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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