Dementia and Delirium as Cognitive Impairments

Differences Between Dementia and Delirium

Both delirium and dementia are types of cognitive impairment, but it is crucial for psychiatric nurses to differentiate between them. The major difference is that while dementia occurs in patients with clear consciousness, delirium involves the decline in both cognition and consciousness (Sadock, Sadock, & Ruiz, 2015). There are some other features allowing specialists to distinguish between the two conditions.

The important place in this process belongs to the time during which the illness develops. In delirium, the decline is acute whereas, in dementia, it is gradual (Sadock et al., 2015). Also, the level of attention is not the same: comparatively consistent in dementia, and fluctuating in delirium. The progression of symptoms is almost always slow and gradual in dementia and fast in delirium. An exception is a vascular dementia, in case of which the development of signs and symptoms is sudden and quick (Sadock et al., 2015).

The level of alertness under the two conditions is not the same. Patients with dementia are usually stable and alert. Individuals with delirium frequently experience episodes of eliminated consciousness (Sadock et al., 2015). Sometimes, a person suffering from dementia may develop delirium: this condition is called “beclouded dementia” (Sadock et al., 2015, p. 701). Unlike delirium, dementia has several types: Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. If a patient has a definite history of dementia, it is possible to make a dual diagnosis of delirium (Sadock et al., 2015).

Challenges in Prescribing Medication

There are several issues that might complicate the process of medicine prescribed for patients with dementia. These challenges include the lack of patients’ insight, the failure to adhere to treatment, the deficit of support systems following up the physician’s recommendations, and the patients suffering from multiple chronic conditions simultaneously. The most difficult of the aspects is that dementia patients may have several medical conditions at the same time.

Research indicates that treatment with antipsychotic drugs does not always result in benefits for patients (Ballard, Corbett, & Howard, 2014). Scholars note that there is not enough evidence of treatment advantages for individuals with non-Alzheimer’s dementia. Also, Ballard et al. (2014) report that medication prescription is challenging since it has to be adjusted to various adverse aspects such as gait disturbance, pneumonia, stroke, sedation, cognitive decline, and others. Moreover, the mortality risk due to inaccurate prescriptions becomes increased (Ballard et al., 2014). Therefore, the combination of dementia and other chronic medical conditions is the most challenging aspect to consider when prescribing medication for such patients.

Dementia Alzheimer Type: Treatment

For the diagnosis of Alzheimer’s disease, treatment with Aricept (donepezil) is the most relevant. The recommended dose is 5mg daily, which would be best taken orally at bedtime. The rationale behind selecting donepezil is that this drug has been approved by the Food and Drug Administration as one of three medicines, along with galantamine and rivastigmine, that can delay the progress of Alzheimer’s disease (Burock & Naqvi, 2014).

Alzheimer’s type dementia involves changes in the brain that lead to breaking down acetylcholine. The expected outcome of prescribing donepezil is the prevention of acetylcholine’s disintegration (Birks & Harvey, 2018). As a result, the symptoms of dementia may become enhanced. Additionally, donepezil is reported to decrease the need for patients to be admitted to a nursing home (Burock & Naqvi, 2014). Also, this drug is anticipated to lead to improvements in patients’ cognitive status. However, a psychiatric nurse needs to be mindful of observing side effects, such as nausea, anorexia, fatigue, and insomnia (Burock & Naqvi, 2014).

References

Ballard, C., Corbett, A., & Howard, R. (2014). Prescription of antipsychotics in people with dementia. The British Journal of Psychiatry, 205(1), 4-5.

Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s disease (review). Web.

Burock, J., & Naqvi, L. (2014). Practical management of Alzheimer’s dementia. Identifying and Managing Psychiatric Emergencies, 97(6), 36-40.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.