Discussion: Patient Presentation of Dementia, Delirium, and Depression

Discussion: Patient Presentation of Dementia, Delirium, and Depression

With the prevalence of dementia, delirium, and depression in the growing geriatric population, you will likely care for elderly patients with these disorders. While many symptoms of dementia, delirium, and depression are similar, it is important that you are able to identify those that are different and properly diagnose patients. A diagnosis of one of these disorders is often difficult for patients and their families. In your role as the advanced practice nurse, you must help patients and their families manage the disorder by facilitating necessary treatments, assessments, and follow-up care. Consider the patient presentations in the following case studies. What distinct symptoms or factors would lead you to a diagnosis of dementia, delirium, or depression?

Case Study 1

HPI: Mrs. Mayfield is a 75-year-old woman who is brought to the emergency room by the police at 11 p.m. She was found wandering and confused in a local neighborhood. The police were called when Mrs. Mayfield tried to use her key on a neighbor’s door. When confronted by the police she became abusive, confused, and frightened and looked very pale and agitated. The police could not establish her correct address and they subsequently brought her to the emergency room.

Review of Symptoms (ROS): Unable to obtain at this time.

Objective Data:

PE:

VS: Pulse 96 and regular; B/P 150/90; Axillary temperature 99°F.

General: She appears clean and well nourished, with no signs of injury, trauma, or neglect.

Her physical exam is unremarkable except –

Neuro: No gross focal neurological signs, but she is only intermittently cooperative. Her mental status fluctuates and a full neurological evaluation is not possible at this time.

Psych: A & O x 1 to person only. She has episodes of agitation and alternating withdrawal/somnolence. During the examination, it takes several attempts to gain Mrs. Mayfield’s attention to answer questions, but once focused, she rambles on in a disorganized and incoherent way.

To prepare:

• Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
• Select one of the three case studies. Reflect on the way the patient presented in the case study you selected, including whether the patient might be presenting with dementia, delirium, or depression.
• Think about how you would further evaluate the patient based on medical history, current drug treatments, and the patient’s presentation. Consider whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist.

By Day 3

Post an explanation of whether you suspect the patient in the case study you selected is presenting with dementia, delirium, or depression and why. Then, explain how you would further evaluate the patient in the case study based on medical history, current drug treatments, and the way the patient presented. Include whether you would modify drug treatments, use additional assessment tools, and/or refer the patient to a specialist

ANSWER

Identification of the Disease

            The patient is suffering from Delirium. Delirium refers to an acute and fluctuating mental status. Patient suffering from this condition are also characterized by lack of attention, lower degree of consciousness and unsystematic thought process (Bush Tierney and Lawlor, 2017). In addition, Delirium also leads to lower level of attention, which may lead to confusion. For accurate diagnosis of Delirium, the patient must have a record of poor attention, change in cognition ability, and development of mental disturbance over a short duration (Heinrich and Sponagle, 2007).

            In the above case of Mrs. Mayfield, the presentation indicates that she is suffering from Delirium. Her Psych result of A& O * 1 person indicates that she has cognitive dysfunction as she failed to recognize location and context. In addition, her mental fluctuation and lack of comprehensive thoughts is an indication of Delirium, which is common among the elderly (Ehlenbach et al., 2010). Since the medication history of the patient and review of symptoms is not available, performing extra tests is the appropriate cause of action.

Additional Assessment to Confirm Presence of Delirium

Despite testing patient’s cognitive status for Delirium being one of the diagnostic procedure, it does not distinguish delirium from dementia. For further confirmation of delirium, additional cognitive tests such as naming months of the year in a reverse order or digit span test may help to identify impairment of attention that is present in delirium. In addition, laboratory evaluation based on the presentation of the patient may be used to establish major causes of confusion status. The laboratory tests should aim at evaluating metabolic panel, hepatic panel and blood cell count. Testing of thyroid functioning together with evaluation of folate and vitamin B12 is important because their deficiency is associated with cognitive dysfunction (Siddiqi et al., 2016). Lastly, use of electroencephalogram (EEG) may also be used to confirm delirium…