Who Am I? Where Am I? Facts and Fears About Dementia and Delirium November 12, 2007 Karen Rose, PhD, RN Dorothy Tullmann, PhD, RN Assistant Professors.

Slides:



Advertisements
Similar presentations
The Three Ds of Confusion Delirium, Depression, Dementia
Advertisements

Duke GEC Duke Geriatric Education Center (GEC) January 21, 2014 Delirium and Dementia.
Martha Stearn, MD Institute for Cognitive Health St John’s Medical Center Jackson, Wyoming.
Mr. Chris Webb. Overview Dementia is a common condition. In England there are currently 570,000 people living with dementia. That number is expected to.
Cognitive Disorders and Neurological Disorders Assessment & Diagnosis SW 593.
Neurocognitive Disorders
Dementia & Delirium in Surgical Patients Damian Harding Department of Geriatric Medicine February 2008.
Mental Health Nursing I NURS 1300 Unit II Cognitive Impairment in the Elderly.
Introduction to neuropsychiatric disorders
Cognitive Disorders Madiha Anas Institute of Psychology Beaconhouse National University.
Recognition of Dementia Syed Zaman Consultant Physician Geriatric Medicine Palmerston North Hospital.
Managing Acute Confusion in The Elderly
Recreational Therapy: An Introduction Chapter 9: Geriatric Practice PowerPoint Slides.
{ Dementia and Delirium Christine Hatcher. Imagine yourself in your mid to late thirties and you have become the primary care provider for a parent or.
Screening for Stroke and Cognitive Impairment Chapter 2: Background.
PSYC 2314 Lifespan Development Chapter 24 Late Adulthood: Cognitive Development.
Delirium: A Disturbance of Consciousness By Amy Wisniewski, RN, CCM, BSN Nursing made Incredibly Easy! January/February ANCC/AACN contact hours.
Shannan K. Hamlin, PhD, RN, ACNP-BC, AGACNP-BC, CCRN
WELCOME TO IS IT DEMENTIA, DELIRIUM, OR DEPRESSION ?
COGNITIVE ASSESSMENT IN THE ELDERLY PATIENT Jennifer Breznay, MD, MPH Division of Geriatrics Department of Medicine Maimonides Medical Center November.
P SYCHOLOGICAL A GING P ART 2 C OGNITIVE D ISORDERS HPR 452.
Chapter 16: Cognitive Disorders: Delirium, Dementia, and Amnestic Disorders Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights.
Cognitive Impairment Disorders. Assessing Brain Damage  Mental status examination  Information about current behavior and thought including orientation.
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 14 Cognitive Disorders and Life-Span Issues.
Mental Health Nursing: Organic Disorders By Mary B. Knutson, RN, MS, FCP.
Delirium in the acute hospital
Contemporary Psychiatric-Mental Health Nursing Third Edition Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER Contemporary Psychiatric-Mental.
Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 37 Confusion and Dementia.
Chapter 13: Delirium.
Introduction to neuropsychiatric disorders
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 33 Delirium and Dementia.
Ms. Gordon.  Alzheimer's is the most common form of dementia, a general term for memory loss and other intellectual abilities serious enough to interfere.
10 signs to early detection 1. Memory loss that affects daily life 2. Challenges in planning or solving problems 3. Difficulty completing projects at.
CONFUSION & DEMENTIA CHAPTER 35.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 24 Cognitive Disorders.
Cognitive Disorders Chapter 15. Defined as when a human being can no longer understand facts or connect the appropriate feelings to events, they have.
“3 D’s” of Geriatrics Dementia, Delirium, and Depression These common disorders can look alike. GAI often helps uncover or differentiate them. All are.
Cognitive Disorders. Recent Memory Impairment Disorientation Poor Judgment Confusion General loss of intellectual functioning May have: Hallucinations,
What are the warning signs? How can I help?.  Aging & Disability Resource Center ◦  Alzheimer’s & Dementia Alliance of.
Neurocognitive Disorders: Delirium and Dementia Jamie Rusch.
Duke GEC DELIRIUM What’s in a name? Duke Geriatric Education Center
Delirium Acute and sub acute disturbance in cognition, with evidence of an underlying medical etiology. Types: Hyperactive, Hypoactive, mixed form. Predisposing.
Chapter 39 Confusion and Dementia All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 44 Confusion and Dementia.
Cognitive Disorders Chapter 13 Nature of Cognitive Disorders: An Overview Perspectives on Cognitive Disorders Cognitive processes such as learning, memory,
Alzheimer’s disease.
CONFUSION AND DEMENTIA Copyright © 2004 Mosby, Inc. All rights reserved.Slide 0.
Used to be called Dementia Neurocognitive Disorders.
Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Chapter 17 Cognitive Impairment, Alzheimer’s Disease, and Dementia.
1 Alzheimer’s Disease: Delirium and Dementia For use in conjunction with: The Eastern North Carolina Chapter of the Alzheimer’s Association. (2003). Module.
COGNITIVE DEVELOPMENT IN LATE ADULTHOOD CHAPTER 18 Lecture Prepared by: Dr. M. Sawhney.
Neurocognitive Disorders & Geropsych Neurocognitive Disorders & Geropsych Chapters 22 & 34.
Cognitive Disorders Delirium, Dementia, Amnestic Disorders.
PSYCHOTIC DISORDER Mental Health First Aid By Mental Health Commission of Canada, 2010.
DISEASES OF MENTAL STATUS AND ELDER ABUSE. Delirium  Disturbance of consciousness with deficits of attention and changes in cognition or perception that.
Chapter 10: Nursing Management of Dementia
DEMENTIA Shenae Whitfield & Kate Maddock.
Cognitive Impairment, Alzheimer’s Disease, and Dementia
Yard. Doç.Dr. N. Berfu AKBAŞ
Dementia Jaqueline Raetz, M.D..
Cognitive Disorders and Aging
What is Dementia? A term that describes a wide range of symptoms associated with a decline in memory or other thinking skills. Dementia may be severe.
Disabilities , Dementia, and Brain Injury
Karen Rose, PhD, RN Dorothy Tullmann, PhD, RN
Chapter 30 Delirium and Dementia
Chapter 13: Delirium.
Common Health Problems of Older Adults
Chapter 25 The Elderly.
Delirium Nancy Weintraub, MD, FACP Professor of Medicine, UCLA Director, UCLA Geriatric Medicine Fellowship Director, VA Special Advanced Fellowship in.
Presentation transcript:

Who Am I? Where Am I? Facts and Fears About Dementia and Delirium November 12, 2007 Karen Rose, PhD, RN Dorothy Tullmann, PhD, RN Assistant Professors of Nursing University of Virginia

Presentation Objectives Dementia –Focus on long-term aspects of caring for persons with dementia –Emphasize caregiving environment Delirium –How delirium differs from dementia –Importance of early recognition of delirium

What is Dementia Dementia is a general term for the loss of memory and other intellectual abilities serious enough to interfere with daily life. Classifications –Alzheimer’s disease (AD): 50% - 70% of all dementias –Vascular dementia –Mixed dementia –Frontotemporal lobe dementia –Lewy Body dementia –Mild cognitive impairment –Others

How Common is Dementia? < 65 yearsRare –Less than 4% of all cases of dementia 65 – 85 years10% –At age 65, risk increases 1% per year 86 – 100+ years50% –At age 86, risk increases 11% per year The fear of developing dementia is FAR greater!!

Alzheimer’s Quiz! Fact or Fiction? 1. Memory loss is a natural part of the aging process. 2. Alzheimer’s is a fatal disease. 3. All relatives of Alzheimer’s patients inherit the disease. 4. Alzheimer’s is a disease of the elderly. 5. Life is over upon receiving an Alzheimer’s diagnosis.

U.S. Department of Health and Human Services, 2001 Who Are Caregivers? Family caregivers are the mainstay of caregiving support to persons with dementia. Over 30 percent of caregivers for the elderly are, themselves, age 65 years or older.

Living with Alzheimer’s Audio from Vermont Public Radio, November 6, 2007

Benefits of Caregiving Psychological –Self-worth –Altruism –Connection with care recipient Economic –Costs of care at home vs. costs of care in institutions Home care: ≈ $19,000 / year In California alone, cost of care is 2.1 billion now; 4.6 billion in Alzheimer’s Association, 2006; Fox et al., 2001

Perils of Caregiving Physical –Increased risks for: Cardiovascular disease Metabolic syndrome Other co-morbidities MortalityPsychological –Increased incidence of: Anxiety Depressive symptoms Connell et al., 2001; Gallicchio, 2002; Irwin, 2001; Schulz & Beech, 1999

Caring for the Caregiver Importance of caring for self –For you –For them Community resources –One size does not fit all

Importance of Caregiving Environment Socialization (Zarit et al., 2004). Activities (Rentz et al., 2002; Palo-Bengtsson & Ekman, 2002). Mental & Physical Stimulation (Camp et al., 1997). Sleep (Richards, Beck, et al., 2001).

When Things Go Bad Dementia is a PROGRESSIVE loss of memory and function…. –When changes are abrupt: Something’s wrong!!

Lipowski, 1990 What is Delirium? “Semantic muddle” –Acute brain syndrome –Acute confusion –Acute confusional states –Acute brain failure –ICU (intensive care unit) psychosis –Sundowner syndrome

American Psychological Association, 2002 Definition of Delirium Reduced level of consciousness –difficulty focusing, shifting or sustaining attention Cognitive change –deficit of language, memory, orientation, perception; not attributed to dementia Develops rapidly (hours to days) –varies during the day General medical condition has directly caused the condition

American Psychological Association, 2000 Variations of Delirium Hyperactive –Increased responsivity to stimuli; hyperalert –Moves constantly; may be combative Hypoactive –Quiet and listless; hypoalert –Appears indifferent, oblivious Mixed –Alternates irregularly

How Does Delirium Differ from Dementia? Delirium Rapid onset Fluctuates; worse at night Altered level of consciousness Easily distracted; attention impaired Dementia Chronic, insidious Symptoms progressive but stable Level of consciousness usually not affected Tries hard to do task; great effort to recall

What Causes Delirium? The pathogenesis of delirium is unclear. –Anatomic defects? Changes in different parts of the brain seen on diagnostic scans –Neurotransmitter imbalance? Serotonin, acetylcholine deficit Dopamine excess See Trzepacz, 2000 in “Further Reading” –Genetic predisposition?

Lipowski, 1990; Inouye et al, 1999 Who is At Risk for Delirium? Predisposing factors –Age (60+ years) –Brain damage –Chronic brain disease (e.g. Alzheimer’s) Precipitating factors (organic causes) –Primary cerebral disease –Systemic diseases affective brain (e.g. sepsis) –Drug, poison intoxication (e.g. polypharmacy) –Withdrawal from substances of abuse (especially alcohol and sedative-hypnotics)

Lipowski, 1990; Inouye et al., 1999 Facilitating factors –Psychosocial stress –Sleep deprivation –Sensory underload or overload –Immobilization

Ely et al., 2001, 2004; McNicoll et al., 2003 Delirium in ICU New instrument to screen for delirium in ICU (non-verbal patients) –Higher mortality rate –Long-term cognitive and functional decline Mechanically ventilated patients –> 80% had at least one day of delirium –Related to intravenous sedation In ICU patients, 65+ years –31% had delirium on admission to the ICU –31% developed delirium in ICU

What Can Be Done in the Hospital? Early recognition Treat underlying condition –Medication reaction –Infection Non-pharmacologic management Medication (antipsychotics, sedatives) should be a last resort.

What Can I Do? If you see rapid mental changes, report them. –The changes could signal an undetected illness or other physiologic problem. Delirium may be prevented or slowed. –Minimize psychosocial stress –Avoid sleep deprivation –Avoid sensory underload or overload –Avoid immobilization –Frequent reorientation

Thank you! Questions?