls, prolonged hospitalization, or worsening cognitive impairment.

5. Use simple, clear communication with a calm tone, provide orientation cues (clocks,
calendars), and avoid arguing or correcting delusional statements.

6. Safety measures:
o Bed alarms or sitter supervision
o Remove hazards from the room
o Use non-restraint methods first
o Assist with toileting and mobility
7. Donepezil should be continued as it treats Alzheimer’s symptoms; review other
medications for possible delirium contributors (e.g., anticholinergics).

8. Educate the spouse on:

o Differences between delirium and dementia
o Importance of treating infections promptly
o Strategies to manage confusion at home
o When to seek urgent care

9. Long-term care involves:

o Progressive assistance with ADLs
o Behavioral symptom management
o Support for caregivers
o Planning for safe living environments

10. Psychotic symptoms may be managed with low-dose antipsychotics cautiously, with
close monitoring for side effects; non-pharmacological strategies are preferred first.