Delirium or Dementia - Do you know the difference?

From   http://www.alz.org/norcal/in_my_community_17590.asp from Northern California and Northern Nevada Chapter Home > Delirium or Dementia - Do you know the difference?

What do we mean by delirium?

Also called the acute confusional state, delirium is a medical condition that results in confusion and other disruptions in thinking and behavior,
including changes in perception, attention, mood and activity level.

Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized even by healthcare professionals
because many symptoms are shared by delirium and dementia. Sudden changes in behavior, such as increased agitation or confusion in the late evening, may be labeled as “sundowning” and dismissed as the unfortunate natural
progression of one’s dementia.

When is a change in behavior delirium and not part of dementia?

In dementia, changes in memory and intellect are slowly evident over months or years. Delirium is a more abrupt confusion, emerging over days or weeks,
and represents a sudden change from the person’s previous course of dementia.

** Unlike the subtle decline of Alzheimer’s disease, the confusion of delirium fluctuates over the day, at times dramatically. Thinking becomes more
disorganized, and maintaining a coherent conversation may not be possible. Alertness may vary from a “hyperalert” or easily startled state to drowsiness and lethargy. The hallmark separating delirium from underlying dementia
is inattention. The individual simply cannot focus on one idea or task.

What if you suspect delirium?

..... Secondly, create a safe and soothing environment to help improve the course of delirium: keep the room softly lit at night, turn off the television
and remove other sources of excess noise and stimulation. The reassuring presence of a family member, friend, or a professional often prevents the need to medicate.

And lastly, tread lightly with medications. Sedatives, sleeping medications and other minor tranquilizers play a very limited role in delirium management
unless a patient is experiencing drug withdrawals.

Prevention of Delirium

  Avoid illness through smoking cessation, a balanced diet, regular exercise, adequate hydration and vaccinations to prevent influenza and pneumonia.

  Avoid alcohol in any amount.

  Exercise caution with medication, especially sleep aids, and periodically ask the physician for a “medication review.”

  Eliminate or reduce the use of the following medications:

  Antihistamines (e.g., diphenhydramine)

  Bladder relaxants

  Intestinal antispasmodic

  Centrally-acting blood pressure medicines (e.g., clonidine, methyldopa)

  Muscle relaxants

  Anticholinergics (drugs with atropine-like effects)

  Opioids (e.g., codeine, hydrocodone, morphine)

  Anti-nausea medication

  Benzodiazepine type sedatives

The following interventions appear to reduce the risk of delirium during hospitalization:

  Early mobilization after surgery

  (e.g., walking, getting up in a chair)

  Assisting the individual with eating

  Round-the-clock acetaminophen for surgical pain (may lessen the need for stronger drugs)

  Minimizing bladder catheter use

  Avoiding physical restraints

  Avoiding multiple new medications

  Hydration – encourage and assist with fluids

  Normalizing the environment (e.g., pictures from home, familiar objects, cognitively stimulating activities and reminders, visits from family
members)

  Providing sensory devices if needed

  (glasses, hearing and visual aides from home)

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Overview of Delirium and Dementia

by Juebin Huang, MD, PhD

Delirium (sometimes called acute confusional state) and dementia are the most common causes of cognitive impairment, although affective disorders (eg,
depression) can also disrupt cognition.

Delirium and dementia are separate disorders but are sometimes difficult to distinguish. In both, cognition is disordered; however,

dementia affects mainly memory, and

delirium affects mainly attention

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 Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium.
Flaherty JH1, Little MO.

Abstract

Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. 

{snipped} The authors have found that a restraint-free environment can be achieved; "tolerate, anticipate, and don't agitate" (the T-A-DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data,