Dementia and Delirium

What’s the difference, and
strategies to help the patient

and caregiver
Delirium Dementia
 Acute disturbance of  Alzheimer’s disease, a type of
consciousness with reduced dementia, is an irreversible,
ability to focus, sustain, or progressive brain disease that
shift attention affects an estimated 5.4 million
 A change in cognition, a Americans.
perceptual disturbance not  It is the 6th leading cause of
accounted for by preexisting, death among all adults (CDC)
established or evolving  It is the 5th leading cause for
dementia those aged 65 or older (CDC)
 Occurs over a short time  In more than 90% of people
period and fluctuates during with Alzheimer’s, symptoms do
the day not appear until after age 60.
 Has a causal component  The incidence of the disease
increases with age and doubles
every 5 years beyond age 65.
Delirium vs. Dementia
Delirium Dementia
 Acute  Gradual
 Reversible  Irreversible
 Consciousness: fluctuating  Consciousness: rarely alters
 Decreased awareness of self
 Decreased awareness of self
 Perceptions: Hallucinations
 Perceptions: illusions,
not common
hallucinations common
 Speech: repetitive difficulty
 Speech: slow, incoherent finding words
 Disorientation: time, others  Disorientation: time, person,
 Cognitive dysfunction place
 Illness, med. toxicity: often  Memory impairment
 Illness, med. toxicity: rarely
 Diurnal disruptions
 Diurnal disruptions
 Outcome: excellent if
 Outcome: poor
corrected early
Delirium
 A medical emergency
 Triggered by
 Oxygen deprivation
 Drug use/poisons, meds
 Infections, recent surgery, or trauma
 Severe chronic illness
 Electrolyte imbalances
 Pre-morbid brain conditions, and functional status
 Preexisting cognitive impairment
 Old age/ sensory losses
Prevention
Risk factors Intervention
 Cognitive impairment  Routine mental status
 Dehydration/electrolyte assessment, staff education
imbalance  I&O, skin assessment, early
 Sensory deprivation/ sleep recognition of the problem
disturbances  Non pharmacologic sleep
 Poly-pharmacy aids, decreased noise and
light at night, frequent rest
periods, daytime activities
 Staff education of medication
side effects, pharmacy liaison,
start low go slow
Dementia
 Comes on over time, short term memory loss evident
 May progress slowly or quickly
 May affect younger persons as well as elderly
 Different kinds of dementia
 Treatment generally depends on the stage/ severity of the
disease
 Becoming old doesn’t mean you will develop dementia
 Is terrifying while the client is still able to realize that they
are not thinking properly
Treatment of Dementia
 Cholinesterase inhibitors such as donepezil,
galantamine, and rivastigmine.
 Memantine. Memantine (Namenda) works by
regulating the activity of glutamate, another chemical
messenger involved in brain functions, such as
learning and memory. In some cases, memantine is
prescribed with a cholinesterase inhibitor.
 Other Therapies:
 Occupational therapy.
 Modifying the environment
 Modifying tasks
Communication
 Is often what relationships are built on
 When communication
becomes faulty our
relationships crumble
 Our communication
strategies can help an
older adult with advancing
dementia feel safe, less
anxious, and less likely to
become upset or aggressive
Getting their attention
 Gain the persons attention
 Turn off extraneous noise
 Stand in front of the person and
maintain eye contact
 Go slow, direct and redirect their
attention
Be aware of your tone of voice
 Do not shout!
 Do not speak in a condescending

tone
 Speak slowly
Take care with your use of language
 Use adult language
 Concrete simple language, short phrases
 Be positive and reassuring

Try yes or no questions
 Use 2 choice questions like do you
want juice or soda?
 Are you hungry?
 Are you tired?
 Can I read to you?
Repeat rephrase and repair:
 This is a difficult strategy but is helpful to maintain
conversation and helps fill in the missing information
the person with dementia may omit
 Repeating-helps fill in speech Ex: I want a cup of…. If
you repeat this the elder may add the word coffee, water
or juice
 Rephrasing- helps the person hear the corrected
response if they say juice you might point to a juice
container and say I want a glass of juice
 Repairing-uses both tactics to fix or fill in missing
information for example a person points at a pantry
cabinet and says, “look there.”, you might say, “your
Hungry?”
Orient and reorient frequently
 Use visual aids
 Make sure they have hearing aids or
glasses if they need them
 Calendars and message boards
 Keep them up to date, make sure they are
easy to locate
 Orient the person with your language
Use touch
 Touch makes us human and is
reassuring
 Helps maintain attention during
conversation
 Can be calming
Learn to be a good listener
 Listen and watch/ wait for the response
 Do not interrupt
 Be willing to talk about old times then

redirect
Lastly-DON’T ARGUE
 You won’t win
 The person with dementia is not trying to be disagreeable

they are usually unaware that they are making mistakes
 If the person is in immediate danger then correcting the

thought or behavior might be appropriate. If not-
 DON”T ARGUE you will only cause

frustration, fear and anger so what’s the
point?
Beta Amyloid found in Young
Brains
 A new study lead by Changiz Geula, a research
professor at the Northwestern University Feinberg
School of Medicine in Chicago, found evidence of
Alzheimer’s disease in the brains of deceased adults as
young as 20 years old.
 The research team analyzed the brains of:
 13 people between the ages of 20-66 with no health issues,
 14 people without dementia between the ages of 70-99, and
 21 brains of people with Alzheimer’s between the ages of 60-95.
 They observed that toxic amyloid buildup was evident
irrelevant of age and health.
References
 Bell, L. (November, 2011). AACN practice alert: Delirium
assessment and management. American Association
of Critical Care Nurses.
 Cason-McNeeley, D. (2004). Delirium the Mistaken
Confusion. PESI Healthcare, Eau Claire, Wisconsin
 Galik, E. M., Sparks, M., Spurlock, W. (2008). Effective
communication and behavior management strategies in
the care and treatment of Alzheimer’s disease.
Counseling Points, 1(2).
 Kohler, S. (2004). How to Communicate with Alzheimer’s.
Granny’s Rocker Publishing, Venice, CA.
 http://www.alzheimers.net/3-16-15-alzheimers-signs-
found-in-young-adults/

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What’s the difference, and

strategies to help the patient

 Do not speak in a condescending

 Use adult language

 Concrete simple language, short phrases

 Be positive and reassuring

 Be willing to talk about old times then

 The person with dementia is not trying to be disagreeable

 If the person is in immediate danger then correcting the

 DON”T ARGUE you will only cause

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