1. Delirium & Dementia
IPP 3-2016

2. Delirium

3. Delirium
•A sudden onset (often within hours or a
few days) of disturbance in mental
abilities that results in a decreased
awareness of environment and confused
thinking

4. Symptoms
•Inability to stay focused
•Withdrawn from environment
•Poor memory, particularly of recent events
•Difficulty understanding speech

5. Symptoms
•Rambling or nonsense speech
•Difficulty reading or writing
•Restlessness, agitation, irritability/combative
behavior
•Disturbed sleep habits

7. Causes
•Dementia
•Older age
•Fever and acute infection
•Previous delirium episodes

8. Causes
•Poor nutrition, dehydration, chronic or terminal
illness
•Alcohol, drug abuse or withdrawal
•Pain medications (opioids)
•Sleep medications (hypnotics)
•Allergy medications (antihistamines)

9. Investigations
•Mental status assessment
•Physical and neurological exams
•Vision, balance, coordination and reflexes
•Brain-imaging tests (used when a diagnosis can't be
made with other available information)

10. Treatment
•Address any underlying causes or triggers
•Protect the airway, provide fluids and nutrition
•Assist with movement, treat pain, incontinence
•Keep oriented to the surroundings
•A calm, comfortable environment that includes
familiar objects from home

11. Treatment
•Pharmacologic treatment indicated for acute
agitation
•Neuroleptics/anxiolytics are often used
•Duration commonly ranges from days to weeks

12. Drugs Used-Generic Names
Neuroleptics-Major Tranquilizers
• Haloperidol
• Aripiprazole
• Asenapine
• Chlorpromazine
•Olanzapine
•Paliperidone
•Quetiapine
•Risperidone

13. Drugs Used-Generic names
Anxiolytics-Benzodiazepines
• Alprazolam
• Diazepam
• Brotizolam
•Clonazepam
•Clorazepate
•Zaleplon

14. Anti-psychotics-MOA
•Neuroleptics
•Block D2 receptors in brain dopamine pathways
•Atypical neuroleptics antagonize
5HT2A receptors

15. Adverse Effects
•Parkinson’s syndrome
•Akathisia
•Acute dystonic reactions
•Tardive dyskinesia
•Seizures
•Weight gain
•Infertility
•Loss of libido
•Impotence & infertility
in men

16. •Act on GABA receptors
•Binding results in opening chloride channels &
increased chloride conductance
•Influx of chloride ions causes a small hyper-
polarization therefore inhibiting the formation of
action potential

18. •Drowsiness and confusion: most common side
effects
•Ataxia at high doses
•Cognitive impairment, early morning
insomnia

19. Some Brand Names
Antipsychotics
•Largectil, Flunox, Pride, Clopenia,
clopixol, Clozepin, Olenaz, Ozapine,
Rizdon, Zaydon, Motival

20. Some Brand Names
Benzodiazepines
•Calm, Restoril, Siesta, Zolp, Somnia, Clonexa,
Alloram, Alp, Alpram, Enzo, Xanax, Zenith,
Lexotanil, Freedom, Relaxin, Diazepam, Diazen,
Valium, Ativan, Tranquil

21. Dementia

22. Dementia
•Not a specific disease
•Group of symptoms affecting thinking &
social abilities severe enough to interfere with
daily functioning.
•Alzheimer's disease is most common cause

23. Dementia
•Gradual memory loss
•Impaired judgment or language, and the inability
to perform some daily activities
•Changes in personality and social behavior
•Some causes are treatable and even reversible

24. Symptoms
• Difficulty communicating, performing complex tasks,
planning and organizing
• Difficulty with coordination and motor functions
• Problems with orientation, such as getting lost
• Personality changes, inappropriate behavior
• Paranoia, Agitation, Hallucinations

25. Risk factors
• Age. Increases (especially after 65, not a normal part of aging), can occur in
younger people.
• Family history.
• Down syndrome. By middle age, many with Down syndrome develop plaques
and tangles in brain that are associated with Alzheimer's
• Diabetes. increased risk
• High estrogen levels. years after menopause, greater risk
• Obesity. Being overweight or obese during the middle life may increase risk

26. Risk factors
• Alcohol use. heavy alcohol consumption may have a higher risk
• Atherosclerosis. buildup of fats other substances in artery walls can reduce the
blood flow to brain and lead to stroke. Reduced blood flow to brain can also
cause vascular dementia
• Blood pressure. high or low both may increase risk.
• Cholesterol. high levels of LDL cholesterol, may have an increased risk of
developing vascular dementia or Alzheimer's disease
• Depression. not yet well understood, late-life depression, especially in men,
may be an indication for the development of Alzheimer's-related dementia.

27. Dementia-causes-Reversible
• D= Drugs, Delirium
• E=Emotions (such as
depression) and Endocrine
Disorders
• M=Metabolic Disturbances
• E=Eye and Ear Impairments
• N=Nutritional Disorders
• T=Tumors, Toxicity, Trauma
to Head
• I=Infectious Disorders
• A=Alcohol, Arteriosclerosis

28. Dementia-causes
• Irreversible:
• Alzheimer
• Lewy Body Dementia
• Pick’s Disease (Fronto-temperal Dementia)
• Parkinson’s disease
• Huntington’s Disease
• Jacob-Cruzefeldt Disease

29. Normal vs AD Brain
Normal brain Alzheimer’s brain

30. Related Drugs
• Acetylcholine esterase inhibitor- Donezipil, Galantamine
• Benzodiazepines
• Antiepileptics- Sodium Valporate, Oxcarbezapine
• Parasympathomimetic- Rivastigmine
• Glutametargic receptor antagonist- Memantine
• SSRI- Sertraline

31. Donepezil
• Used to delay or slow the symptoms of AD in mild,
moderate and severe AD
• Loses its effect over time
• Does not prevent or cure AD

32. Citalopram
• Used to reduce depression and anxiety
• May take 4 to 6 weeks
• Sometimes used to help to sleep

33. Rivastigmine
• Used to delay or slow the symptoms of AD
• Loses its effect over time

34. Sodium Valproate
• Used to treat severe aggression
• Also used to treat depression and anxiety

35. Sertraline
• Used to reduce depression and anxiety
• May take 4 to 6 weeks
• Sometimes used to help people get to sleep

36. Oxcarbazepine
• Used to treat severe aggression
• Also used to treat depression and anxiety

37. Psychologist Role
Required for both patient & family
• Crisis intervention counseling
• Individual counseling
• Family therapy
• Group therapy
• Institutionalization

38. Difference b/w delirium &
dementia

39. Differences between delirium and dementia include:
• Delirium occurs within a short time, while dementia
usually begins with relatively minor symptoms that
gradually worsen over time.
• Inability to stay focused or maintain attention is
significantly impaired with delirium
• A person in the early stages of dementia remains generally
alert

40. •Delirium symptoms can fluctuate
significantly and often throughout the
day
•People with dementia, memory and
thinking skills stay at a fairly constant
level during the course of a day

41. Some Brand Names
•Donepizil-- Azenil, Donep, Donecept
•Galantamine- -Dementio, Reminyl
•Mamantine- -Afdol, Dementin, Mantex
•Rivastigmine- -Exelon, Memomax, Zivar
•Valproic acid- -Epival, Valprux

42. Yes We Are Done