Confusion, dementia and depression - Dartmouth...
Transcript of Confusion, dementia and depression - Dartmouth...
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K E L L Y K I R K P A T R I C K , B S N , R N - B C
CONFUSION, DEMENTIA AND DEPRESSION
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OBJECTIVES
•Explain the difference between
acute and chronic confusion
•Describe depression and how it is
similar to and different from
confusion
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TOUR OF THE BRAIN
• Alzheimer’s Association:
• http://www.alz.org/braintour/3_main_parts.
asp
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CHRONIC VS. ACUTE CONFUSION
Dementia
• Chronic
• Changes in mental
abilities that occur
slowly; over weeks to
years
• Caused by physical
changes in the brain
• Usually not reversible
Delirium
• Acute
• Changes in mental
abilities that occur
quickly; over hours to
days
• Caused by toxins in the
brain
• Usually reversible
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TYPES OF DEMENTIA
•Alzheimer’s Disease
•Vascular Dementia
• Frontotemporal Dementia
• Lewey Body Dementia
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IS IT NORMAL AGING OR DEMENTIA?
•Alzheimer’s Association: 10 signs
http://www.alz.org/alzheimers_disease_
10_signs_of_alzheimers.asp
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ALZHEIMER’S DISEASE
• Progressive decline
•May include problems with:
• Memory loss (especially short-term)
• Executive function
• Personality changes
• Functional ability
• Sundowning
• Behavior
• Speaking and swallowing
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WHAT’S HAPPENING IN THE BRAIN?
•Alzheimer’s Association
• http://www.alz.org/braintour/alzheimers_
changes.asp
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ALZHEIMER’S DISEASE
• Diagnosis
• No single test to
diagnose
• Mainly based on
mental and
behavioral changes
• Blood tests and scans
to rule out other
causes
• Treatment
• No cure
• Some medications
available to slow
progression of
symptoms
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VASCULAR DEMENTIA
• Caused by changes in the blood flow
to the brain
• Can have a slow or sudden onset
• Similar changes in memory, language,
and motor abilities as in Alzheimer’s
Disease
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VASCULAR DEMENTIA
• Diagnosis
• Screening to identify
mental and
behavioral changes
• Sometimes changes
in blood flow to the
brain can be seen on
scans (CT, MRI)
• Treatment
• “What’s good for the
heart is good for the
brain”
• Manage blood
pressure, blood sugar
and cholesterol
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FRONTOTEMPORAL LOBE DEMENTIA
• Frontal and temporal lobes of the
brain shrink which affects their
functioning
• Usually occurs between ages of 35-75
• May run in families
• Usually first changes are in language
and behavior
• Often causes socially inappropriate
behavior
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LEWY BODY DEMENTIA
• Caused by abnormal deposits in the brain
called Lewy bodies
• Early, well-formed visual hallucinations are
common
• Often develop Parkinson’s-like movements
(shuffling gait, hunched posture, rigid
muscles)
• Usually less drastic fluctuations in memory
and thinking than in Alzheimer’s or vascular
dementia
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DELIRIUM
•Acute change in mental abilities
that occurs quickly, usually over
hours or days
•Caused by toxins in the brain
•Usually reversible, especially if
treated early
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DELIRIUM SIGNS AND SYMPTOMS
• Sudden change
• Very sleepy and drowsy or agitated and restless
• New difficulty focusing; very easily distracted
• Hallucinations (seeing, hearing, smelling, tasting,
feeling)
• Delusions (usually paranoid)
• Disorganized thinking
• Incoherent or rambling speech; switching unpredictably
from subject to subject
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POSSIBLE CAUSES OF DELIRIUM
• Infection (especially urinary or respiratory)
• Stroke
• Heart attack
• Medications
• Drugs/alcohol
• Dehydration
• Pain
• Severe constipation
• Liver or kidney problems
• Breathing problems
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TREATMENT OF DELIRIUM
• Key to reversal of delirium is to find and
treat the cause of the delirium as soon
as possible
• If left untreated, can cause permanent
changes in mental abilities
• People with dementia are at a higher
risk to develop delirium
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DEPRESSION
• How common is depression in older adults?• Living at home: 2%
• Chronically Ill: 9%
• Hospitalized: 36%
• Nursing home (cognitively intact): 10-20%
• Nursing home (cognitively impaired): 50-70%
• Stroke: 47%
• Heart attack: 45%
• Parkinson’s: 39%
(from uptodate.com)
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RISK FACTORS FOR DEPRESSION IN OLDER ADULTS
• Female
• Widowed, divorced or separated
• Social isolation
• Other medical conditions
• Uncontrolled pain
• Insomnia
• Functional impairment
• Cognitive impairment
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SIGNS AND SYMPTOMS OF DEPRESSION
• Feeling down
• Decreased interest or pleasure in activities*
• Weight change*
• Problems sleeping*
• Restless or sluggish*
• Having no energy
• Feeling guilty or worthless
• Problems thinking or making decisions*
• Suicidal thoughts
*Can also happen with dementia/delirium
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TREATMENT FOR DEPRESSION
•Support groups
•Counseling
•Regular exercise
•Medications
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IF YOU’RE LOVED ONE HAS DEPRESSION…
• Remember…it is not your fault!
• Help establish a daily routine and try to schedule
challenging tasks for times of day the person usually
feels best
• Include daily physical activity, especially in the
morning
• Make a list of activities, people and places the
person enjoys and incorporate them into the daily
routine
• Acknowledge person’s feelings of
sadness/frustration
• Provide reassurance and celebrate small successes
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RESOURCES FOR HELP
• Alzheimer’s Association
https://www.alz.org/we_can_help.asp