What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
Mr. White is an elderly patient whose chief complaints include increased confusion, restlessness at night, visual hallucinations, and urinary incontinence in addition to a history of hypertension, COPD, and modern dementia. Delirium and dementia are defined as the two most common causes of cognitive impairment among older adults, and this interrelation may be caused – as well as maybe the cause of – a variety of health problems and unpredictable complications (Fong, Davis, Growdon, Albuquerque, & Inouye, 2015). Delirium results in a disturbance in mental abilities, confusion, and reduced awareness and is usually observed in about 20% of older patients (Richardson et al., 2017). Therefore, such symptoms as confusion, hallucinations, and restlessness can prove the presence of delirium in a patient.
Dementia is a mental disease characterized by a set of symptoms that include memory problems, anxiety, or agitation along with a considerable decline from the last baseline (Lippmann & Perugula, 2016). Mr. White is in a higher-risk group due to multiple factors, including his age, hypertension history, and COPD with tachypnea as its outcome. However, consideration of such problems as urinary incontinence and mildly enlarged prostate may be used to prove the presence of another disease.
Regarding the patient’s problems with delirium and dementia, Mr. White may be diagnosed with unspecified adverse effects of drug or medicament (T88.7) or as challenged by a urinary tract infection. Urinary tract infections (ICD-10-CM-N39.0) are serious bacterial infections among geriatric patients with dementia and delirium (Chae & Miller, 2015). Infections and drugs are the main precipitating factors of delirium in older patients (Oh, Fong, Hshieh, & Inouye, 2017). New symptoms may occur with time.
What additional testing should you consider if any?
In addition to the MMSE test that has already been taken by the patient, several new tests should be considered to check the correctness of the diagnosis. For example, an ECG can be used to check the work of the heart and identify any changes (Bates, 2017). Also, clinicians should be ready to take various laboratory tests like blood counts or CRP and check the levels of electrolytes, creatinine, and calcium. Urine and blood cultures should be tested for glucose, alcohol, and drugs to comprehend what may cause the rise of delirium (Solomon, 2017). CSF, EEG, and CT may be used to test for cognitive problems that can influence the work of the brain or prove the presence of infection in the body. Chest X-rays are necessary for patients with a history of COPD and tachypnea. Finally, O2 saturation should be a part of the physical examination to evaluate all possible vital signs.
What are treatment options to consider with this patient?
Treatment for people with delirium and dementia who suffer from different infections and inappropriate drug use can be divided into pharmacological and non-pharmacological categories. On the one hand, medications can help decrease the level of pain, and psychotropic medications are required to control delirium behaviors. Clinicians should note disturbance and delusions (Solomon, 2017). Oh, et al. (2017) suggest such drugs as melatonin orally or xenon to reduce the problems and changes caused by delirium. However, some drugs may have a negative impact, and side effects should be evaluated and controlled thoroughly.
Non-pharmacological treatment is integral to the care of the older patient. It aims at managing behavioral problems and improving communication help to reduce self-harm among patients (Solomon, 2017). Nutrition, physical exercise and supportive therapy are suggested as the main treatment options for such patients as Mr. White.
References
Bates, C. (2017). Confusion and delirium in the acute setting. Medicine, 45(2), 110-114. Web.
Chae, J.H.J., & Miller, B.J. (2015). Beyond urinary tract infections (UTIs) and delirium: A systematic review of UTIs and neuropsychiatric disorders. Journal of Psychiatric Practice, 21(6), 402-411. Web.
Fong, T.G., Davis, D., Growdon, M.E., Albuquerque, A., & Inouye, S.K. (2015). The interface between delirium and dementia in elderly adults. Lancet Neural, 14(8), 823-832. Web.
Lippmann, S., & Perugula, M.L. (2016). Delirium or dementia? Innovations in clinical neuroscience, 13(9-10), 56-57.
Oh, E.S., Fong, T.G., Hshieh, T.T., & Inouye, S.K. (2017). Delirium in older persons: Advances in diagnosis and treatment. JAMA, 318(12), 1161-1174. Web.
Richardson, S.J., Davis, D.H., Stephan, B., Robinson, L., Brayne, C., Barnes, L., … Allan, L.M. (2017). Protocol for the delirium and cognitive impact in dementia (DECIDE) study: A nested prospective longitudinal cohort study. BMC Geriatrics, 17(1), 98. Web.
Solomon, C. (2017). Delirium in hospitalized older patients. The New England Journal of Medicine, 377(15), 1456-1466. Web.