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Wednesday, October 13, 2010

Table(2): Comparison between Delirium and Dementia

By : Lamiaa Moustafa Elbosaty

 

 

Dementia	Delirium	Characterist
Gradual and insidious development	Rapid development	Onset
Long, with progressive deterioration	Brief duration of 1 month or less, depending on cause	Duration
Stable progression of symptomatology	Diurnal alterations, more nocturnal exacerbations	Course
Short-term and long-term memory impair­ments, with eventual complete loss	Disorganized and impaired	Thinking and short-term memory
Progressively decreases	Markedly decreased, especially to environ- mental cues	Orientation
Difficulty recalling the correct word; later may lose language	Rambling, pressured, irrelevant	Language
Often absent but can progress to paranoia delusions, hallucinations, and illusions	Environment unclear, progressing to illu­sions, hallucinations and delusions.	Perceptual disturbance
Not affected	Cloudiness that fluctuates; inattentiveness to hyper alert with distractibility	Level of consciousness
Piecemeal	Day-night reversal, insomnia, vivid dreams and nightmares	Sleep
Not affected	Sluggish to hyperactive; change of range unpredictable	Psychomotor action
Depression/ anxiety when insight into con­dition is present; late in pathology anger with outburst, restlessness with pacing	Anxious with changes in sleep; fearful if experiencing hallucinations; weeping; yelling	Emotion status

                                                                        Adopted from Mohr (2006).

Saturday, October 9, 2010

Severe Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty

At this stage of Alzheimer's disease only fragments of memory remain. There may be emotional recognition of family, but names and relationships identification are lost. There is orientation to self only. Language is limited to short phrases and repeated words, and only simple spoken language is understood. The individual may eventually become mute and unable to communicate. There is complete dependence on others for all care, behavior manifestation disappear, although vocalization (screaming, cursing, or crying) may continue at this stage (Cotter, 2002).

Neurological changes may include Parkinsonism (slow, shuffling gait, falls, rigidity, and brady kinesis), occurrence of generalized tonic–colonic seizures, and myoclonus, weight loss, dysphagia, increased sleeping, fecal and urinary incontinence. At the end, the individual spends most of time in bed. Death is frequently attributed to complications associated with chronic debilitation, aspiration pneumonia, sepsis, urinary tract infection, pulmonary embolus or inanition (NIH, 2003).

Friday, October 8, 2010

Mild Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty

          The individual with mild Alzheimer's disease continues to look and act normally to others, and only close family or friends may note any change. There is moderate memory loss, more marked for recent events that interfere with every day activities. The individual has difficulty learning and retaining new information. In addition, there may be disorientation in familiar places, difficulty handling complex financial transactions (paying bills, balancing a check book), and poor problem solving (Reisberg, et al., 2003).

The individual is independent in completing usual activities of daily livings (ADLs) but may need prompting to complete tasks. The ability to participate in complex home repairs and hobbies is reduced. The individual may experience personality changes of withdrawal from usual social activities because of fear of others detecting changes, lack of confidence in function, or lack of interest in his/her usual activities (Linton & Lach, 2007).

·        Moderate Alzheimer's Disease:

In moderate Alzheimer's disease, memory loss is sever and only highly learned material or established memory is retained, while new material is lost rapidly. As the damage of Alzheimer's disease spreads in cerebral cortex, language, reasoning, sensory processing, and conscious thought are impaired. The individual may be confused about the identity and relationships of relatives. The individual becomes increasingly dependent on the others and assistance is needed to carry out ADLs (Monias & Meier, 2003).

The individual may get lost in familiar settings, language changes are revealed as incomplete sentences and poor comprehension of written and spoken language. At this stage of Alzheimer's disease, disruptive behavioral changes often emerge. Agitation, restlessness (including wandering), sleep disturbances, day-night disorientation, verbal or physical aggression, suspiciousness, and hallucinations are common behaviors manifested (ADRDA, 2004).

The individual has decreased tolerance for stress and can't reliably interpret the environment. Disinhibition, socially in appropriate behaviors, and saying or doing things not usually said or done in public occur at this stage. Also there are weight loss, and dehydration which require careful monitoring (Monias & Meier, 2003).

Thursday, October 7, 2010

Clinical features

By : Lamiaa Moustafa Elbosaty

Alzheimer's disease is classified according to the stage of the degenerative process. The number of stages defined ranges from three to seven, depending on the source. However, four stages, as discussed subsequently, are commonly to categorize the progressive deterioration seen in those diagnosed with Alzheimer's disease (Varcarolis, 2006).

· Very Mild Alzheimer's Disease: At this stage, cognitive changes is subtle, typically this stage of the disease is only detected by dementia specialists because of the very mild nature of the changes. Individuals may dismiss these very mild changes as normal aging (National Institute on Aging, 2007).

Memory is consistently impaired, and details of recent events are only partially recalled. Although the individual may be fully oriented, there may be difficulty with time relationships, knowing when events happen in relation to one another. The family/individual may note slight impairment in community activities or slight change in interest or participation in hobbies. Complex tasks take longer and errors are evident. The working individual may continue to work but will require support to function at the same level or will assume decreased responsibility (Galvin et al., 2005).

Personality changes such as lack of spontaneity and initiative, loss of a previously sharp sense of humor, lack of energy and enthusiasm, or decreased interest in work, family may be noted at this stage. Anxiety and depression are not uncommon at this stage and should be treated. The duration of the disease from onset to death a mostly average 8 to 10 years, but can range from 3 to 10 years (Duchek et al., 2003).

Wednesday, October 6, 2010

Ten Warning Signs of Alzheimer's Disease

By : Lamiaa Moustafa Elbosaty

Ten Warning Signs of Alzheimer's Disease:

Alzheimer's Association (2008) provides this warning signs of Alzheimer's disease to allow early detection of the patients, it includes the following:

1- Recent memory loss:  It's normally to occasionally forget an assignment, deadline, or friends' name, but frequent forgetfulness, our unexplainable confusion at home or in the work place may signal problems.

2- Difficulty performing familiar tasks: Busy people frequently get distracted, for example, you might leave something on the stove too long or not remember to serve part of a meal. People with Alzheimer's disease might prepare a meal and not only forget to serve it, but forget they made it.

3- Problems with language: Everyone has trouble finding the right word sometimes, but person with Alzheimer's may forget simple words or substitute inappropriate words, making his or her sentences difficult to  understand.      

4- Disorientation of time and place: It's normal to momentarily forget the day of the week or what you need from the stove. But people with Alzheimer's disease can become lost on their own street, not knowing where they are, how they get there or how to get home.

5- Poor or decreased judgment: Choosing not to bring a sweater or coat along on a chilly night is a common mistake. A person with Alzheimer's, however, may dress inappropriately in more noticeable ways, wearing a bathrobe to the stove or several blouses on a hot day.

6- Problems with abstract thinking: Balancing a check book can be challenging for many people, but for someone with Alzheimer's, recognizing numbers or performing basic calculations may be impossible.

7- Misplacing things: Everyone temporarily misplaces a wallet or keys from time to time. A person with Alzheimer's disease may put these and other items in inappropriate place – such as an iron in the freezer, or a wrist watch in the sugar bowl, then not recall how they got there.

8- Changes in mode or behavior: Everyone experiences a broad range of emotions, it is part of being human. People with Alzheimer's tend to exhibit more rapid mood swings for no apparent reason.

9- Changes in personality: People personalities may change somewhat as they age. But a person with Alzheimer's can change dramatically, either suddenly or over a period of time. Someone who is generally easy going may become angry, suspicious or fearful.

10- Loss of initiative: It's normal to tire of house work, business activities, or social obligations, but most people retain eventually regain their interest. The person with Alzheimer's may remain disinterested and uninvolved in many or all her/his usual pursuits.

Sunday, October 3, 2010

Types of Dementia -7

By : Lamiaa Moustafa Elbosaty

Dementia due to Pick's Disease: The onset of Pick's disease is between 40 and 60 years of age; it occurs slightly more in men, usually those with first degree relative with the illness. Although the cause is unknown, genetic factors are suspected (Sadock & Sadock, 2003). Pick's disease is another degenerative cognitive disorder that resembles Alzheimer's disease in its clinical picture that in several instances it is only at autopsy that differentiation can take place. General microscopic findings include atrophy of the front temporal regions of the brain, in contrast to the more parietal-temporal distribution in Alzheimer's disease (Arciniegas & Dubovsky, 2001). The victims of this disorder have less disorientation and memory loss than those with Alzheimer's disease and more personality changes, including loss of social constraints (resulting in frequent behavioral problems) (Mohr, 2006).

- Dementia due to Vitamin B12 Deficiency: The prevalence of vitamin B12 deficiency in patients with dementia varies significantly, but the incidence of reversible vitamin B12 deficiency as the primary etiology is probably less than one percent. Cognitive deficits may include poor spatial coping skills, diminished episodic memory, and impaired abstract thinking (Whyte et al., 2002).

Thursday, September 30, 2010

Types of Dementia -4

By : Lamiaa Moustafa Elbosaty

Dementia due to Creutzfeldt-Jakob Disease: It is a rare, rapidly progressive neurodegenerative disorder that results in dementia and sever neurological impairment. It is the main prion disease with an approximate annual incidence of one case per million. The age of onset is 65 to 79, with a sharp decline in incidence over age 79. The duration of the disease is 2 to 9 months, however, some cases have lasted 2 to 5 years (Will et al., 2004). The human form of this prion disease is variant Creutzfeldt-Jakob disease, which is due to the transmission of bovine prions to humans through the consumption of cattle infected with bovine spongiform encephalopathy "mad cow disease" (Bacchetti, 2003).

According to Neary and Snowden (2003), the clinical characteristics of Creutzfeldt-Jakob disease are rapidly progressive dementia, behavior disturbance, and motor disturbance including myoclonic prodromal symptoms which may include fatigue, sleep disturbance, memory disturbance, mild behavioral changes, depression, vertigo, and seizures

occur later in the course. There is usually a rapid progression to death often with 6 months.