Chapter 64: Dementia & Delirium Care

Dementia represents a syndrome of cognitive decline affecting memory, executive function, language, and social cognition severe enough to interfere with independent functioning, with Alzheimer disease accounting for the majority of cases alongside vascular dementia, dementia with Lewy bodies, frontotemporal lobar degeneration, and Parkinson disease dementia. The pathological mechanisms of Alzheimer disease involve beta-amyloid plaque accumulation, neurofibrillary tangle formation from hyperphosphorylated tau protein, synaptic dysfunction, and progressive neuronal death leading to brain atrophy. Risk factors encompass genetic predisposition including apolipoprotein E4 allele, family history, cardiovascular disease, diabetes mellitus, and traumatic brain injury. Clinical stages progress from mild cognitive impairment through moderate dementia characterized by aphasia, apraxia, agnosia, and behavioral disturbances, ultimately advancing to severe dementia with complete dependence in activities of daily living. Diagnostic evaluation utilizes neuropsychological assessments including Mini-Mental State Examination, Montreal Cognitive Assessment, and Mini-Cog screening tools, supplemented by neuroimaging and cerebrospinal fluid biomarker analysis. Pharmacological management relies on cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine to enhance acetylcholine neurotransmission, while memantine provides neuroprotection through NMDA receptor antagonism. Nursing care emphasizes safety promotion, behavioral symptom management including sundowning and agitation, nutritional support, communication enhancement, fall prevention, and comprehensive caregiver education. Delirium represents an acute confusional state characterized by fluctuating attention deficits, disorganized thinking, and altered consciousness, commonly occurring in hospitalized elderly patients and intensive care settings, requiring prompt identification using tools like the Confusion Assessment Method and systematic addressing of underlying precipitating factors through interprofessional collaboration.