Content Contributor: Tiffany Fields, RN, BSN, MSN, DNP, CRNP
Overview: Delirium, Dementia, and Amnesia
This content is intended as a Quick Reference for delirium, dementia, and amnesia will cover an overview and nursing considerations utilizing the nursing process.
Etiology and Epidemiology
In most adults, it is not unusual to forget things such as locating keys, finding a parked car, or recalling someone’s name. During the aging process, adults may need a longer time to remember things but when this memory loss affects activities of daily living it is more serious.
There are three types of memory loss:
- Dementia, which is a slow decline in learning abilities, problem-solving, memory, or judgement occurring over weeks to months. It can be caused by health conditions such as Alzheimer’s disease and usually affects the population older than 65.
- Delirium, which is a sudden change in the brain which causes alterations in sleep patterns, mental status, and behaviors. Delirium can be associated with withdrawal from alcohol, drugs, or medications, as well as caused by infections.
- Amnesia, which is memory loss caused by a stroke, head injury, substance abuse, motor vehicle accident, emotional event, or combat. It can be temporary or permanent depending on the severity.
The presence of memory loss may indicate a risk factor for dementia, which affects 10% of the 65 or older U.S. population (Harvard School of Public Health, 2008). Additionally, delirium can be reversible with proper diagnosing, early detection is the key in treatment (Lippmann & Perugula, 2016).
Diagnosis
To diagnose delirium, dementia, and amnesia, providers should ask about:
- Medical history
- Utilization of over-the-counter medications
- Diet
- Ability to perform activities of daily living
- Changes in personality or behaviors
Perform memory tests to assess:
- Attention
- Counting
- Language
- Problem-solving skills
Diagnostic testing may also be needed and includes:
- Testing (e.g., magnetic resonance image (MRI), positron emission tomography (PET), and blood and urine tests) to rule out other medical problems
- Computerized tomography (CT) scan
Management
To manage dementia, delirium, and amnesia, the goals are to:
- Improve or maintain quality of life
- Improve cognition, mood, and behavior
- Promote safe environment
- Promote social engagements
- Improve or maintain functioning of daily living
Nursing Care Plan & Considerations
Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with Delirium, Dementia, and Amnesia are listed below.
Assessment
Signs and Symptoms:
- Altered mental status
- Irritability
- Social withdrawal
- Decreased activities of daily living
- Struggling to work with numbers
- Losing and misplacing items
- Changes in behavior and decision making
- Repeating of questions multiple times
- Forgetting conversations
- Unable to multitask
- Struggling with words for a person, place, or thing
Nursing Diagnosis/Risk For
- Dehydration
- Falls
- Infections
- Wandering
- Social isolation
- Self-care deficit
- Impaired communication
- Disturbed thought process
Interventions
- Collect baseline cognitive level.
- Assess the ability to read, write, and comprehend.
- Develop a daily routine.
- Allow rest time.
- Avoid reality checks.
- Provide time to respond to stimuli.
- Allow time with activities.
- Maintain weight.
- Assist with activities of daily living.
Expected Outcomes
- Remain safe and free from injury
- Be able to express needs freely
- Maintain weight
- Remain free from irritability
- Maintain or improve level of function
Individual/Caregiver Education
- Getting regular checkups
- Eating a healthy diet
- Getting enough rest
- Reporting behavioral changes
- Keeping a daily schedule
- Avoiding activities that cause behavioral changes
- Speaking slowly and giving time to respond
- Assisting with activities of daily living
- Finding local support
- Consulting provider, as needed
Dementia in the Older Adult CE Course
Delirium: Identification and Management CE Course
Additional Information
Content Contributor
The content was created by Relias staff writer Tiffany Fields, RN, BSN, MSN, DNP, CRNP.
Tiffany has been a clinical nurse for over 20 years. She was educated and trained as a Licensed Practical Nurse in Alabama, where she practiced as a Gerontological Nurse at the local Nursing Homes. She earned her Associate, Bachelor’s and Master’s degrees in Nursing and a Doctorate in Nursing Practice. She also as a Certified Family Nurse Practitioner degree. Her clinical expertise is Adult-Geriatric Nursing and Medical-Surgical medical complexity. She is currently Assistant Director of Nursing at a Rural Hospital as well as a writer for Relias.
Resources
How is Alzheimer’s Disease Diagnosed?
https://www.nia.nih.gov/health/how-alzheimers-disease-diagnosed
What is the Prevalence of Delirium, Dementia, and Amnesia in the U.S.?
Patient Education: Dementia (Including Alzheimer’s Disease)
https://www.uptodate.com/contents/dementia-including-alzheimer-disease-beyond-the-basics
References
Altman, M. T., Knauert, M. P., Murphy, T. E., Ahasic, A. M., Chauhan, Z., & Pisani, M. A. (2018). Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: an observational cohort study. Annals of intensive care, 8(1), 1-8. https://doi.org/10.1186/s13613-018-0408-4
Ghaeli, P., Shahhatami, F., Zade, M. M., Mohammadi, M., & Arbabi, M. (2018). Preventive intervention to prevent delirium in patients hospitalized in intensive care unit. Iranian journal of psychiatry, 13(2), 142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037578/
Harvard School of Public Health. (2008). Active social life may delay memory loss among U.S. elderly population. https://www.hsph.harvard.edu/news/press-releases/active-social-life-delay-memory-loss-us-elderly/
Honig, L. S., Vellas, B., Woodward, M., Boada, M., Bullock, R., Borrie, M., ... & Siemers, E. (2018). Trial of solanezumab for mild dementia due to Alzheimer’s disease. New England Journal of Medicine, 378(4), 321-330. https://doi.org/10.1056/NEJMoa1705971
Lippmann, S., & Perugula, M. L. (2016). Delirium or dementia?. Innovations in clinical neuroscience, 13(9-10), 56. https://www.researchgate.net/profile/Malathi-Perugula/publication/317085491_Delirium_or_Dementia/links/5c59bb5e45851582c3cff9b4/Delirium-or-Dementia.pdf
Mayeda, E. R., Glymour, M. M., Quesenberry, C. P., & Whitmer, R. A. (2016). Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer's & Dementia, 12(3), 216-224. https://doi.org/10.1016/j.jalz.2015.12.007