Known causes that induce acute delirium include the following (Sadock et al., 2015): ● Seizures. ● Trauma (especially head trauma after a fall).
paired cognitive functioning (can look like disorientation), and di- minished memory (Sadock et al., 2015). It can present like other mental health disorders. A psychotic episode of schizophrenia, mania, or a factitious disorder can look like delirium upon the first encounter. Generally speaking, schizophrenia presents with bet- ter organization and a more stable level of consciousness; mania will be explained historically with a bipolar diagnosis or become apparent over time; and in a factitious disorder, inconsistencies will surface during examination or be easily revealed after an electroencephalography (Sadock et al., 2015). The healthcare worker can provide or request further examination of the older adult. Cognitive testing can be administered and compared to a baseline examination if available, along with laboratory studies looking for underlying causes of delirium. The treatment will often be dependent on the underlying cause of the delirium. Caution is needed for the older adult receiving treatment for psychosis. The AGS (2019) highly recommends avoidance of antipsychotic medications such as haloperidol (Haldol), risperidone (Risperdal), and quetiapine (Seroquel) due to their increased affiliation with tremors, fall risk, stroke, and death in patients with dementias. A refined assessment and understanding of underlying sequalae of psychosis are needed for treatment of delirium long term. ● Utilize tools such as calendars, to-do lists, notes, and remind- ers. ● Place daily objects in the same place in your house. ● Consider learning a new skill (check community resources). ● Volunteer time (give back to the local community). ● Increase time spent with friends and family. The older adult with MCI needs to be assessed regularly to rec- ognize increased symptoms that would warrant intervention. The findings of MCI do not predict further impairment, do not necessi - tate treatment, and can cease without medical intervention (NIA, 2022f). Further evaluation by a neurologist or neuropsychologist can be provided if desired. in the brain lumped with proteins known as alpha-synuclein and called Lewy bodies after the physician who discovered them (NIA, 2022e). The accumulation of Lewy bodies causes destruction and death of neurons and results in gradually decreasing brain activity (NIA, 2022e). There are two types of Lewy body dementia—de- mentia with Lewy bodies and Parkinson’s disease dementia. The biggest difference between Lewy body and Parkinson’s dementia is the timing and disruption in thought and movement. Classification of dementia with Lewy bodies (NIA, 2022e): ● Ensure adequate sleep at night. ● Prioritize exercise and nutrition. ● Avoid alcohol (receive help if needed). Problems with thinking, unpredictable change in attention and alertness, and visual hallucinations develop early in rela- tion to movement symptoms, such as slow movement, dif- ficulty walking, and muscle stiffness. Classification of Parkinson’s dementia (NIA, 2022e): Movement symptoms start first and are consistent with a di - agnosis of Parkinson’s disease. Later, problems with thinking and changes in mood and behavior develop. Not everyone with Parkinson’s disease will develop dementia. The evaluation of a person with either Lewy body or Parkinson’s dementia will entail a physical exam, mental status examination, cognitive functioning evaluation, and brain imaging. LBD is nei- ther preventable nor curable, and treatments focus on the pa- tient’s safety and quality of life (NIA, 2022e). Interventions can in- clude many disciplines, especially case management. The mental healthcare worker can also offer community resources and non- profit organizations as care options, dependent on their acces - sibility to the older adult. Frontotemporal dementia (FTD), also known as Pick’s disease, is named after a physician who described it and the “Pick bod- ies” seen in the brain postmortem (Sadock et al., 2015). FTD is a rare, progressive disease with an unknown etiology. It carries a
● Diabetes. ● Infection. ● Insufficient nutritional status. ● Uncontrolled pain.
● Medications (e.g., pain medication, antibiotics, antivirals, an- tifungals, steroids, anesthesia, cardiac medications, anticho- linergics). ● Serotonin syndrome. ● Over-the-counter substances (e.g., herbs, teas, supplements). ● Cardiac disturbances (failure, arrhythmias, myocardial infarc- tion). ● Disease (abnormality or failure in pulmonary, endocrine, renal, and hepatic systems). Delirium can be life threatening but is usually reversible with treat- ment. The healthcare worker must be able to identify the signs of delirium. Key features of delirium include rapid and abrupt onset, decreased level of consciousness, altered attention, im- Mild cognitive impairment (MCI) MCI lives in the space between normal age-related cognitive changes and dementia. Older adults with MCI are at greater risk for developing dementia or Alzheimer’s disease (NIA, 2022f). The mental healthcare provider can note subjective data from the older adult or from caregivers, family, or friends (with consent). Data to note for older adults with suspicion of MCI: increased fre- quency of losing items; forgetting important dates, events, or ap- pointments; and difficulty with word selection (NIA, 2022f). These symptoms can be concerning to the older adult. The NIA recom- mends tips to improve MCI. These suggestions can empower the older adult who feels embarrassed or saddened by their cognitive state. Recommendations for improving memory include the fol- lowing (NIA, 2022f): ● Stick to a daily routine—predictability is key.
Dementia (vascular, lewy body, frontotemporal, Alzheimer’s disease) Dementia is a major neurocognitive disorder classified in the DSM-5 by severe impairment of memory, judgment, orientation, and cognition (APA, 2013). It is not part of normal aging and is common in older adults. Half of older adults age 85 years or older have a diagnosis of dementia (NIA, 2022c). Not all causes of de- mentia are known, and differentiating them can be challenging to the healthcare worker. If a specific dementia cannot be cat - egorized but symptoms meet criteria, the diagnosis of general dementia will stand. Delirium and dementia are often confused, but they can be contrasted by several clinical features. The most distinguishable characteristic of delirium is the rapid onset of pre- sentation and attention level. Delirium has an abrupt beginning and inconsistent level of attention, while most dementias occur over the course of time and maintain a consistent level of atten- tion (Sadock et al., 2015).
Although vascular dementia, which is caused by a stroke, presents very similarly to delirium, it can be separated by clinical evaluation. Vascular dementia is one of the several subcategories of demen- tia. It is the second most common type behind Alzheimer’s disease (NIA, 2022g). Those most at risk for developing vascular dementia are men, people with hypertension (especially uncontrolled), peo- ple with high cholesterol, and those who have other cardiovascular diseases (Sadock et al., 2015). The cognitive invasion of this type of dementia is a result of an infarcted plaque or emboli traveling to the brain. A diagnosis can be made after cognitive testing is per- formed, a medical history is taken, and brain imaging is completed (NIA, 2022g). One unfortunate truth about vascular dementia is the irreversibility of its damage. Treatment can include preventing fur- ther strokes by thinning the blood and lowering risk factors with lifestyle changes and medications (NIA, 2022g). Another subtype of dementia is Lewy body disease (LBD). It presents similarly to Alzheimer’s but it is distinguished by areas
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