Delirium, Dementia and
Amnestic Disorders
Second Year Psychiatry
Cognition
The mental process of knowing.
Includes awareness, perception,
reasoning, judgment, memory,
language, orientation, conducting
personal relationships,
performing actions and problem
solving.
Cognitive Disorders
Disruptions in the acts and
processes involved in cognition.
Usually associated with
behavioral symptoms.
Historical Background
Used to be classified under
organic mental disorder.
Under DSM-IV-TR, classified
under
Delirium, Dementia and
Amnestic
and other Cognitive Disorders
Historical Background
In DSM-V, under Neurocognitive
Disorders
Delirium retained
Dementia replace with major and
minor neurocognitive disorder
Emphasis on decline in functioning
rather than memory disturbance
Areas of Primary
Disturbance
Delirium level of consciousness
with associated impairments in
memory, judgment, orientation
and attention
Areas of Primary
Disturbance
Dementia impairment in
memory, language and intellect
Amnestic Disorder impairment
in memory in the absence of
clouded consciousness and
deficits in other areas of
cognition
Delirium
Acute onset of disturbance in
level of consciousness and
fluctuating cognitive
impairments.
Reflects response to widespread
altered cerebral functions.
DSM-IV-TR Classification of Delirium
Delirium due to a general medical
condition (indicate the condition)
Substance intoxication delirium
Substance withdrawal delirium
Delirium due to multiple
etiologies (indicate the etiologies)
Delirium not otherwise specified
Epidemiology Delirium
Higher prevalence and incidence
in
Elderly
Multiple medical problems
Hospitalized patients especially
critically ill patients
Terminally ill patients
Clinical Features of
Delirium
Primary feature -diminished clarity of
awareness of the environment
(disturbance of consciousness)
Language and other cognitive changes
Perceptual disturbances
Disturbance in sleep and wakefulness
Disturbance in orientation
Disturbance in arousal level
Clinical Features of
Delirium
Develops over a short period of
time (hours or days)
Tends to fluctuate over the course
of a day
From history, PE or laboratory
there is/are identified condition/s
or substance/s as a likely etiology
Causes of Delirium
Infections
Metabolic and endocrine abnormalities
Intracranial states
Hypoperfusion states
Substance intoxication/withdrawal
Postoperative states
Sensory and environmental changes
Evaluation of Delirium
Evaluation of Delirium
Evaluation of Delirium
Management of Delirium
Find cause/s
Correct or eliminate cause/s
Supportive therapy,
environmental control
Pharmacologic agents
Course and Prognosis Delirium
After cause/s removed symptoms
usually recede over 3 to 7 days.
Seldom persist beyond 2 weeks if
causative factors are reversible
and removed.
Older patients and longer duration
of delirium longer time to resolve
Dementia
A progressive impairment of
multiple cognitive functions
occurring in an individual with
clear consciousness
Global impairment in intellect
Decline from a higher level of
function
DSM-IV-TR Classification of
Dementia
Alzheimers Type
Vascular Dementia
Due to Other General Medical
Conditions
Substance Induced Persisting
Dementia
Dementia Due to Multiple Etiologies
Not Otherwise Specified
Epidemiology of
Dementia
65 years and older 5%
85 years and older 20% to 40
%
General medical outpatient
15% to 20%
Chronic care facilities 50%
Potentially Reversible
Causes
of Dementia
Structural central nervous
system factors
Vascular factors
Head trauma
Subdural hematoma
Normal-pressure hydrocephalus
Multiple sclerosis
Potentially Reversible Causes of
Dementia
Psychiatric illnesses
Major depression
Substance dependence
Systemic/metabolic factors /infectious diseases
Hypothyroidism
Hypercalcemia
Hypoglycemia
Thiamine, niacin, B12 deficiency
Renal failure
Hepatic failure
Medications
CNS infections
Clinical Features of
Dementia
Multiple cognitive deficits
-memory impairment inability to learn
and recall
- apraxia impaired ability to carry out
motor functions
-agnosia inability to recognize or identify
objects
-disturbance in executive functioning
planning,
organizing, sequencing,
abstracting
Clinical Features of
Dementia
Decline from a higher level of
functioning
Gradual onset and continuing
cognitive decline
Does not occur exclusively in the
course of a delirium
Evaluation of Dementia
Treatment and Management of
Dementia
Identification and correction of
possible cause
Environmental manipulation to
reorient patient
Multiple interventions involving
family and patient
Pharmacological management when
appropriate
Course and Prognosis of Dementia
Factors which influence course and
prognosis
-etiology
-time span between onset and start of
treatment
-presence of comorbid psychiatric
symptoms
-level of psychosocial support
Delirium vs. Dementia
Depression vs. Dementia
Amnestic Disorder
characterized by a lost of
memory due to effects of a
general medical condition or
persisting effects of a substance
DSM-IN-TR Classification of
Amnestic Disorder
amnestic disorder due to a general
medical condition
substance-induced persisting
amnestic disorder
not otherwise specified
Clinical Features of Amnestic
Disorder
development of memory impairment
manifested by inability to learn new
information and to recall previously learned
information
represents a decline from a previous level of
functioning
does not occur exclusively in the course of a
delirium or dementia
presence of a general medical condition of
evidence of persisting effect of a substance
Causes of Amnestic
Disorder
Treatment and Management of
Amnestic Disorder
Directed at identifying and
correcting underlying cause
Psychosocial intervention
Course and Prognosis of
Amnestic Disorders
Depends on underlying cause
Transient global amnesia and
amnestic disorder due to head
trauma have better outcomes
Generally little improvement over
time but no progression seen too for
those due to other causes
Reference
Sadock BJ, Sadock, VA. . In Kaplan and
Sadocks Synopsis of Psychiatry. Philadelphia,
PA: LWW; 2007, 319-350.
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