9. Neurological diseases: cognitive impairment and dementia

The cognitive level changes are attributed to multiple factors associated with aging, which may be regarded as extrinsic (psychiatric disorders, cultural isolation, sensory disturbances and the aging process itself) and intrinsic (functional reserve and brain structure, genetic background and level of adaptation to changes during the life).

Delirium

The confusional acute syndrome, also called delirium, is an alteration in mental status that is characterized by acute and reversible. It is one of the most important cognitive disorders in the elderly.

These patients require more attention from professionals, because an agitated patient is difficult to manage and are at risk of falls and fractures.

It should be very careful in diagnosing impaired elderly, as it is very easy to attribute mental deterioration to a progression of underlying disease. The delay in diagnosis can be fatal.

It usually occurs a prodrome characterized by restlessness, hypersensitivity to visual and auditory stimuli and reversal of sleep rhythm / monitors, as well as nightmares and insomnia.

The predisposing factors are multifactorial:

• Aging
• Decreased vision and / or hearing
• Mental / physical illness (Parkinson's, dementia, depression ..)

There are other factors have a multiplicative effect rather than summation:

• Adverse reactions to drugs
• Benzodiazepines + alcohol
• Environmental factors (temperature change, overstimulation, lack of sleep, fatigue..)
• Trauma or recent surgery (especially hip)
• Renal or hepatic
• Infections

The main characteristics of delirium are:

• Acute onset fluctuations throughout the day
• Disorientation in space and time
• Inability to maintain attention to external stimuli; are easily distracted
• Impairment of short-term memory
• Visual hallucinations or misinterpretations
• Altered level of activity: agitation, wandering, restlessness ..
• Language disorders: vague, incoherent
• Disorganized thinking (distorted)
• Variable Humor

One of the characteristics of the treatment is the prevention, that consists in:

• Minimize or avoid the use of anticholinergic drugs, sedatives and narcotics
• Maintaining good hydration and oxygenation
• Treat early medical complications
• Have a careful nursing management and continuous
• Physical environment quiet and guidance elements (clock, calendar ..)
• Family company

I believe that delirium is one of the age-related pathologies common suffering these patients. Likewise, I also think that it's very important to recognize this early, as many time can be confused with dementia.

Bibliography

• Nogales Gaete, J; Donoso, A; Verdugo, R. N. tratado de neurología clínica. Santiago: Editorial universitaria; 2005.
• Guías en demencia. Conceptos, criterios y recomendaciones para el estudio del paciente con demencia. Barcelona: Editorial Masson; 2003