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N6603-CompareContrastwk1.docxfrom Week 1: Compare and Contrast Assignment
Mar 6, 2021 9:38AM
Dementia and Delirium
Neurological disorders are diseases that affect the central nervous system, brain, and central automotive system. Dementia and delirium are two major types of neurological disorders that have various similarities and differences. Dementia is a disorder that affects thinking, memory, and an individual’s social abilities. Under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), dementia is considered a common neurological disorder. Delirium is an acute disturbance in an individual's mental abilities, resulting in confused thinking and reduced awareness of the environment. This paper compares and contrasts dementia and delirium as neurological disorders.
Presentation
Dementia and delirium have significant differences and similarities. Dementia is a neurodegenerative condition with a slow onset and progresses throughout an individual’s life. Delirium means sudden confusion; hence delirium is an acute change in the mental status of an individual, delirium cause a severe disturbance in thoughts, moods, and behavior. Though the two neurological disorders are different, they have similar symptoms, including impaired memory, confusion, poor judgment, disorientation, and varying hallucinations. In dementia, it is more of memory loss, while delirium affects attention and concentration. An individual with delirium finds it challenging to focus, while in dementia, in the early stages, the person is alert. In reviewing a patient's presentation, delirium and dementia may differ in that the consideration of delirium can be considered when it's a sudden change in cognitive behavior. At the same time, a physician can establish dementia if the incidence has occurred slowly over time. The duration for delirium is variable may be in days or hours, while dementia is progressive and chronic( Meagher, O’Connell, Leonard, Williams, Awan, Exton, and Adamis, 2020). Deciding the length when the condition presented itself gives a better understanding of dementia or delirium. Both disorders are more common among the elderly. In delirium, the medical complaints include exposure to poison, infection, diabetes, and depression, while dementia has issues related to stroke and Parkinson's disease. For a patient with delirium, the speech may be incoherent, and disorganized while that of a patient with dementia presents anomia, difficulty in remembering words.
Pathophysiology
Dementia is more evident with the symptom of a variety of structural brain diseases and degeneration. Dementia occurs due to brain cells' damage, which makes it difficult for the brain cells to communicate. When the brain cells cannot communicate, the patient's behavior, feelings, and moods become affected. Dementia causes cortical-subcortical degeneration of chlorogenic neurons and pyramidal cells in the cerebral cortex. Dementia reflects the deterioration of the cortex cell's ability to function (Nina-Estrella, 2017). The pathophysiology of delirium is not clearly understood. Delirium may be due to inflammatory mechanisms and the deficiency of a cholinergic transmitter in the brain. Another occurrence may be due to central abnormalities where an imbalance may occur. Delirium is reversible since it’s an impairment of the neurotransmitter, while dementia is progressive and irreversible due to an altered brain function.
Assessment
For dementia and delirium, the patient’s history is essential, preferably from the patient. If the patient is unable to communicate, a caregiver, close relative, or guardian can provide the patient's health history. A neurological exam and neuropsychological tests should also be conducted for both dementia and delirium. In delirium, specific patient assessments include observation of the patient’s ability to speak, changes in behavior, movement, and consciousness (Maldonado, 2017). Detailed reviews in dementia include neuropsychological tests, blood tests, brain imaging, cardiac examination, and the individual's overall behavior. The loss of memory has often been considered as a part of normal aging; hence in most instances, dementia is underdiagnosed. The diseases' assessments are similar; therefore, determining delirium causes requires strong clinical expertise for diagnosis.
Diagnosis
Assessment tools for diagnosis of dementia and delirium care used. In delirium, the Confusion Assessment method is utilized and is commonly known for screening delirium. The instrument assesses the presence, severity, and fluctuation of agitation. CAM is also used to determine the onset, altered consciousness, and thinking of an individual. The assessment tool recommended for dementia is the Montreal Cognitive Assessment (MoCA). This screening tool assists physicians in detecting neurocognitive disorder and is used to diagnose dementia (Arvanitakis, Shah, and Bennett, 2019). Blood tests are used but not considered a significant way for diagnosing dementia or delirium; however, blood tests can be used after a positive assessment of dementia and delirium. The use of simple cognitive tests is essential in differentiating and diagnosing dementia and delirium. In addition to the use of history, the use of Magnetic resonance imaging and Computed tomography can be used for either dementia or delirium to check whether there is evidence of stroke, bleeding, infection, or a tumor.
Treatment
Currently, there is no curative treatment for dementia; however, certain medications can reduce the rate of progression. There are various medications used to improve the symptoms of dementia temporarily. This includes Cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). These help to boost the levels of the chemical messenger involved in memory. Memantine regulates the activity of glutamate. The inclusion of therapy in treatment may include occupational therapy, environmental modification, and simplifying of tasks. Delirium is often resolved on its own and may sometimes take weeks to resolve. In some instances, it’s treated according to the cause. A healthcare provider may prescribe the use of antipsychotic drugs such as Haloperidol, Risperidone, Olanzapine, and Quetiapine (Ospina, King IV, Madva, and Celano, 2018). Minimal medication may be utilized; the patient should be closely monitored and provided with orientation reminders.
References
Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia. Jama, 322(16), 1589-1599.
Ospina, J. P., King IV, F., Madva, E., & Celano, C. M. (2018). Epidemiology, mechanisms, diagnosis, and treatment of delirium: a narrative review. Clinical Medicine and Therapeutics (CMT).
Maldonado, J. R. (2017). Acute brain failure: pathophysiology, diagnosis, management, and sequelae of delirium. Critical care clinics, 33(3), 461-519.
Meagher, D. J., O’Connell, H., Leonard, M., Williams, O., Awan, F., Exton, C., ... & Adamis, D. (2020). Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients. World journal of psychiatry, 10(4), 46.
Nina-Estrella, R. E. (2017). Update on Dementia. Pathophysiology, Diagnosis, and Treatment. DSM-IV versus DSM-V. In Psychiatry and Neuroscience Update-Vol. II (pp. 477-493). Springer, Cham.
from Week 1: Compare and Contrast Assignment
Mar 7, 2021 6:36PM
Good evening Ewa, Staphanie, and Taylor great discussion on migraines and tension headaches! Taylor I want to elaborate on a point you mentioned in your discussion post, which was drug-induced headache. As you stated, medication-overuse headache (MOH) previously called rebound headache or drug –induced headache is a secondary disorder caused by excessive use of medications, such as analgesics to treat acute pain like NSAID, triptans, opioid, and ergot alkaloids (Mose, Pedersen, Debrabant, Jensen, & Gram, 2018). MOH is defined by Arnold (2018) as a headache occurring on (1) 15 or more days in a month for a patient who has pre-existing migraines (2) overuse of medication for more than three months (3) and headache which can’t be otherwise diagnosed.
Symptoms may vary among individual, but MOH mostly occurs daily, present upon awakening, and improve with analgesics, but return when the medication wears-off. Furthermore, MOH is often accompanied with anxiety, irritability, memory problems, and nausea. Certain classes of acute medications may increase the risk for MOH. Simple analgesic such as NSAID, Tylenol, and aspirin may cause rebound headaches when individual surpasses the daily dosages when used 15 or more days per month. Triptans, ergotamines, and opioids can also cause MOH if it is taken more than ten or more days (Walter, 2016).
References
Arnold, M. (2018). Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia, 38(1), 1-211.
Mose, L. S., Pedersen, S. S., Debrabant, B., Jensen, R. H., & Gram, B. (2018). The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study. The Journal Of Headache And Pain, 19(1), 39.
Walter, T. R. (2016). Medication overuse headache. Journal Of Pain & Palliative Care Pharmacotherapy, 30(1), 66–68.
from Week 1: Compare and Contrast Assignment
Mar 7, 2021 9:18PM
Thank you professor for your response. It’s imperative to be able to rule out certain acute states such as UTI especially when it comes to the elderly population. Clinical presentation for delirium may present as an acute onset of fluctuation of confusion. I have seen instances where in both the outpatient and inpatient settings a family member is bringing their parent in and saying that mom or dad is not acting like themselves or is confused or forgetting certain things. So when it comes to the treatment, the appropriate approach to treat delirium is the management of symptoms and detect the cause.
