Hi class and professor,
In this discussion my topic is dementia and delirium. Between dementia and delirium, the biggest
difference I noticed is that delirium can affect any age and is sudden and acute onset vs. dementia is
usually affects older adults and has a gradual onset. Patients with dementia & delirium both presents
with memory loss, confusion, changes in mood or behavior. However, with dementia family members
tends to notice the change in behaviors first. Risk factors and pathophysiology for both can be age
related however, one thing to note with delirium is its usually a disruption of neurotransmitter related to
acute illness such as infection, medication side effects, electrolyte imbalances which can be reversible
when treating the underlying cause. While dementia has a chronic health factor such as diabetes,
hypertension, cardiovascular disease, and lifestyle.
As far as assessments for dementia and delirium it will be a neurologic exam and a thorough medical
history. In addition, utilizing assessment tools such as the mini-mental state exam for dementia.
However, for delirium a rapid assessment confusion assessment and focusing on an acute infection
related symptoms such as UTI. The appropriate diagnostic testing for both would be blood tests such as
CBC, CMP, UA, Vitamin B12 deficiency, and serum TSH (Larson, 2024). Brain CT, MRI, and cerebrospinal
fluid analysis is a vital diagnostic for dementia (Brosch & Farlow, 2024). For delirium focusing on EEG with
patients with altered consciousness to rule out seizure (Francis & Young, 2022). Depending on the results
of the diagnostic tests and assessments it can rule out differential diagnosis such as depression,
substance toxicity, hypothyroidism, sundowning, and stroke.
Treatments for both focus on treating the underlying issues as well as a multidisciplinary approach.
Nonpharmacological intervention such as nutrition, hydration, cognitive rehabilitation, and promoting an
overall healthy environment is key in both diseases. Medication for dementia include cholinesterase
inhibitors such as donepezil, rivastigmine, and galantamine in addition, NMDA receptor such as
memantine (Press & Buss, 2021). Aducanumab is an infusion which is a monoclonal antibody that
reduces the protein deposits in the brain however, it does not cure or reverse dementia (Woloshin &
Kesselheim 2022). However, a new medication Lecanemab has been approved by the FDA for early
Alzheimer’s disease due to the ability remove amyloid plaques seen on PET scans (Hossain et al., 2024).
There isn’t a specific medication for treatment of delirium. Antipsychotics or benzodiazepines may be
used to treat the symptoms such as agitation and alcohol withdrawal.
Education and support systems are essential with dementia and delirium. Ensuring that caregivers and
patients understand the progression and onset of disease is key. Safety is a tremendous factor in patient
education as both diseases can cause high risk of falls and behavioral disturbances. Providing preventive
measures such as avoiding medications that may cause altered mental status, ensuring at home safety
guidance with stoves, and sleep hygiene is vital. In addition, providing referrals to local community
support groups, social services, and ensuring patients are following up with PCP, and/or neurologist is
key.
References
Brosch, J.R., & Farlow, M.R. (2024). Early- onset dementia in adults. UpToDate. Retrieved July 10, 2024,
from https://www.uptodate.com/contents/early-onset-dementia-in-adults?
