This document provides information on delirium and dementia: - Delirium is characterized by a rapid deterioration in higher cognitive functions, fluctuating mental status, and symptoms that last hours to days. Common causes include age over 60, drug or alcohol use, and prior brain injuries. - Dementia involves impaired social or occupational functioning and impaired memory plus deficits in other cognitive domains. It is not the same as Alzheimer's disease but can be caused by conditions like Alzheimer's. - Symptoms of dementia include disrupted sleep, wandering, and aggressive behavior in some patients. The prevalence of dementia increases significantly with age.

1. Delirium

2. An Acute Confusional State Criteria - Rapid deterioration in all higher cortical functions - Mental status fluctuates widely - Short duration of symptoms (Hours to days) - Disturbance in both level and content of consciousness - Autonomic Instability (Abnormal vital signs) Risks - Age over 60 - Drug or alcohol addiction - Prior brain injury (vascular or traumatic) Delirium

3. Signs Fluctuating levels of consciousness - Inattention, perseveration, decreased alertness - Disorientation - Extremes of activity, somnolence to agitation Disorganized thought processes (delusions) Memory impairment (especially short term) Perceptual disturbances - Vivid visual hallucinactions Emotional lability Course Reversible in >80% of cases Delirium (cont’d)

4. Dementia

5. Diagnostic Criteria for Dementia Impaired social or occupational function Impaired memory, plus one or more area of the following cognitive functions Abstract/problem solving Judgment Language Personality Clear consciousness Dementia

6. Overview of Dementia Population is aging Prevalence of dementia increases with age Amnesia: Isolated memory loss Amnesia may be the first sign of dementia Delirium is a deficit of attention Dementia

7. Dementia Disruptive and aggressive behavior is a common problem in patients with dementia. Shouting Agitation (being upset, frustrated, and confused) Disrupted sleep Wandering away Resisting care If the dementia is part of the Alzheimer’s Syndrome they may also have: Delusions Hallucinations

8. Dementia Men and women contract dementia about equally. Women live longer than men, therefore they live long enough to contract the illness. There is some evidence that estrogen may actually help prevent it. Dementia is on the increase 1% of those 60-64 32% of those 90-94 There are roughly 590 million people in the world around age 60. There will be 976 million in 2020. The stage is set for an “epidemic” of dementia

9. Dementia Dementia is not inherited. Dementia is neither temporary nor reversible. Aphasia is a form of dementia Primary Progressive Aphasia - Speech and language functions deteriorate gradually over a period of years. Dementia is not the same as Alzheimer’s Disease….It is a symptom. Dementia is not a disease, but describes a group of symptoms that accompany some brain diseases. Dementia can occur at any age….not just in old people.

10. Dementia Some physical disorders may contribute to the confusion associated with dementia. Heart failure Hypoxia Thyroid disorders Anemia Nutritional disorders Psychiatric conditions such as depression Certain drugs can also exacerbate confusion Anticholinergics Analgesic Cimetidine CNS depressants Lidocaine

11. Dementia People with severe dementia can be helped by morning bright light. They are more alert and sleep better when exposed to bright light in the morning. Tests in California used light boxes, but sitting them outside or near a window was just as effective.

12. Some sources of Dementia Alzheimer's dementia Multiinfarct dementia HIV Dementia Dementia

13. Dementia Recent research suggests that Alzheimer’s can be prevented. Drugs that lower lipid levels (statins) such as Zocor. A Canadian study showed significant decrease in developing Alzheimer’s in people under 80 who used statin drugs. If you have heart disease you are more likely to get Alzheimer’s. American research showed moderate increase for developing the disease in persons with cardiovascular disease.

14. Amnestic Disorders

15. Major Causes of Amnestic Disorders Systemic medical conditions - Thiamine deficiency (Korsakoff’s Syndrome) Hypoglycemia Seizures Head trauma (closed and penetrating) Brain tumors Encephalitis due to Herpes Simplex Hypoxia ECT Multiple Sclerosis Alcohol abuse Neurotoxins Benzodiazepines and other sedative-hypnotics Over the counter medications (sleep aids, antihistamines)

16. Amnestic Disorder Due to General Medical Condition The development of memory impairment as manifested by impairment in the ability to learn new information or the inability to recall previously learned information. Specify if: Transient: lasts for one month or less. Chronic: lasts for more that one month.

17. Substance-Induced Persisting Amnestic Disorder The development of memory impairment as manifested by impairment in the ability to learn new information or the inability to recall previously learned information. Caused by ingestion of a substance. Record specific substance when coding (i.e., cocaine-induced persisting amnestic disorder). Can code as “unknown” substance-induced