Delirium, Dementia, and A

Delirium, Dementia,
and Amnestic
Disorders
Nursing 202
Introduction
• Disorders in which a clinically significant
deficit in cognition or memory exists
• The number of people with these disorders
is growing because more people now
survive into the high-risk period for
dementia, which is middle age and beyond.
Delirium
• Characterized by a disturbance of consciousness and a change in
cognition that develop rapidly over a short period.
• Symptoms
• Symptoms include autonomic manifestations such as

Delirium
• Usually begins abruptly
• Can have a slower onset if underlying
etiology is systemic illness or metabolic
imbalance
• Duration usually brief and subsides
completely on recovery from underlying
determinant
Predisposing Factors
• Delirium due to a General Medical
Condition
• Substance-Induced Delirium
• Substance-Intoxication Delirium
• Substance-Withdrawal Delirium
• Delirium due to Multiple Causes
Dementia
• Defined by a loss of previous levels of cognitive,
executive, and memory function in a state of full
alertness.
• Primary dementias
• Secondary dementias
Symptoms
Alzheimer’s disease
• accounts for 60 to 80 percent of all cases of dementia
• AD can be described in stages:
– Stage 1.
No apparent symptoms
– Stage 2.
Forgetfulness
– Stage 3.
Mild cognitive decline
– Stage 4.
Mild-to-moderate cognitive decline; confusion
– Stage 5.
Moderate cognitive decline; early dementia
– Stage 6.
Moderate-to-severe cognitive decline; middle
dementia
– Stage 7. Severe cognitive decline; late dementia
Dementia of the Alzheimer’s
type
• Onset is slow and insidious, and the course of the
disorder is generally progressive and deteriorating.
– Early onset (first symptoms at age 65 or before)
– Late onset (first symptoms after age 65)
– Etiologies may include
• Acetylcholine alterations
• Plaques and tangles
• Head trauma
• Genetic factors
Vascular dementia
– Dementia is due to significant cerebrovascular

disease.
– There is a more abrupt onset than is seen in
association with Alzheimer’s disease, and the course
is more variable.
– Etiologies may include
• Arterial hypertension
• Cerebral emboli
• Cerebral thrombosis
Dementia due to HIV disease
– Dementia results from brain infections caused by

opportunistic organisms or the HIV-1 virus
directly.
– Symptoms may range from
barely perceptible changes
to acute delirium to
profound dementia.
Dementia due to head trauma
• Serious head trauma can result
in symptoms associated with the syndrome of
dementia.
* Amnesia is the most common symptom
– Repeated head trauma can result in dementia
pugilistica with symptoms of:
* Dysarthria * Emotional lability
* Ataxia * Impulsivity
Dementia due to Huntington’s
Disease
• Dementia due to Huntington’s disease
– Damage from this disease occurs in the areas of the
basal ganglia and the cerebral cortex.
– The client usually declines into a profound
state of dementia and ataxia.
– Average course of the disease
to complete incapacitation and
death is about 15 years.
Dementia Due to Pick’s Disease
– Etiology of Pick’s disease is unknown
– Clinical picture similar to that of Alzheimer’s
disease
– Pathology results from atrophy in the frontal and
temporal lobes
of the brain
Dementia due to Creutzfeldt-
Jakob disease
- Clinical symptoms typical of syndrome of dementia
– Symptoms also include involuntary movements, muscle
rigidity, and ataxia
– Onset of symptoms typically occurs between ages 40 and
60 years; course is extremely rapid, with progressive
deterioration and death within 1 year
– Etiology is thought to be a transmissible agent known as a
“slow virus.” There is a genetic component in 5 to 15
percent.
Dementia due to other medical
conditions
• Endocrine disorders
– Pulmonary disease
– Hepatic or renal failure
– Cardiopulmonary insufficiency
– Fluid and electrolyte imbalance
– Nutritional deficiencies
– Frontal lobe or temporal lobe lesions
– CNS or systemic infection
– Uncontrolled epilepsy or other neurological conditions
Substance-induced persisting
dementia
• Related to the persistent effects
of abuse of substances such as:
• Alcohol
• Inhalants
• Sedatives, hypnotics, and anxiolytics
• Medications (e.g., anticonvulsants, intrathecal
methotrexate)
• Toxins (e.g., lead, mercury, carbon monoxide,
organophosphate insecticides, industrial solvents)
Amnestic Disorders
• Amnestic disorders are characterized by an inability to
– Learn new information despite normal attention
– Recall previously learned
information
• Symptoms
– Disorientation to place and time (rarely to self)
– Confabulation, the creation
of imaginary events to fill
in memory gapsDenial that a problem exists or
acknowledgment that a problem exists, but with a lack of
concern
– Apathy, lack of initiative, and emotional blandness
• Onset may be acute or insidious, depending
on underlying pathological process.
• Duration and course may be quite variable
and are also correlated with extent and
severity of the cause.
Amnestic Disorder due to a
General Medical Condition
• Head trauma
– Cerebrovascular disease
– Cerebral neoplastic disease
– Cerebral anoxia
– Herpes simplex virus–related encephalitis
– Poorly controlled diabetes
– Surgical intervention to the brain
Substance-Induced Persisting
Amnestic Disorder Related to
- Alcohol abuse
– Sedatives, hypnotics,
and anxiolytics
– Medications (e.g., anticonvulsants,
intrathecal methotrexate)
– Toxins (e.g., lead, mercury, carbon
monoxide, organophosphate insecticides,
industrial solvents)
Assessment
Diagnostic Laboratory
Evaluations
Nursing Diagnosis
Outcomes
Planning/Implementation
Client/Family Education
Treatment Modalities
• Delirium
• Dementia
Pharmaceutical Agents
• For agitation, aggression, hallucinations, thought
disturbances, and wandering
– Risperidone (Risperdal)
– Olanzapine (Zyprexa)
– Quetiapine (Seroquel)
– Ziprasidone (Geodon)
– Haloperidol (Haldol)
• For depression
– Fluoxetine (Prozac)
– Sertraline (Zoloft)
– Citalopram (Celexa)
– Paroxetine (Paxil)
• For anxiety (should not be used routinely for prolonged
periods)
– Chlordiazepoxide (Librium)
– Alprazolam (Xanax)
– Lorazepam (Ativan)
– Oxazepam (Serax)
– Diazepam (Valium)
• For sleep disturbances (for short-term therapy only)
– Flurazepam (Dalmane)
– Temazepam (Restoril)
– Triazolam (Halcion)
– Zolpidem (Ambien)
– Aleplon (Sonata)
– Trazodone (Desyrel)

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Delirium, Dementia,

• Symptoms include autonomic manifestations such as

– Dementia is due to significant cerebrovascular

– Dementia results from brain infections caused by

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