Dementia - Dementia Medical Aspects of Disability October...

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Dementia Medical Aspects of Disability October 17, 2006
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DEMENTIA DEFINITION: Group of symptoms that can be caused by over 60-70 disorders. Syndrome which refers to progressive decline in intellectual functioning severe enough to interfere with person’s normal daily activities and social relationships. ( National Institute on Aging- 1995 No. 95-3782)
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Dementia Marked by progressive declines in memory. visual-spatial relationships performance of routine tasks language and communication skills abstract thinking ability to learn and carry out mathematical calculations.
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Dementia Two Types: Reversible Irreversible Individuals must have intensive medical physical to rule out reversible types of dementia.
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Delirium vs. Dementia Delirium defined--- characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time About 10-15% of surgical patients experience delirium, and 15-25% of medicine inpatients will experience delirium 30% Surgical Intensive Care Unit patients develop delirium, and up to 30% of AIDS patients while inpatient, will develop delirium
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Delirium vs. Dementia A major risk factor is advanced age Other factors include very young people (children), organic brain damage including stroke, MVA, etc, substance use, previous delirium, malnutrition, sensory deprivation (hearing or visual loss), diabetes, cancer Having an episode of delirium is more than just inconvenience 3 month mortality following an episode of delirium is 25-30%. 1 year mortality after an episode of delirium may be as high as 50%.
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Delirium vs. Dementia Many causes of delirium: Some examples… epilepsy, CNS trauma, CNS infection, CNS neoplasm, endocrine dysfunction (pituitary, thyroid, adrenal, parathyroid, pancreas), liver failure, UTI , cardiac dysrhythmias, hypotension, vitamin deficiency, sepsis, electrolyte imbalance, iatrogenic- any medication, substance withdrawal
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Delirium vs. Dementia Could be psychiatric disorder, i.e. major depression or generalized anxiety disorder, in which case need to initiate treatment for this disorder, i.e. get a psych consult Or is the cause a delirium from other meds or an infection, in which case should look at labs and med list. Or is cause alcohol withdrawal, in which case need to treat w/d with benzodiazepines If patient is having chronic trouble sleeping, a good choice to help them is Ambien/zolpidem or Sonata/zaleplon
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Delirium vs. Dementia Watch for alcohol withdrawal as cause of delirium. If elevated pulse and blood pressure, see elevated MCV, and patient begins to act bizarre, talk to family if at all possible, about substance use. If patient enters delirium tremens (DT’s), untreated has a mortality rate of 20%.
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Delirium vs. Dementia How is delirium treated? First line treatment for delirium is to treat underlying
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Dementia - Dementia Medical Aspects of Disability October...

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