Delirium Superimposed on Dementia in Perioperative Period and Intensive Care
Abstract
1. Introduction
2. Pathophysiology of Dementia
3. Pathophysiology of Delirium
4. Delirium and Dementia—A Pathophysiological Interrelationship
5. Symptoms of Delirium
6. Types of Delirium
7. Diagnosis of Delirium Superimposed on Dementia
- Loneliness of the patient and absence of a person that would monitor the patient’s daily condition and who could notice a sudden change in behavior;
- Lack of doctor–patient communication;
- Misconception that older people are “withdrawn” and disorganized on their own;
- Misconception that a patient being asleep is only attributable to fatigue.
8. Dementia Management
8.1. Acetylcholinesterase Inhibitors
8.2. Memantine
9. Delirium Management
10. Summary
Author Contributions
Funding
Conflicts of Interest
References
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Vulnerability Factors | Precipitating Factors |
---|---|
Demographics male gender age ≥ 65 years old educational background | Severe illness infection, sepsis inadequate pain control trauma hypo- or hyperthermia |
Comorbidity dementia chronic kidney disease endstage liver disease terminal illness | CNS illness intracerebral hemorrhage cerebrovascular accident meningitis/encephalitis nonconvulsive status epilepticus cerebral edema tumor hydrocephalus |
Functional status immobility visual impairment hearing impairment | Metabolic disorder thiamine deficiency renal failure liver failure electrolyte imbalance hypo- or hyperglycemia thyroid dysfunction glucocorticoid therapy hypophysis disfunction porphyria |
Baseline medication usage polypharmacy baseline psychoactive medication and drug use * substance withdrawal | Cardiorespiratory acute coronary disease congestive cardiac failure hypoxemia hypercarbia shock hypertensive encephalopathy |
Malnutrition & dehydration | Mobility restriction use of physical restraints use of bladder catheters intubation assisted ventilation use of vascular catheters intermittent pneumatic compression orthopedic cast |
Depression | Other malignant hyperthermia serotonin syndrome malignant catatonia paraneoplastic syndrome >3 medications added anti-NMDA(N-methyl-d-aspartate) encephalitis any iatrogenic event drugs and medications taken |
Circadian rhythm disruption |
Feature | Delirium | Dementia |
---|---|---|
Onset | Sudden—hours/days | Insidious and slow |
Cause | Other medical emergency | Baseline CNS disease—neurodegenerative or other |
Course | Can be short if treated; usually reversible | Progressive—treatment slows the progression |
Attention | Impaired initially | Usually preserved; may be impaired in advanced stages |
Orientation | Impaired initially | Usually preserved; may be impaired in advanced stages |
Memory | Impaired initially; may be unable to recall the incident | Initially lost of short-term memory; degree of memory loss increases as the disease progresses |
Behaviour | Agitated/somnolent | Usually normal; may become agitated in advanced stages |
Perceptual Disturbances | Visual hallucinations; misperceptions; illusions | Hallucinations and misperceptions may occur mostly in DLB |
Feature | Hypoactive | Hyperactive |
---|---|---|
Arousal | Decreased arousal and alertness; somnolence; reduced awareness | Hypervigilant; easily startled; distractable |
Mood | Depressed, irritable; mood swings; patient is disinhibited | Labile: from comative to euphoric |
Psychomotor activity | Slow, quiet, withdrawn | Restless, agitated, combative, irritable |
Past psychiatric history | May have experienced delirium before | Correlated with alcohol or drug withdrawal; may have experienced delirium before |
Circadian rythm | Increased daytime sleepiness | Prominent disturbances; nightmares and night terrors |
Disease | Diagnostic Method | |
---|---|---|
CNS | stroke, trauma brain injury, subsclerotic haemorrhage | CT/MRI |
Non-convulsive status epilepsy, partial epileptic seizure with cognitive decline | EEG | |
Cardiovascular System | Acute coronary syndrome | ECG, Troponin, CK-MB |
Atrial fibrillation | ECG | |
Abdominal aortic aneurysm | Abdominal ultrasound, CT, MRI | |
Respiratory System | Pulmonary embolism | CT, angiography of pulmonary vessels, ventilation/perfusion scintigraphy |
Pulmonary oedema | Chest radiograph | |
Metabolic Disturbances | Hypermetabolic crisis, myxoedema | TSH, fT4 |
Diabetes mellitus—keto alkalosis Hyperosmolar Hyperglycaemic Nonketotic Syndrome (HHNS) | Glycaemia measurement | |
Acid-Base balance disturbances | Arterial blood gas | |
Electrolyte balance disturbances; dehydration | Plasma electrolytes measurement | |
Hematologic Disturbances | Acute blood loss | Blood morphology evaluation |
Medication | benzodiazepines, antipsychotics, opioids, sedation drugs, anticholinergic drugs | Drug level in blood/urine |
Other | Sleep deprivation, psychosis, depression | Psychiatric evaluation |
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Krzych, Ł.J.; Rachfalska, N.; Putowski, Z. Delirium Superimposed on Dementia in Perioperative Period and Intensive Care. J. Clin. Med. 2020, 9, 3279. https://doi.org/10.3390/jcm9103279
Krzych ŁJ, Rachfalska N, Putowski Z. Delirium Superimposed on Dementia in Perioperative Period and Intensive Care. Journal of Clinical Medicine. 2020; 9(10):3279. https://doi.org/10.3390/jcm9103279
Chicago/Turabian StyleKrzych, Łukasz J., Natalia Rachfalska, and Zbigniew Putowski. 2020. "Delirium Superimposed on Dementia in Perioperative Period and Intensive Care" Journal of Clinical Medicine 9, no. 10: 3279. https://doi.org/10.3390/jcm9103279
APA StyleKrzych, Ł. J., Rachfalska, N., & Putowski, Z. (2020). Delirium Superimposed on Dementia in Perioperative Period and Intensive Care. Journal of Clinical Medicine, 9(10), 3279. https://doi.org/10.3390/jcm9103279