Neurological Disorders and Management of TIA, CVA, Delirium and Dementia

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Delirium and dementia

Delirium is a severe and somewhat sudden decline in cognition, attention-focus and perception. It commonly occurs in patients with dementia. However, dementia has a diagnostic criterion different from that followed for delirium. If it is hyperactive, it is characterized by high agitation or combativeness. Nonetheless, it may also be hypoactive where it is characterized by inability to follow commands, incapacity of the patient to focus or attention or inability to converse.

The acute change in cognition and attention that characterizes delirium develops over time course of hours which may extend to days. The trend is always different during the day a time at which it fluctuates. Delirium is common among the older patients and it is a life threatening condition thus qualifies as a medical emergency for instance hypoglycemia or hypoxia or even medication overdose (FERNE 2006).

Conversely, delirium must be differentiated from dementia. While dementia is an illness, delirium is a set of symptoms mostly caused by acute surgical or medical illness. Therefore delirium is a reversible syndrome in most patients. Hence delirium on its own is not a disease but rather it is a set of symptoms (a clinical syndrome) and careful

Management of Delirium

Given that delirium is a set of symptoms that are reversible in most patients and is caused by severe surgical or medical illness, the most appropriate treatment for this is to speedily expose these organic factors and reorganize them. In the course of the diagnostic it is advisable to handle the patients with care as some patients tend to be bluntly combative or highly agitated and thus may require the use of chemical restraints. Patients with delirium may be egged on to use hearing aids or glasses since sensory deprivation may alleviate the situation by causing delirium. The patients also need to be provided with time reminders so that chronobiologic disturbances do not cause or exacerbate the delirium.

It is helpful to provide reasonable amount of stimulation hence it is reasonable to avail a wall clock and illuminate the patient’s room appropriately during both the day and night. Consistency in giving orientation is important as it will help in overcoming impairment in acute memory functions. This should continually be accompanied with the explanations of the illness (Melillo & Houde 2005).

Pharmacological management may be administered too. This would be done by administering antipsychotic drugs (Melillo & Houde 2005). Thus haloperidol could be administered in the right dose. Delirium arising as a result of drug withdrawal is managed through treatment by titration with intravenous benzodiazepines.

Differential Diagnosis of Delirium

Dementia, neurovascular insult, acute psychotic illness and non-convulsive status epilectus are among the differential diagnosis of a patient with delirium though this paper will limit itself on dementia.

Dementia

This is a persistent disease with growing loss of cognitive function. Nevertheless, the rate at which loss of cognitive function progresses is variable and somewhat sudden as the patient keeps losing critical masses of compensating neurons. Demented patients exhibit fluctuating levels of cognition connected with environmental cues and conceivably to the impulsive ebb and flow of chronic delirium.

Areas of cognition affected in the demented patients are the memory, language, problem solving and attention. Dementia has symptoms which may either reversible or irreversible.

Difference between transient ischemic accident (TIA) and cerebral vascular accident (CVA)

Cerebral vascular accident, also known as stroke, is the functional or structural abnormality of the brain resulting from a pathological condition of either the entire cerebro-vascular system or the cerebral vessels. This condition impedes proper cerebral circulation where there is occlusion, either complete or partial, of the vessel lumen. The effects resulting form this may be permanent or transient. The major causes of CVA include Thrombosis, hemorrhage and embolism. Carotid arteries are the primary vessels most commonly involved (FERNE 2006).

TIA (transient ischemic attack) on the other hand is mini-stroke which generates stroke-like symptoms though it does not have a lasting damage on the patient. It generally lasts less than 24 hours. TIAs are vital in foretelling if stroke is likely to occur as compared to when one will happen. Symptoms of TIA include:

Abrupt numbness or failing of some parts of the body e.g. the face, arm or leg, more so on one side of the body
unexpected confusion, difficulty speaking or understanding
Sudden difficulty seeing in one or both eyes
Sudden difficulty walking, dizziness, loss of balance or coordination
Sudden, acute headache with no identified cause

Treatment and Prevention

Ischemic CVA is managed by administering a drug that will clear or dissolve the blood clots. Prevention of further complications and reoccurrence may also be done through re-education so that the damaged functions not only recover but those close to the patient become fully aware of the situation and how to handle it.

The main aim of Treatment of TIA is to prevent a second stroke. To give an anti-platelet therapy, it is recommended that the patient be administered with aspirin (325mg per day) if at all the patient was not taking it at the time of occurrence otherwise another anti-platelet therapy should be administered. The patient should be given anti-hypertensive medications, cholesterol lowering drugs if the blood pressure or cholesterol levels are normal. As a way of preventing the possible occurrence of TIA is recommended to avoid smoking, drinking of alcohol and then do exercises on regular basis (FERNE 2006).

References

Foundation for Education and Research in Neurological Emergencies (2006) “Recognition and Management of Delirium in the Emergency Department”. Web.

Melillo, K. & Houde, S. (2005) “Geropsychiatric and mental health nursing” Boston: Jones and Bartlett.

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