02: Dementia, Delirium & Depression: Causes & Risk Factors

This program will help you to understand the:

• Various forms of dementia and their causes and risk factors
• Causes and risk factors for delirium and depression

• There are no easy answers when it comes to the care of another
• Our Hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

Loss of mental functions (memory, thinking, and reasoning) caused by various forms of brain damage and disease common symptoms:

• Confusion about the date or time of day.
• Repeatedly asking the same questions.
• Inability to follow directions.
• Becoming lost or disoriented in familiar places.
• Lack of recognition or confusion about familiar people.
• Difficulty with routine tasks such as paying the bills.
• Personality changes.
• Neglect of personal safety, hygiene, and nutrition.
• Difficulty with coordination or balance.
• Irreversible or reversible.

A temporary state of confusion and disorientation that typically develops quickly and fluctuates Common symptoms:

• Reduced awareness of surroundings and events delusions and hallucinations
• Confused, loud or belligerent speech
• Disorganized thought processes
• Bizarre behavior
• Fluctuating level of consciousness

CAUSES

• High fever
• Infections
• Medications
• Dehydration
• Toxins in the system (such as alcohol)
• Severe constipation or fecal impaction
• Unfamiliar surroundings or people
• The first response to delirium should be to provide calm reassurance and make sure that the person and caregiver are safe.

Mental disorder that typically presents with depressed mood Common symptoms:

• Feeling depressed, sad or gloomy
• Loss of interest or pleasure
• Lack of energy, fatigue, or sluggishness
• Concentration or memory problems
• Feeling worthless or guilty
• Feeling helpless, discouraged, or hopeless
• Feeling overwhelmed or nervous
• Feeling irritable, restless, or anxious
• Thoughts of death or suicide
• Appetite or weight changes
• Sleep disturbances
• Aches and pains
• Diarrhea or constipation
• This means that depressed people are more vulnerable to infections and poor health
• Older people are especially vulnerable to depression because of the many losses they experience
• Aging also brings about physiologic changes such as alteration in metabolism and brain chemistry that contribute to fatigue and slowing of thought processes
• Because depression and dementia have many symptoms in common,it is important to get a thorough evaluation by a healthcare professional to distinguish the two

What do you think could be the reason for Robert’s behavior?

• A. He has a medical condition other than dementia affecting him.
• B. He is frightened by something in the house.
• C. He is having a delusion.
• D. All of the above.

Choice A: He has a medical condition, other than dementia affecting him, could be a possible reason.

Choice B: He is frightened by something in the house, is a good possibility.

Choice C: He is having a delusion, is also a good possibility. Choice D: Because Choices A through C are all good possibilities, Choice D is the best answer.

RISK FACTORS FOR DEMENTIA

• Age
• Genetics
• Head trauma
• Lower education

DEMENTIA SYMPTOMS CAN BE DUE TO:

• Chronic medial conditions
• Medications
• Depression
• Alzheimer’s and other irreversible dementias

• Associated with loss of brain cells in the parts of the brain that control memory and cognitive functions.
• The areas of the brain that control memory,logical thinking,and personality are generally the most affected
• Memory impairment
• Poor executive functioning
• Aphasia (inability to use or understand language)
• Apraxia (inability to make purposeful or coordinated movements)
• Agnosia (inability to recognize or identify objects or people)

VASCULAR DEMENTIAS:

• Multi-infarct (multiple cortical infarcts)-Series of small strokes
• Single infarct,Small vessel disease

SYMPTOMS:

• Sudden or gradual onset
• Stepwise progression
• Disinhibition,Lack of judgment,Loss of social awareness and insight
• Vascular dementia is irreversible and incurable
• Multi-infarct dementia is caused by a series of small strokes due to loss of blood supply resulting in dead tissue in the brain
• From time to time, mini strokes may occur, causing a brief period of confusion and perhaps memory or speech impairment

• Binswangers disease
• Vascular dementias
• Hardening of small vessels

SYMPTOMS:

• Psychiatric
• Memory loss
• Speech impairment
• Loss of self-care skills
• Agnosia

• Nutritional deficiency

SYMPTOMS:

• Memory impairment
• Apathy
• Slowed thought processes
• Impaired judgment
• Persons with alcoholic dementia should abstain from further alcohol intake, eat food with high nutritional content, and take vitamin supplements,especially the B vitamins
• People with alcoholic dementia are at risk of resuming heaving drinking

SYMPTOMS:

• Mental confusion
• Uncoordinated movement
• Eye disturbances
• Deficiency of thiamin (vitamin B1)
• Wernicke-korsakoff syndrome
• Confabulation

• Damage to frontal and temporal lobes

SYMPTOMS:

• Behavior and personality changes
• Judgment, decision making
• Decline of personal hygiene and dress
• Apathy,Compulsive or repetitive behaviors
• Stealing,Inappropriate language

• May develop 5-7 years earlier than Alzheimer’s disease
• Can progress rapidly
• Symptoms
• Poor thinking
• Attention
• Concentration
• Hallucinations

Parkinson’s disease: Symptoms:

• Tremor at rest, stiffness in limbs and joints
• Difficulty in initiating physical movement
• Speech problems
• Dementia may develop late
• Genetic mutations,toxins, or head trauma

Huntington’s disease: Symptoms:

• Involuntary movement of the face, arms and legs
• Memory and speech problems
• Disorientation
• Intellectual decline
• Impaired judgment
• Personality changes
• Genetic mutation

Creutzfeldt-Jakob disease (CJD):

• Prion disease

Symptoms:

• Memory impairment
• Dramatic behavior changes
• Tremor
• Involuntary movements
• Loss of coordination and balance
• Progresses rapidly.
• BSE(Bovine Spongiform Encephalopathy)
• HIV or AIDS dementia comple
• HIV-1 infection

Symptoms:

• Cognitive decline
• Motor impairment
• Behavioral changes
• Psychosis

• A person may have two or more types of dementia, or mixed dementia, with one type usually dominating.
• There is a strong interaction between Alzheimer’s disease and vascular dementia.

Medical causes:

• Chronic lung disease
• Heart disease
• Thyroid disease
• Kidney disease
• Liver disease

• Mild loss of memory that often precedes Alzheimer’s disease
• Can affect language, reasoning and judgment
• Brain changes are milder versions of various forms of dementias
• Risk factors include high blood pressure, diabetes, sedentary lifestyle, mental inactivity, fewer years of education, and the APOE gene
• The speed of thinking and other mental processes declines with aging
• Recalling the names of things, places and people becomes more difficult

RISK FACTORS:

• Older age, Alzheimer’s disease or other dementia
• Pain, Certain medications
• Alcohol and drug dependence
• Vision or hearing impairment
• Brain and Medical conditions
• The changes associated with aging can make older people more susceptible to delirium
• The immune response in an older person is also less effective

• Head trauma
• Bleeding in the brain or head
• Brain infections
• Seizures
• Strokes
• Hypoxemia
• Hypercapnia
• Dementia
• Pain
• Stressful experience
• High fever
• Toxins
• Sensory loss

CHRONIC MEDICAL CONDITIONS:

• Congestive heart failure
• Heart attacks
• Arrhythmias
• Chronic obstructive pulmonary disease
• Respiratory failure
• Kidney failure
• Liver failure
• Electrolyte imbalance
• Malnourishment
• Vitamin deficiency
• Anemia
• Diabetes mellitus
• Thyroid disease

• Physical trauma
• Infections
• Fever
• Elderly people are more susceptible and sensitive to body temperature changes
• fever can caused by trauma or a foreign substance entering the body and tiggering and inflammatory or immune response
• Hypothermia
• Urinary retention
• Fecal impaction

• Drug intoxication
• Drug withdrawal
• All medications have side effects,some more dangerous than others
• Withdrawal from drugs can also cause delirium

MEDICATIONS:

• Anticholinergics
• Sedatives
• Antidepressants
• Anticonvulsants
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
• Corticosteroids
• Anticancer drugs
• Lithium
• Cimetidine
• Antibiotics
• L-dopa

PSYCHOACTIVE DRUGS:

• Ethanol (drinking alcohol)
• Marijuana
• LSD (lysergic acid diethylamide) and other hallucinogens
• Amphetamines
• Cocaine
• Opiates (heroin and morphine)
• PCP (phencyclidine)
• Inhalants

POISONS/TOXINS:

• Solvents
• Carbon monoxide
• Freon
• Heavy metals (lead, mercury, arsenic)
• Insecticides (parathion, sevin)
• Mushrooms (amanita species)
• Plants (jimsonweed, morning glory)
• Animal venoms

• Family history of depression
• Increasing medical issues
• Substance abuse problems
• Lack of support systems
• Loss of loved ones
• Loss of abilities
• Pain, disabilities and changing body image
• Medication side-effect
• Fear of dying
• Financial concerns
• Aging
• Social isolation
• Female gender
• Unhappy marriage
• Previous episodes of depression

DEMENTIA:

• Older age
• Genetics
• Head trauma
• Lower education
• Risk factors for heart and vessel disease
• Reversible and irreversible medical conditions
• Infections
• Medications
• Alcohol and other drugs
• Nutritional deficiencies

DELIRIUM:

• Older age
• Dementia
• Vision and hearing impairment
• Pain, fever
• Trauma, illness
• Brain conditions
• Medical conditions
• Stress
• Drugs, toxins

DEPRESSION:

• Aging factors
• Family or personal history of depression
• Medical issues
• Pain, diabilities
• Medication side-effects
• Substance abuse problems
• Social factors
• Financial concerns
• Female gender

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

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