Psychiatric Mental Health Nursing by Videbeck

522 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

• Moderate:Confusion is apparent along with
  progressive memory loss. The person no
  longer can perform complex tasks but
  remains oriented to person and place. He or
  she still recognizes familiar people. Toward
  the end of this stage, the person loses the
  ability to live independently and requires
  assistance because of disorientation to time
  and loss of information such as address and

telephone number. The person may remain

in the community if adequate caregiver

support is available, but some people move

to a supervised living situation.

• Severe:Personality and emotional changes
  occur. The person may be delusional, wander
  at night, forget the names of his or her
  spouse and children, and require assistance
  in activities of daily living (ADLs). Most
  people live in a nursing facility when they
  reach this stage unless extraordinary
  community support is available.

Etiology

Causes vary although the clinical picture is similar

for most dementias. Often no definitive diagnosis can

be made until completion of a postmortem examina-

tion. Metabolic activity is decreased in the brains of

clients with dementia (Fig. 21-1); it is not known

whether dementia causes decreased metabolic activ-

ity or if decreased metabolic activity results in de-

mentia. A genetic component has been identified for

some dementias such as Huntington’s disease. An

abnormal APOE Gene is known to be linked with

Alzheimer’s disease. Other causes of dementia are

related to infections such as HIV or Creutzfeldt-Jakob

disease.The most common types of dementia and their

known or hypothesized causes follow (APA, 2000;

Caine & Lyness, 2000; Small, 2000):

• Alzheimer’s diseaseis a progressive brain
  disorder that has a gradual onset but causes
  an increasing decline in functioning includ-
  ing loss of speech, loss of motor function, and
  profound personality and behavioral changes

Multiple cognitive deficits of dementia.

Table 21-1

COMPARISON OFDELIRIUM ANDDEMENTIA

Indicator Delirium Dementia

Onset

Duration

Level of consciousness

Memory

Speech

Thought processes

Perception

Mood

Gradual and insidious

Progressive deterioration

Not affected

Short- then long-term memory impaired, eventu-

ally destroyed

Normal in early stage, progressive aphasia in later

stage

Impaired thinking, eventual loss of thinking abilities

Often absent, but can have paranoia, hallucina-

tions, illusions

Depressed and anxious in early stage, labile mood,

restless pacing, angry out-bursts in later stages

Rapid

Brief (hours to days)

Impaired, fluctuates

Short-term memory impaired

May be slurred, rambling,

pressured, irrelevant

Temporarily disorganized

Visual or tactile hallucinations,

delusions

Anxious, fearful if hallucinating;

weeping, irritable

Adapted from American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and statistical manual of
mental disorders(4th ed.). Washington, DC: APA, & Ribby, K. J., & Cox, K. R. (1996). Development, imple-
mentation, and evaluation of a confusion protocol. Clinical Nurse Specialist, 10(5), 241–247.