UNIT 4: COMMON DISORDERS IN THE AGING 4.4 GERIATRIC SYNDROMES: DEMENTIA AND DELIRIUM

Dementia is the progressive loss of cognitive function due to brain damage or brain disorders attributable beyond the normal aging. It is an age-related disease. It is a decline of higher functions: memory (in relation to the previous level of the patients),etc. And later, add psychological and behavioral changes, resulting in progressive disability the patient.

The geriatric syndrome of dementia must meet the following characteristics:

- Provide a level of normal consciousness.

- Be acquired and persistent over time.

- Affect different functions.

- Be of sufficient intensity to have an impact on personal functioning, or social work.

Dementias are Alzheimer's, Parkinson's disease, Huntington's disease and may also be secondary to metabolic processes, endocrine drugs, psychiatric diseases, toxic, etc.

Delirium is a syndrome characterized by acute onset with fluctuating course, with attention disorders, changes in alertness. Is multifactorial in origin and is an indicator of long hospital stay, increased morbidity and mortality. It is common in the elderly, especially elderly frail and dementia (Burns A, 2004). Mortality associated with delirium (25-33%) is as high as that associated with acute myocardial infarction or sepsis. (Ionuye SK, 1994) 

There are several factors of delirium: (Ionuye SK, 2007)

- Psychotropic drugs, opioids, diuretics, anticholinergic effect, etc.

- Fluid and electrolyte imbalance.

- Surgical Procedures.

- General anesthesia.

- Hypoxia.

- Neurological disorders.

- Use of benzodiazepines.

- Pain and Sleep Deprivation.

- Physical restrictions.

- Using tubes and catheters in general.

By detecting delirium in the elderly, they should get the precipitating causes and recommended referral to an emergency department for comprehensive assessment. (Francis J, 2011) The Confusion Assessment Method (CAM) is used for the rapid identification of delirium (Wei LA, 2008). It is recommended to ask the primary caregiver if the patient has had recent changes in behavior or consciousness. If the answer is yes, it would conduct an assessment using the CAM for the detection of delirium (Wei LA, 2008)

Therefore, the patient with loss of cognitive functions will present:

- Memory problems: often the first to appear. Limiting intellectual and social activities.

- Speech disturbances: decreases the ability to communicate orally and writing.

- Impairment of spatial orientation: become disoriented easily, even at home. They keep objects which will hardly be found.

- Inability to perform certain tasks: the end is manifest in the simplest tasks, such as greeting.

- Disorders of personality and behavior: agitation, etc.

- Changes: hallucinations, neurological disorders, anxiety, depressive features, motor incoordination, etc.

REFERENCES

-Treaty for geriatric residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2013] Available at: http://www.segg.es/tratadogeriatria/main.html

- Clinical Practice Guideline: Assessment Comprehensive Geriatric Gerontological Ambulatory Elderly. Mexico: Ministry of Health, 2011. Available at: http://sgm.issste.gob.mx/medica/medica_documentacion/guias_autorizadas/Geriatr%C3%ADa/IMSS-491-11-valoraci%C3%B3n%20geronto-geriatrica/IMSS-491-11-GER%20Valoraci%C3%B3n%20geronto%20geriatrica.pdf