discussion review

 

Peer Response

Instructions:

Please read and respond to at least two of your peers' initial postings. You may want to consider the following questions in your responses to your peers:

• Compare and contrast your initial posting with those of your peers.  
• How are they similar or how are they different?
• What information can you add that would help support the responses of your peers?
• Ask your peers a question for clarification about their post.
• What most interests you about their responses? 

Please be sure to validate your opinions and ideas with citations and references in APA format.  

 

Reply from April Williams

For the results of Mrs. Outcome scores, she reveals moderate cognitive deficiency with functional decline, which points to dementia. However, delirium and depression must be ruled out. Delirium varies from dementia; its onset is acute, inconsistent, and diminished attention/awareness (Harvard Health Publishing, 2024). Additionally, delirium is often reversible and can be triggered by illness (Inouye, S, 2019). On the other hand, dementia is exhibited as irreversible, progressive and chronic. This will require longer-term management.

The two foremost medication groups for dementia are cholinesterase inhibitors such as donepezil, galantamine, rivastigmine, and NMDA receptor antagonists memantine (Harvard Health Publishing, 2024). They function by improving cholinergic transmission and lowering glutamatergic excitotoxicity, while preserving normal signaling.

References

Harvard Health Publishing. (2024, May 1). Drugs for Alzheimer’s disease: Available medications and how they help. Harvard Medical School. https://www.health.harvard.edu/mind-and-mood/drugs-for-alzheimers-diseaseLinks to an external site.

Inouye, S. K. (2019). Delirium, dementia, and the brain. Harvard Medical School. https://hms.harvard.edu/news-events/publications-archive/brain/delirium-dementia-brainLinks to an external site.

Reply from Katie Bruce

Based on the test scores above, do you believe that Mrs. Outcome does have dementia?

The scoring indicates that the patient does have dementia. 

FAQ measures a patient's ability to perform ADLs. Her score indicates that she needs assistance with ADLs. The MMSE measures her cognitive function. She is considered moderately impaired with regarding memory, orientation, attention, and language. The clock drawing test shows that the patient has severe difficulty with visuospatial and executive functioning. The other test GAD and PHQ-9 indicates that the patient also has some mild anxiety and deression. 

What are the differences between delirium and dementia?

Delirium, a condition characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder (Wilson et al., 2020). Delirium can also be caused by precipitating factors such as a urinary tract infection. Patients also often have altered arousal, from reduced responsiveness at the level of near-coma to hypervigilance and severe agitation (Wilson et al., 2020). They may also experience highly distressing symptoms of psychosis, including delusions and hallucinations, and altered mood (Wilson et al., 2020). The features of delirium tend to fluctuate in presence and severity (Wilson et al., 2020). Delirium is associated with considerable distress in patients and caregivers (Wilson et al., 2020).

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person's daily life and activities (What is dementia? symptoms, types, and diagnosis | National Institute on Aging 2022). Some people with dementia cannot control their emotions, and their personalities may change (What is dementia? symptoms, types, and diagnosis | National Institute on Aging 2022). Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living, such as feeding oneself (What is dementia? symptoms, types, and diagnosis | National Institute on Aging 2022).

What two categories of medications are often used to treat dementia and how do these medications work?

Cholinesterase inhibitors and NMDA receptor antagonist and two categories of medications that treat dementia. Cholinesterase inhibitors and memantine are the only currently available symptomatic medications for cognition and global functioning in patients with dementia (Press & Buss, 2025). Cholinesterase inhibitors target the acetylcholine deficit arising from loss of neurons in the nucleus basalis of Meynert and its projections in patients with dementia (Press & Buss, 2025). They are considered symptomatic therapies and are not believed to be neuroprotective or to alter the underlying disease trajectory (Press & Buss, 2025). In Alzheimer’s disease (AD), early synaptic dysfunction is associated with the increased oligomeric amyloid-beta peptide, which causes NMDAR-dependent synaptic depression and spine elimination (Liu et al., 2019). Memantine, low-affinity NMDAR channel blocker, has been used in the treatment of moderate to severe AD (Liu et al., 2019).

References

Huang, J. (2025, February). Dementia - neurologic disorders. MSD Manual Professional Edition. https://www.msdmanuals.com/professional/neurologic-disorders/delirium-and-dementia/dementia#Diagnosis_v1036707

Liu, J., Chang, L., Song, Y., Li, H., & Wu, Y. (2019, February 8). The role of NMDA receptors in alzheimer’s disease. Frontiers in neuroscience. https://pmc.ncbi.nlm.nih.gov/articles/PMC6375899/

Press, D., & Buss, S. (2025, June 18). Cholinesterase inhibitors in the treatment of dementia. UpToDate. https://www.uptodate.com/contents/cholinesterase-inhibitors-in-the-treatment-of-dementia

Rosenzweig, A. (2024, June 8). Screening tests used for alzheimer’s and other Dementias. Verywell Health. https://www.verywellhealth.com/alzheimers-tests-98647

What is dementia? symptoms, types, and diagnosis | National Institute on Aging. National Institute of Aging. (2022, December 8). https://www.nia.nih.gov/health/alzheimers-and-dementia/what-dementia-symptoms-types-and-diagnosis

Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020, November 12). Delirium. Nature reviews. Disease primers. https://pmc.ncbi.nlm.nih.gov/articles/PMC9012267/#S37

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