Dementia or Hospital-Induced Delirium?

Aug 2nd, 2016

One of the complexities related to diagnosing patients presenting symptoms of cognitive decline is that the behavioral markers can mimic many mental disorders, and most commonly impacts the elderly. Commons symptoms that can make diagnosis more challenging include signs of memory impairment, persistent disorientation and rapid shifts in mood.

While many disorders can contribute to some or all of these observable behaviors, dementia and delirium are often difficult to distinguish, and may even present as comorbid conditions. While a misdiagnosis of dementia or delirium can occur, it can be avoided by understanding the various environmental and biological triggers.

Identifying Hospital-Induced and Perioperative Delirium

Unfortunately, hospital-induced delirium is a relatively common condition affecting up to a third of patients 70-years-old and above, and the rate is even higher for those in intensive care or undergoing surgery.

One of the telltale indicators is the rate at which the disease progresses. In contrast to dementia, which develops gradually and worsens over time, the sudden onset of delirium presents very rapidly and fluctuates in severity during the course of a day.

In general, delirium occurs when the normal brain chemistry becomes unbalanced – disrupting the normal flow of information between nerve cells. This malfunction in brain activity can have serious consequences since neurotransmitters affect a wide variety of mental and physical processes including cognition, mood, sleep patterns, hunger and stress.

Understanding Sudden Onset Delirium 

Typical symptoms include:

  • Rapid and unpredictable mood shifts
  • Poor memory, particularly of recent events
  • Disorientation, for example, not knowing where you are or who you are
  • Difficulty speaking or recalling words
  • Rambling or nonsense speech
  • Seeing things that don't exist (hallucinations)
  • Restlessness, agitation or combative behavior
  • Personality changes

There are many different environmental and biological triggers that can increase a patient’s risk of developing delirium while in the hospital. Bacterial infections, sleep deprivation, emotional stress and adverse reactions to anesthesia and new medications are some of the most common causes of delirium and this condition is especially common among patients who have undergone hip replacement or heart surgery.

While delirium is a common occurrence, healthcare professionals and caregivers can prioritize early intervention to reduce their patients’ risk of developing delirium while under their care:

  1. Ensure patients receive adequate fluids and nutrients.
  2. Educate friends and family members about the symptoms of delirium for early detection.
  3. Position familiar objects, such as framed photos, in the patient’s room to avoid disorientation.
  4. Routinely screen high risk patients – those coming out of surgery or anesthesia.
  5. Avoid sensory disruptions by making hearing aids, dentures and glasses readily available.

Recognizing Dementia

According to the Institute for Dementia Research & Prevention, approximately five million Americans have at least one form of age-related dementia with Alzheimer’s contributing to up to 70% of cases among the elderly.

While dementia does share many of the signs and symptoms of delirium, dementia progresses more slowly over time and the symptoms are less erratic throughout the course of the day. Patients with dementia frequently exhibit signs of confusion, difficulty concentrating and agitation.

In general, dementia involves the damage of nerve cells in the brain but the specific causes vary and can include:

  • An abundance of beta-amyloid plaques
  • Abnormal clumps of Lewy Bodies
  • Vascular issues impairing blood supply to the brain
  • Traumatic brain injuries

Making a Differential Diagnosis

While patients with delirium and dementia may present a similar cohort of symptoms, it is important to make an early and accurate diagnosis to leverage interventional treatments and therapies for optimal health outcomes.

Since each patient’s physical, emotional and cognitive health is unique, we can help you better understand the most appropriate treatment options for your elderly patients with sudden onset delirium. Ask an Oceans expert for help with diagnosing and treating mental illness.

*Sources Include: News Medical Life Sciences and Medicine, The Gerontologist, Medscape and National Institutes of Health, Institute for Dementia Research and Prevention and Mayo Clinic.

 

 

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