DELIRIUM

What is a delirium? It is very different than dementia. A delirium is also known as an acute confusional state or another sometimes used term is encephalopathy. It is a medical emergency in this sense, an untreated delirium can have as high as a 25% mortality rate.

There are many, many causes of delirium, for example toxic or metabolic states. Drug withdrawal can be a common cause of delirium. Most people have heard of the DT's: delirium tremens Alcohol withdrawal causes this. There are metabolic encephalopathies. Delirium is a medical problem, not a functional or psychiatric problem, yet patients with delirium often end up misdiagnosed and on psych units.

Why?

There is bizarre problems and behavior associated with delirium, hallucinations: visual (seeing things) or tactile (feeling things crawling on your skin) are a common problem. Note that in a psychiatric disorder not a auditory (hearing voices) is the most common type of hallucination.

Liver, kidney and thyroid abnormalities are (metabolic) causes, infections, and drugs can be other causes. Basically there is an imbalance and the brains equilibrium with the rest of the body becomes out of whack.

A person with dementia may develop a delirium, for example a untreated urinary tract infection can cause this.

The person with delirium has a fluctuating level of consciousness, they may be in and out of being alert. It may fluctuate over the course of the day, becoming worse at night frequently. The person may be aggressive or violent and lash out.- hence a misdiagnosed psychiatric problem.

A person with delirium has not just an altered fluctuating level of consciousness, somnolence to agitation for example, but they can not attend. The persons attention span is altered.

Attention and level of consciousness are two distinguishing factors of delirium from dementia.

A person with dementia may be disoriented -not know who they are or you are, they may have an impaired memory, not remember things, and that part is the same as delirium.

But someone with dementia really does not have the same alternating level of consciousness, and they generally may not remember a thing, depending on how far the dementia has progressed, but they do have an attention span and they can attend. Example, if you give a demented person a strong of 5-7 numbers to repeat they can say them back, that is attention, not concentration or memory.

Concentration which would be saying the months of the year backwards or of course the classic, spell W O R L D backwards tests concentration. Concentration and memory and orientation are always typically impaired in delirium and dementia.

People with dementia should not have a delirium, but they are more sensitive to developing one. Example a younger person with a urinary tract infection and no dementia is not likely to develop delirium but someone more elderly and with dementia may be more likely.

Mitochondrial dysfunction

Some interesting research although not new exactly, but yet at the cutting edge if you will for Alzheimer's is in the area of Mitochondrial dysfunction. Inside all human cells including cells in the brain and central nervous system, there are various components, for example, the nucleus, mitochondria, endoplasmic reticulum and many other things. In any biology course, even the most basic high school biology courses, one of the first things that is covered is a cell. protein synthesis, genetic coding, and many other things take place inside a cell.
On of the important bodies in the cell is the mitochondria. We are often taught that this is the "powerhouse" of the cell. This is where energy is made basically. The cell need glucose to make energy. The cells take up glucose. The brain needs a lot of glucose. The brain uses a lot of energy. The mitochondria make energy in the form of a chemical called ATP. Its all the basic make-up of life and energy if you will.
Somehow it is seen and felt that fairly early on in Alzheimer's disease, that the mitochondria in cells stop working so well. No one knows exactly why but, it becomes a vicious cycle, perhaps the buildup of amyloid plaque somehow hurts the function of the mitochondria. Bottom line is you get cells not working so well, free radical or oxidative damage and eventually cell death.
It is one more clue one more piece of the puzzle, but something that is defiantly seen in AD.
I watched a short video today of a presentation by Jeffrey Cummings MD out at UCLA. He is one of the biggest names in AD treatment and research over the years.
We will have to see what happens with this area of research, but you will probably be hearing more about it over the next few years.

Name Recognition if Alzheimer's

In 1979 when my mother was diagnosed, I was seventeen years old and I had never heard of the disease. As it turns out most other people had not either. Ronald Regan brought attention to it, the Alzheimer's association took off a couple years later, and within ten years a lot more Americans knew of the disorder. Nowadays it is a household term. We see advertisements on the nightly news for meds to treat Alzheimer's.

A strange irony occurred to me. The word Alzheimer's is a scary word almost taboo to say it. It is like the word "Cancer". Some families are superstitious and don't even want to mention the word, as if it were a death sentence. We have many available and successful treatments available for cancer now, depending on what type of cancer we are talking about, but it was not that way 25 years ago. We were afraid to mention the word.

so the pendulum has swung the other way now, we all have heard of Alzheimer's, yes it is true there is not a cure yet, and yes it is true the treatments are limited. We all know about it but we should not be afraid to mention the word. It is a terrible devastating fatal illness, but by not talking about it, we tend to somehow sociologically shun the victims and their families. By not talking about it, we are not somehow magically preventing it. Dementia is a safer word apparently than Alzheimer's.

The word Alzheimer's is now a lightning rod of fear and misconception.

It is probably not unlike the term leprosy or tuberculosis once was. Its time to get over that, until we do, the politicians are going to vote to underfund it, and look the other way and hope for the best.

I like to think or wish it is not that bad, my views can be skewed if I talk to caregivers and people and families affected by the illness.... they know firsthand and do not carry the biases. So is it safe to assume that society does not carry bias, and misconceptions and insensitivity toward the disease? I am just not so sure about everybody else. all the millions not affected. Look the other way, sweep it under the rug, don't ever say the word, God forbid you might get it, worse yet what if you catch it.

N.B. You can't catch it and not talking about it does not prevent it.

common sense intuitive concepts, but do we really behave as a society like we truly believe this??

Kindle, nook, iSlate

What are books coming to? Electronic tablets. A far cry from the stone tablets that back a long time ago, seemed to probably dominate the written means of communication.

Unlike other animals we seem to have an edge on not just opposable thumbs but on communication. Very developed I'm sure.

Can anyone under thirty remember much about existence before cell phones?

And so it goes. Will the printing press ie. words on paper go the way of the LP and cassette tape and vcr tape?

A most interesting question is: What will happen to our attention spans?

Everything is so on demand now. We are more plugged in and connected than ever. We don't have to interface with people live and in person and face to face so much anymore. Texting is easier. Email is easier. skype, video conferencing, twitter, snippets of info. Multi-tasking.

Hey I think I got adult ADD. Is it a culture bound syndrome?

So is the average nook or kindle buyer really going to download, War and Peace, or Don Quixote? My God you actually have to sit still and concentrate. How boring and un-novelle. That is so not on demand.

Wouldn't it be easier to just peruse 10 new books rather than reading one?

I hope the kindle and iSlate and nook actually ease our growing illiteracy rate. I mean why wouldn't they. And they are so much greener. Right?