Chapter 36

Disorientation, Delirium,
and Dementia

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 Age-Related Brain Changes
 Changes in the brain and nervous system occur with
aging. Confusion, delirium, and dementia are NOT
normal parts of aging.
 Certain diseases affect the brain.
 Changes in the brain can affect cognitive function.
 The term cognitive relates to knowledge.
 Cognitive function involves:
• Memory
• Thinking
• Reasoning
• Ability to understand
• Judgement
• Behaviour
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 Disorientation
 Also called confusion and has many causes:
 Urinary tract infections (UTIs) (one of the main causes)
 Alcohol intoxication
 Low blood sugar
 Head trauma and injury; concussion
 Nutritional deficiencies
 Fever
 Medications
 Sleep deprivation
 Seizures
 Others

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 Disorientation Signs and
Symptoms
 Often exhibit behaviour changes and may be
angry, restless, depressed, or irritable
 Other symptoms:
 Anxiety
 Tremors
 Hallucinations
 Delusions
 Decline in Level of Consciousness (LOC)
 Disorganized thinking and speech
 Attention problems
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 Ways to Minimize or Prevent
Disorientation
 Getting regular hours of sleep
 Eating a balanced diet that has plenty of
vitamins and minerals
 Not drinking alcohol in excess
 Keeping careful control of blood sugar if
diabetes is present
 Not smoking

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Slide 5
 Delirium
 Delirium is a state of temporary but acute mental
confusion
 Onset is sudden
• It is common in older adults with acute or chronic illnesses
 Common causes include:
• Reaction to medications
• Infection or other illnesses
• Poor nutrition
• Food poisoning
• Dehydration
• Emotional trauma
• Major life changes (e.g., death of a loved one)
 Delirium is an emergency
• The cause must be found and treated.

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 Dementia
 Dementia is the progressive loss of cognitive
and social functions
 It interferes with routine personal, social, and
occupational activities
 Affects the ability to perform simple tasks
(e.g., bathing, dressing, eating) and complex
tasks (e.g., driving, managing money,
planning meals, working)
 Dementia is a group of symptoms that may
occur with certain diseases or conditions
 Dementia is not a normal part of aging
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 Dementia (Cont.)
 Some early warning signs include:
 Recent memory loss that affects job skills
 Problems with common tasks
 Problems with language; forgetting simple words
 Getting lost in familiar places
 Misplacing things and putting things in odd places
 Personality changes
 Poor or decreased judgement
 Loss of interest in life

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Supporting Clients with Dementia
 Communication
 Safety
 Wandering
 Hallucinations and delusions
 Sleep
 Basic needs

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 Treatable Forms of Dementia
 If changes in the brain have not occurred, some
dementias can be reversed
 Treatable forms of dementia include:
• Metabolic problems
• Brain injury or tumour
• Alcohol
• Nutritional deficiencies
• Infections
• Poisoning

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Untreatable Forms of Dementia
 Untreatable forms of dementia include
Alzheimer’s disease and related dementias
 Alzheimer’s disease (AD)
 Vascular dementia
 Dementia with Lewy bodies
 Fronto-temporal dementia
 Parkinson’s disease
 Creutzfeld-Jakob disease (CJD)
 Normal pressure hydrocephalus
 Substance-induced persisting dementias
 Wernicke-Korsakoff syndrome
 Other causes (AIDS, Huntington’s disease, multiple
sclerosis, syphilis)
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Slide 11
 Vascular Dementia
 Vascular dementia (multi-infarct dementia)
 Caused by small strokes resulting in brain tissue
death
 These strokes do not necessarily lead to
hemiplegia but may instead cause changes in
personality or memory

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 Lewy Body Dementia
 Dementia with Lewy bodies (DLB)
 One of the most common types of progressive
dementia
 Progressive decline combined with three defining
features:
• Severe fluctuations in alertness and attention
• Recurrent visual hallucinations
• Parkinson-like motor symptoms

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 Fronto-Temporal Dementia
 Fronto-temporal dementia
 Rare form of dementia
 Affects the frontal and temporal lobes of the brain
 Marked changes in emotional and social
functioning

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 Creutzfeldt-Jakob Disease
 Creutzfeldt-Jakob Disease
 Rapid progressive neurological disease
 Affects people and animals
 “Mad cow” disease (BSE)
 Signs include:
• Fatigue
• Difficulty sleeping and insomnia
• Changes in personality
• Balance and walking disturbances

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 Stages of Dementia
 Stage 1: Mild (early stage)
• Client is usually aware of diagnosis and will be able to
participate in decisions affecting future care
• Mild forgetfulness, difficulty learning new things, problems
with orientation, communication difficulties
 Stage 2: Moderate (middle stage)
• Further decline in client’s mental and physical abilities
• Memory continues to deteriorate—client may forget
personal history; may not recognize friends and family
 Stage 3: Severe (late stage)
• Client incapable of remembering, communicating,
carrying out self-care
• Care is required 24 hours a day
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 Supporting Clients With
Dementia
 Meeting basic needs
 Safety
 Hygiene, grooming, and dressing
 Elimination needs
 Nutrition and fluids
 Exercise
 Health issues
 Comfort
 Sleep
 Therapy and activities
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 Managing Challenging
Behaviours
 These behaviours are common with dementia:
 Wandering
 Sundowning (signs, symptoms, and behaviors of AD
increase during hours of darkness)
 Hallucinations (seeing, hearing, smelling, or feeling
something that is not real)
 Delusions (false beliefs)
 Catastrophic reactions (extreme responses)
 Agitation and restlessness
 Aggression and combativeness
 Screaming
 Abnormal sexual behaviours
 Repetitive behaviours
 Hoarding
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 Caregiver Needs
 The family
 Health care is sought when the family cannot deal with the
situation or meet the client’s needs
 Home health care may help for a while
 Adult day care is an option
 Long-term care is needed when:
• Family members cannot meet the client’s needs
• The client no longer knows the caregiver
• Family members have health problems
• Money problems occur
• The client’s behaviour presents dangers to self and others

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 Caregiver Needs (Cont.)
 The client’s medical care can drain family finances
 The family has special needs
 Adult children are in the sandwich generation
• They are caught between their own children who need attention
and an ill parent who needs care
 Caregivers
need much support and
encouragement
• Many join AD support groups
 The family often feels helpless.
 The family is an important part of the health team
• They need support and understanding from the health team

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