Psychiatric Mental Health, part 38: Disorders - Alzheimer's Disease & Dementia vs. Delirium

by Cathy Parkes September 18, 2023 4 min read

Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, we will be talking about Alzheimer's disease as well as the differences between dementia and delirium. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in the video, so definitely stay tuned for that. And as always, I will be following along with our Level Up RN psychiatric mental health nursing flashcards. If you have our flashcards, be sure to pay close attention to the bold red text on these cards because those represent the most important facts that you are likely to get tested on in nursing school.

Alzheimer's disease is gradual, irreversible dementia that results in memory problems, judgment issues, and changes in personality. Symptoms of Alzheimer's disease will vary depending on whether the patient is in early-, moderate-, or late-stage Alzheimer's. Symptoms of early-stage Alzheimer's include forgetfulness, short-term memory loss, and mild cognitive impairment. Symptoms of moderate-stage Alzheimer's disease include disorientation, agitation, as well as incontinence and wandering. Individuals in moderate-stage Alzheimer's disease typically require help with their ADLs or activities of daily living. Then during late-stage Alzheimer's disease, patients will become bedridden, and they will lose their verbal and motor skills. And dysphagia, or difficulty swallowing, also occurs during the stage. Another symptom that can occur with Alzheimer's disease is something called confabulation, which is the creation of false memories. So to be clear, a patient who exhibits confabulation is not lying or intending to deceive anyone. They are simply trying to fill in gaps in their memory. Preservation is another symptom of dementia. This is where the patient repeats words, phrases, or gestures over and over again. And then sundowning is very common with Alzheimer's disease. This is an increase in agitation or aggression in the evening. So if you end up working the night shift on a med-surg floor or in a SNF or LTAC, you will definitely see this in action. A patient may be very calm and agreeable during the day, but in the evening, they can get really out of hand.

Diagnosis of Alzheimer's disease includes a review of the patient's symptoms, memory and thinking tests, as well as ruling out underlying causes of the patient's symptoms. Treatment options include medications such as memantine and donepezil, which can help improve cognition in patients with Alzheimer's disease. However, it's important to note that these medications do not cure Alzheimer's disease. Other medications such as antipsychotics, antidepressants, and anxiolytics can also be used to help manage the patient's symptoms.

Nursing care of the patient with Alzheimer's disease is heavily tested on in nursing school. As the nurse, you need to maintain a structured environment. You need to provide the patient with short directions, repetition, and frequent reorientation. Overstimulation of the patient should be avoided. Use of a single-day calendar is recommended. And then it's also important to maintain a routine toileting schedule. In terms of home safety, it's important to advise the family or caretaker to remove clutter from the home as well as remove scatter rugs, which are trip hazards. And for some reason, nursing school exams are obsessed with scatter rugs. So definitely remember, no scattered rugs. Door locks should be installed out of sight and out of patient reach due to wandering behavior. There should be good lighting in the home, particularly over the stairs, and then step edges can be marked with colored tape to make it clear where those step edges are, which can help prevent falls.

Let's now review the key differences between dementia and delirium. Dementia is chronic, irreversible confusion that is caused by a neurodegenerative disease such as Alzheimer's disease, whereas delirium is temporary and reversible confusion that is caused by an underlying disorder such as an electrolyte imbalance or infection. So delirium is reversible when that underlying disorder is addressed. Dementia has a gradual onset as opposed to delirium, which has a sudden onset. With dementia, the individual's level of consciousness is unchanged, whereas, with delirium, alterations in level of consciousness are typically present. With delirium, the patient's behavior can be very disturbed. They can be easily distracted and may experience hallucinations, as opposed to dementia, where behavior is typically normal until the advanced stages of this disease.

All right. It's quiz time, and I've got five questions for you because we went over a lot of important information. Question number one, blank is the creation of false memories to fill in memory gaps. The answer is confabulation. Question number two, to prevent falls in the home, scatter rugs should be removed. True or false? The answer is true. Question number three, donepezil is a medication used to cure Alzheimer's disease. True or false? The answer is false. So donepezil can help improve cognition in a patient with Alzheimer's disease, but it will not cure the disease. Question number four, an altered level of consciousness is expected with dementia. True or false? The answer is false. So an altered level of consciousness often occurs with delirium but not with dementia. Question number five, delirium has a sudden onset and is reversible. True or false? The answer is true.

Okay. I hope you did great with that quiz. Thank you so much for watching and take care.

[BLOOPERS]Of the patients and [inaudible] that is caused by a [inaudible]. I don't know why neurodegenerative is so hard to say. A neurodegenerative-- oh, why can't I say the word?

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