Delirium is an alteration in consciousness with reduced focus or attention that occurs for a short period of time. It can be caused by a medical condition, drug use, or withdrawal.

 

Hallucinations (especially visual), illusions, psychomotor agitation, infection and medication toxicity (especially in the elderly). Up to 15% of hospitalized patients may have delirium.

           

-Dementia (but demented patients are alert and do not have alteration in consciousness)

-Psychotic Disorder and Mood Disorders with Psychotic Features (but disorders with psychotic features do not develop as abruptly and there is no medical or drug-related cause).

-Malingering (but these “patients” will not have any evidence to prove that they have a medical problem or that they took a drug or are having withdrawal from it)

 

-Haldol (Haloperidol): can be given via IV. Good for treating agitation, confusion, and problems with perception.

-Quetiapine (Seroquel): orally given in small doses. Should monitor heart rate and blood pressure.

-Lorazepam (Ativan): good for treating agitation. Safe for patients with renal or hepatic problems.

 

Dementia involves multiple cognitive deficits including memory and one or more of aphasia, apraxia, agnosia, and problems with executive functioning. In addition, there is social and occupational impairment. About 3% of people over 65 and 20% over 80 have dementia.

 

-early: losing belongings and getting lost

-later on: problems doing daily living activities.

-Impaired judgement

-paranoid delusion and visual hallucinations

-can have delirium along with dementia because patients are more susceptible to medications and disease

 

I.                    Alzheimer’s

a.       Most common type of dementia. Patients have a gradual onset and continue to decline in cognitive function.

b.      Can have both Early and Late onset types.

c.       8-10 years life expectancy.

II.                 Vascular

a.       Focal neurological signs/symptoms (show up as infarcts on MRI)

b.      Changes can be abrupt instead of gradual.

III.               Medical Conditions

a.       AIDS

b.      Head Trauma: the dementia does not progress.

c.       Parkinson’s

d.      Huntington’s: language and knowledge is not impaired while memory and executive function are impaired.

e.       Pick’s Disease: disinhibition, apathy, language problems

                                                               i.      Affect frontal and temporal lobes

f.        Creutzfeldt-Jakob Disease: caused by prion,

                                                               i.      Dementia, myoclonic movements, EEG activity.

g.       Lewy body Dementia: visual hallucinations, syncope, losing consciousness.

IV.              Substance Induced: lasts longer than the intoxication of the substance

V.                 Multiple Causes

 

-Delirium

-Amnestic Disorder

-Major Depressive Disorder

 

-Alzheimer’s Disease:  Donepezil (Aricept), Galantamine (Reminyl) and Rivastigmine (Exelon); also, Memantine (Namenda) and Vitamin E.

-for Agitation/Aggression: Atypical antipsychotics, Haloperidol, Divalproex, Buspirone, Trazodone, Lorazepam.