California State University, Northridge
Quick Guide
Delirium, Dementia and Amnestic and Cognitive Disorders
Delirium
A delirium is a rapidly developing, fluctuating state of reduced awareness in which the following are true:
• The client has trouble shifting or focusing attention, and
• The client has at least one defect of memory, orientation, perception, or language, and
• The symptoms are not better explained by a dementia.
One of the following causes can be identified (here and throughout, the page number in each case indicates where a more detailed discussion begins):
Delirium Due to a General Medical Condition. Delirium can be caused by
trauma to the brain, infections, epilepsy, endocrine disorders, toxicity from
medications, poisons, and various other diseases throughout the body
Substance-Induced Delirium. Alcohol and other sedative drugs of abuse, as well
as nearly every class of street drug, can cause delirium. Medications can also be
implicated.
Delirium Due to Multiple Etiologies. Occasionally, more than one cause for
delirium will be identified in the same patient
Delirium Not Otherwise Specified. Use this category when you don't know the
cause of a patient's delirium
Dementia
A dementia differs from a delirium in several ways:
• To diagnose a dementia, there must be multiple cognitive deficits (these include
Amnesia, aphasia, apraxia, agnosia, and loss of executive functioning
• Any impairment in the ability to focus or shift attention is not prominent.
• The cause of dementia can usually be found within the central nervous
system (with delirium, the cause is often elsewhere in the body).
• As compared with delirium, dementia is relatively fixed (unchanging).
• Although patients occasionally recover from a dementia, this is not usual.
One of the following types will be identified:
Dementia of the Alzheimer's Type. This is the most common cause of
senility. It begins gradually and usually progresses inexorably. A bit more
than half of all dementias are of the Alzheimer's type
Vascular Dementia. Due to vascular brain disease, these patients
experience loss of memory and other cognitive abilities. Often this is a
stepwise process, with relatively sudden onset and a fluctuating course.
Ten to twenty percent of dementias are vascular.
Dementia Due to Other General Medical Conditions. A large number of
other medical conditions can cause dementia (again, see Appendix B):
Some of the most noteworthy include brain tumor, Creutzfeldt-Jakob
disease (infection by a slow virus), head trauma, human immunodeficiency
virus (HIV) disease, Huntington's disease, Parkinson's disease, and Pick's
disease. The most common toxins causing dementia are those resulting
from kidney and liver failure.
Substance-Induced Persisting Dementia. Five to ten percent of dementias are related to prolonged use of alcohol, inhalants, or sedatives.
Dementia Due to Multiple Etiologies. Use this category when evidence
for your patient points to more than one of the causes above.
Dementia Not Otherwise Specified. This category is useful when you
know the patient is demented, but you don't know why.
Amnestic Disorders
Amnestic is just a fancy way of saying "amnesia." Here are the main features:
• There is no requirement for reduced ability to focus or shift attention.
• Memory is affected far more than any other function, sometimes to the
extent that patients will forget conversations that took place only a
few minutes earlier.
• In some cases, especially early in the course of their illness, patients with
an amnestic disorder will try to hide a loss of memory by making
up (confabulating) experiences.
One of the following types will be identified:
Amnestic Disorder Due to a General Medical Condition. These patients
have symptoms very much like those of Korsakoff's syndrome (see
below), but there is a medical cause (see Appendix B), such as
hypoxia, stroke, head trauma, or herpes simplex encephalitis.
Substance-Induced Persisting Amnestic Disorder. Popularly known as
Korsakoff's syndrome, this is the classical amnestic disorder. It
most of-ten occurs in an alcoholic patient who suffers from
thiamine (vitamin B 1) deficiency.
Amnestic Disorder Not Otherwise Specified. Use this category for
patients who have severe memory problems and little else in the
way of cognitive disability, and you don't know the underlying
cause.
Other Causes of Cognitive Symptoms
Age-Related Cognitive Decline. Older patients who report trouble remembering names, telephone numbers, or places where they put
things may, upon testing, have a memory problem that is consistent
with age and not pathological.
Dissociative Disorders. Profound, temporary loss of memory may occur in
Persons who suffer from DissociativeAmnesia (p. 319), Dissociative Fugue (p. 322), or Dissociative Identity Disorder.
Pseudodementia. From their apathy and slowed responses, some patients
often look as if they have the severe memory loss and other
symptoms of dementia. But careful clinical evaluation and
psychological testing reveal severe Major Depressive Disorder and
cognitive functioning that is relatively intact, though they may have
problems with attention and concentration. Pseudodementia
accounts for about 5% of patients referred for a dementia workup.
Depressive pseudodementia is found only in the elderly.
Malingering. Some patients will intentionally exaggerate or falsify
cognitive symptoms to obtain funds (insurance, worker's
compensation) or to avoid punishment or military service.
Factitious Disorder With Predominantly Psychological Signs and
Symptoms. Some patients may feign, cognitive symptoms, but not
for direct gain. Their motive is to be hospitalized or otherwise cared
for.
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