012 Delirium

DELIRIUM:

Diagnostic Features

The essential feature of a delirium is a

(1) disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a preexisting or evolving dementia.

(2) The disturbance develops over a short period of time, usually hours to days, and tends to fluctuate during the course of the day.

(3) There is evidence from the history, physical examination, or laboratory tests that the delirium is a direct physiological consequence of a general medical condition, Substance Intoxication or Withdrawal, use of a medication, or toxin exposure, or a combination of these factors.

(4)The disturbance in consciousness is manifested by a reduced clarity of awareness of the environment.

(5)The ability to focus, sustain, or shift attention is impaired (Criterion A). Because of these problems, it may be difficult (or impossible) to engage the person in conversation.

(6) There is an accompanying change in cognition (which may include memory impairment, disorientation, or language disturbance) or development of a perceptual disturbance (Criterion B).

h) (Dementia) Alzheimer's symptoms and causes (DSM IV, pgs 133 143)

WHAT IS ALZHEIMER'S DISEASE? CAUSES?

Specific Cufture, Age, and Gender Features

Late onset (after age 65 years) of Dementia of the Alzheimer's Type is much more common than early onset. The disorder is slightly more common in females than in males.

Prevalence

Between 2% and 4% of the population over age 65 years is estimated to have Dementia of the Alzheimer's Type. The prevalence increases with increasing age, particularly after age 90 years.

Course

The course of Dementia of the Alzheimer's Type tends to be slowly progressive. A common pattern is an insidious onset, with early deficits in recent memory followed by the development of aphasia, apraxia, and agnosia after several years. The average duration of the illness from onset of symptoms to death is 8-10 years.

Familial Pattern

Compared with the general population, first degree biological relatives of individuals with Dementia of the Alzheimer's Type, With Early Onset, are more likely to develop the disorder.

Diagnostic criteria for Dementia of the Alzheimer's Type

A.        The development of multiple cognitive deficits manifested by both

(1)        memory impairment (impaired ability to learn new information or to recall
previously learned information)

(2)        one (or more) of the following cognitive disturbances:

        (a) aphasia (language disturbance)
        (b) apraxia (impaired ability to carry out motor activities despite intact motor function)
        (c) agnosia (failure to recognize or identify objects despite intact sensory function)
        (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B.        The cognitive deficits in Criteria Al and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.

C.        The course is characterized by gradual onset and continuing cognitive decline.

D.        The cognitive deficits in Criteria A1 and A2 are not due to any of the following:

(1)        other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease Parkinson's disease, Huntington's disease, subdural hematoma normal pressure hydrocephalus, brain tumor)

(2)        systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)

(3)        substance induced conditions

E.        The deficits do not occur exclusively during the course of a delirium.

F.        The disturbance is not better accounted for by another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia).

Treatment:

Group therapy with "revisiting" (memories, past activities, etc.)
Rx for depression
Utilize strict structural techniques
Family involvement

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