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Here is a new podcast on Delirium, Dementia and Delusion. Some of the major differences and considerations. If you have quesitons please email me or comment below. The podcast is in lecture format, and there is too much to cover for one podcast, but some major features and genreal informaiton are discussed. These issues seem to come up frequently on the blog in search engine queries, so I hope this podcast is helpful.
Showing posts with label dementia. Show all posts
Showing posts with label dementia. Show all posts
Saturday, April 23, 2011
Monday, January 31, 2011
Holding Hands
Sometimes, photos speak for themselves. My daughter holding hands with my dad yesterday at his assisted living home:
Friday, September 24, 2010
Differences Between Delirium, Depression Dementia, Delusions, Alzheimer's
Lots of D's to differentiate.
Alzheimer's disease is one form or type of dementia. The most common form or type of dementia. Dementia is the loss of cognitive ability. A global generic term. There are many other causes of dementia besides the most common Alzheimer's disease. Lewy body dementia, Vascular dementia, traumatic brain injury induced, to name a couple.
The different forms of dementia may look slightly different in their clinical symptoms and presentation and progression.
Dementia is a chronic problem it is typically slow and often progressive.
Delirium is way different. A delirium is an acute confusional state, or an encephalopathy. It generally comes in pretty quickly, hence the term "acute". There is always a cause for delirium. It may be a metabolic problem, eg. not enough oxygen to the brain or too much carbon dioxide, such as someone with really bad lung or heart disease, or a metabolic problem, someones sodium for example is too high or low, or a toxicity, such as illicit drugs or drug withdrawal, alcohol withdrawal is a common cause. A severe infection with for example a high fever is another cause.
Delirium is always a medical emergency. It can have a high death rate up to 25% or more, especially if not treated. Usually it is very treatable, the issue is diagnosing it and finding the cause.
Often it is mistaken for a psychiatric problem. A common symptom is visual hallucinations, seeing things, example bugs crawling on the wall. Sometimes there are tactile hallucinations, feeling things that are not there, such as bugs crawling on one's skin. These kind of hallucinations usually again indicate an "organic" or medical reason and problem.
A person can get extremely agitated in delirium, bizarre, violent aggressive behavior, it often gets worse at night and fluctuates over the course of the day. Sundowning is a term that has been associated with delirium.
A person with dementia can get agitated and worse at night. We also associate the term sundowning with Alzheimer's also, or more agitation at night. Wandering about etc.
A person with dementia can also develop a delirium on top of that. A common cause for example is a person that has Alzheimer's dementia and develops a urinary tract infection, or a metabolic imbalance.
That is where it gets more difficult to diagnose. Usually there is more of an acute change in the persons behavior, a significant worsening or change over hours or a few days.
One of the key things in telling the difference between delirium and dementia is that a person's level of consciousness fluctuates in delirium. They are in and out of consciousness, from awake and alert to sleepy somnolent, to hyperalert and agitated. Sometimes they are difficult to wake up, and may go from sound asleep and difficult to rouse to extremely agitated in a matter of seconds.
A person with dementia typically will not go in and out of consciousness so abruptly. They will be awake and alert, maybe completely impaired with memory, concentration, orientation, but they will be alert.
Another key thing is since delirium is a medical or organic problem, a person with have "autonomic fluctuations" This means there vital signs will fluctuate a lot over the course of the day. Remember it is a medical problem. So their blood pressure may go up and down they may have fevers that come and go, pulse rate may fluctuate. In someone with dementia only, you would not see much fluctuation in vital signs on a daily basis. But if they are not checked you would not know.
It is something a doctor (or medical provider) really needs to diagnose and find the cause of and treat.
As I have stated ion previous blog posts auditory hallucinations are typically associated with a psychiatric disorder, that is "hearing voices" of people that are not there. Unfortunately visual versus auditory hallucinations are not always distinguished by medical people outside of the psychiatric realm of specialists. Hence you can see another reason why it gets confusing.
Delusions are a symptom of psychosis. They are false ideas or beliefs. They can be of different types. Paranoid- eg "aliens planted a computer in my brain" or Ssomatic (physical) there are snakes in my belly eating my insides" Delusions are typically asassociated with a psychiatric disorder, such as schizophrenia, they are fixed and ongoing, however they can also develop in someone with dementia. And in fact are not uncommon as Alzheimer's disease progresses.
Delusions can also be seen in a delirium, but there are so many other things going on when a person has a delirium a fixed delusional belief is usually not a paramount symptom, since the whole medical problem is quickly developing and acute.
The paranoia associtated with for example Alzheimer's is a little bit different say than someone with schizophrenia. The false beliefs in dementia, may be more variable, and less fixed and tend to come and go, more than in a functional psychiatric disease.
but the issue of delusional beliefs is one of those quandaries that makes everyone ask is Alzheimer's a medical or a psychiatric problem (see previous posts).
The delusional material is often treated with anti-psychotics, it may not completely go away, but the person tends to be much less obsessed concerned with or likely to act on their delusional beliefs if they are treated. We then run into all the problems and well publicized issues with antipsychoitcs and the warnings in the elderly etc. (see previous posts).
Hallucinations are also treated with antipsychotics, they are not quite so common in dementia but certainly can and do occur, maybe not as often as delusional beliefs though.
you would not want to start treating visual hallucinations without simultaneously find the cause of any delirium. Auditory again are more common in psychiatric disorders, and it is less likely to find a delirium or medical cause, so the hallucinations are treated there also, and often respond quite well to antipsychoitc meds.
Depression is a psychiatric disorder, that is now more openly talked about over the last 15 years or so, so it has made its way into the mainstream of primary care and is regularly more screened for in general medicine, It is much more socially acceptable to talk about depression. Depression can have a high morbidity- loss of job, divorce, substance abuse) and be fatal for example by suicide if it is not treated.
Persons with dementia can also develop depression, but often unlike someone without dementia they can't necessarily tell us about it or how bad they fell because they are already cognitively impaired.
Here is where it gets even more tricky. Back in the day not so long ago, there used to be a common term called "pseudo-dementia". It was associated with depression. In fact it still is, but the term is no vogue anymore. Probably too confusing for everyone. Here's what it means- a person with depression has lots of symptoms- sad, hopeless, helpless, suicidal, insomnia, low energy, weight loss, for example to name a few, but a person suffering from major depression can also be cognitively slowed. They can be sluggish in memory and thinking. It can be mistaken for dementia,
As a person ages they are at increased risk for developing Alzheimer's, but if they are depressed and have absolutely no dementia, they may still have cognitive slowing from the depression and be misdiagnosed with dementia. IT HAPPENS A LOT. With the health care debacle it will happen even more as we will tend to want to diagnose ourselves or have our friends do it. This is why a medical work-up and psychiatric work up and evaluation is so important.
With health care rationing already here, I am very fearful that there will be many people misdiagnosed or simply not treated. People with Alzheimer's being misdiagnosed with depression and vice versa
Now one final problem, a person can have Alzheimer's disease brewing and depression at the same time. In fact depression can be the first sign of Alzheimer's. The diagnosis of one or both has to be made and differentiated by a medical professional. untreated depression can make the Alzheimer's worse.
Alzheimer's disease is one form or type of dementia. The most common form or type of dementia. Dementia is the loss of cognitive ability. A global generic term. There are many other causes of dementia besides the most common Alzheimer's disease. Lewy body dementia, Vascular dementia, traumatic brain injury induced, to name a couple.
The different forms of dementia may look slightly different in their clinical symptoms and presentation and progression.
Dementia is a chronic problem it is typically slow and often progressive.
Delirium is way different. A delirium is an acute confusional state, or an encephalopathy. It generally comes in pretty quickly, hence the term "acute". There is always a cause for delirium. It may be a metabolic problem, eg. not enough oxygen to the brain or too much carbon dioxide, such as someone with really bad lung or heart disease, or a metabolic problem, someones sodium for example is too high or low, or a toxicity, such as illicit drugs or drug withdrawal, alcohol withdrawal is a common cause. A severe infection with for example a high fever is another cause.
Delirium is always a medical emergency. It can have a high death rate up to 25% or more, especially if not treated. Usually it is very treatable, the issue is diagnosing it and finding the cause.
Often it is mistaken for a psychiatric problem. A common symptom is visual hallucinations, seeing things, example bugs crawling on the wall. Sometimes there are tactile hallucinations, feeling things that are not there, such as bugs crawling on one's skin. These kind of hallucinations usually again indicate an "organic" or medical reason and problem.
A person can get extremely agitated in delirium, bizarre, violent aggressive behavior, it often gets worse at night and fluctuates over the course of the day. Sundowning is a term that has been associated with delirium.
A person with dementia can get agitated and worse at night. We also associate the term sundowning with Alzheimer's also, or more agitation at night. Wandering about etc.
A person with dementia can also develop a delirium on top of that. A common cause for example is a person that has Alzheimer's dementia and develops a urinary tract infection, or a metabolic imbalance.
That is where it gets more difficult to diagnose. Usually there is more of an acute change in the persons behavior, a significant worsening or change over hours or a few days.
One of the key things in telling the difference between delirium and dementia is that a person's level of consciousness fluctuates in delirium. They are in and out of consciousness, from awake and alert to sleepy somnolent, to hyperalert and agitated. Sometimes they are difficult to wake up, and may go from sound asleep and difficult to rouse to extremely agitated in a matter of seconds.
A person with dementia typically will not go in and out of consciousness so abruptly. They will be awake and alert, maybe completely impaired with memory, concentration, orientation, but they will be alert.
Another key thing is since delirium is a medical or organic problem, a person with have "autonomic fluctuations" This means there vital signs will fluctuate a lot over the course of the day. Remember it is a medical problem. So their blood pressure may go up and down they may have fevers that come and go, pulse rate may fluctuate. In someone with dementia only, you would not see much fluctuation in vital signs on a daily basis. But if they are not checked you would not know.
It is something a doctor (or medical provider) really needs to diagnose and find the cause of and treat.
As I have stated ion previous blog posts auditory hallucinations are typically associated with a psychiatric disorder, that is "hearing voices" of people that are not there. Unfortunately visual versus auditory hallucinations are not always distinguished by medical people outside of the psychiatric realm of specialists. Hence you can see another reason why it gets confusing.
Delusions are a symptom of psychosis. They are false ideas or beliefs. They can be of different types. Paranoid- eg "aliens planted a computer in my brain" or Ssomatic (physical) there are snakes in my belly eating my insides" Delusions are typically asassociated with a psychiatric disorder, such as schizophrenia, they are fixed and ongoing, however they can also develop in someone with dementia. And in fact are not uncommon as Alzheimer's disease progresses.
Delusions can also be seen in a delirium, but there are so many other things going on when a person has a delirium a fixed delusional belief is usually not a paramount symptom, since the whole medical problem is quickly developing and acute.
The paranoia associtated with for example Alzheimer's is a little bit different say than someone with schizophrenia. The false beliefs in dementia, may be more variable, and less fixed and tend to come and go, more than in a functional psychiatric disease.
but the issue of delusional beliefs is one of those quandaries that makes everyone ask is Alzheimer's a medical or a psychiatric problem (see previous posts).
The delusional material is often treated with anti-psychotics, it may not completely go away, but the person tends to be much less obsessed concerned with or likely to act on their delusional beliefs if they are treated. We then run into all the problems and well publicized issues with antipsychoitcs and the warnings in the elderly etc. (see previous posts).
Hallucinations are also treated with antipsychotics, they are not quite so common in dementia but certainly can and do occur, maybe not as often as delusional beliefs though.
you would not want to start treating visual hallucinations without simultaneously find the cause of any delirium. Auditory again are more common in psychiatric disorders, and it is less likely to find a delirium or medical cause, so the hallucinations are treated there also, and often respond quite well to antipsychoitc meds.
Depression is a psychiatric disorder, that is now more openly talked about over the last 15 years or so, so it has made its way into the mainstream of primary care and is regularly more screened for in general medicine, It is much more socially acceptable to talk about depression. Depression can have a high morbidity- loss of job, divorce, substance abuse) and be fatal for example by suicide if it is not treated.
Persons with dementia can also develop depression, but often unlike someone without dementia they can't necessarily tell us about it or how bad they fell because they are already cognitively impaired.
Here is where it gets even more tricky. Back in the day not so long ago, there used to be a common term called "pseudo-dementia". It was associated with depression. In fact it still is, but the term is no vogue anymore. Probably too confusing for everyone. Here's what it means- a person with depression has lots of symptoms- sad, hopeless, helpless, suicidal, insomnia, low energy, weight loss, for example to name a few, but a person suffering from major depression can also be cognitively slowed. They can be sluggish in memory and thinking. It can be mistaken for dementia,
As a person ages they are at increased risk for developing Alzheimer's, but if they are depressed and have absolutely no dementia, they may still have cognitive slowing from the depression and be misdiagnosed with dementia. IT HAPPENS A LOT. With the health care debacle it will happen even more as we will tend to want to diagnose ourselves or have our friends do it. This is why a medical work-up and psychiatric work up and evaluation is so important.
With health care rationing already here, I am very fearful that there will be many people misdiagnosed or simply not treated. People with Alzheimer's being misdiagnosed with depression and vice versa
Now one final problem, a person can have Alzheimer's disease brewing and depression at the same time. In fact depression can be the first sign of Alzheimer's. The diagnosis of one or both has to be made and differentiated by a medical professional. untreated depression can make the Alzheimer's worse.
Tuesday, June 1, 2010
Well Doc Here I am again.
You have nagged me to post again. So I decided to post a post that my wife posted on my blog. Is that toooo many posts. She is my main caregiver and since your blog is more to that arena, I thought it would be ok. But notice her post is not 42 paragraphs like some people we know. Love You Man.
Joe posted a few weeks ago about the fact that we have had some difficulity. He has had some issues and yes I was hurt by them. But in all fairness I guess I am to blame too. As you know he can still find his way around the computer and sometimes it gets him and others into trouble. So as a caregiver and as a spouse I am going to say that we need to ask questions when our other half is doing something that we are not sure of. We need to check the bank statements and credit card statements just to make sure there are no charges there that we do not know about. $10 here and there really add up. Also just like we do with our children we need to know who they are talking to. Whether on the phone or on the computer. So I am sure that we will have a few more arguments about how we nag and are trying to control things but, if we don't damage can be done that can not be forgiven or forgotten. Fortunately we are working on our end. So do not be surprised when he writes that I am being a nag and not liking me or others very much. We do it out of love.
Pay Attention to what is going on around the person you care for.
Lynn
Thursday, April 15, 2010
They Say Phsyc's Know What They Are Doing!
Hello,
My name is Joseph Potocny, you see Dr. Joe and I have known each other for sometime now. But let us question his sanity, he is a MD I am an AD (Alhziemers person) and have FTD as well. Now who knows more him on the far left or me on the gentle right.
I thank Doc for asking me to blog here, I guess he is ready to be punished for the well shall we say less than upstanding life he has led. Not true, he is a good guy.
I have had the disease for over 3 yrs confirmed, by the time you know whose professsion would listen to me. So today like many days has been filled with times of where the hell am i and what am i doing. I was going to do this as a video, but he told me creatures were not allowed to appear in person. I read docs' blog daily as he makes posts, some I just do not understand, that is the way it is. Others he is right on. See he was a victim of this disease on the other side and could not understand why his mom was leaving him. I live on the other side of the tracks and do not understand why people are leaving my brain and world. By the way Doc and I are getting married next week last I knew.
I hope to be back latter, but with a more direct post that I do as normal. Just to prepare you visitors and friends of Dr. Joe, I am very blunt and not always choosey about my words. Nor do I use spell check. Read his book, I think you will find solace and vindication in it ( wow big words ) must be getting late. I needed help from my wife with my thought processs on trying to understand it. But I need help in finding the bathroom.
God Bless & Keep You & This Country of Ours!
Joe
Friday, February 12, 2010
Euthanasia, Suicide, Death Panels, Dementia, Sir Terry Pratchett
There has been quite a bit of buzz lately about expediting death in the event of Alzheimer's.
There are a few good reasons for this.
1. Consider the fact that Alzheimer's is now a household word. Most people in America and the Western World have heard of the disease. (see earlier blog posts)
2. Then in the United States throw in the current health care debacle. There is not enough money and resources to go around. Everyone needs health care, it is a right, NOT a benefit, hwo is going to pay for all this, the Democrats don't know what they are doing, the republicans don't care, etc etc etc.
There are a few good reasons for this.
1. Consider the fact that Alzheimer's is now a household word. Most people in America and the Western World have heard of the disease. (see earlier blog posts)
2. Then in the United States throw in the current health care debacle. There is not enough money and resources to go around. Everyone needs health care, it is a right, NOT a benefit, hwo is going to pay for all this, the Democrats don't know what they are doing, the republicans don't care, etc etc etc.
It's so political.
Then we keep hearing about 'LIMITED RESOURCES' hmm, we don't have a cure for AD, the treatments are of limited efficacy.
Alzheimer's patients can't speak up for themselves too well. Families are too busy trying to survive and care for their loved ones with the disease.
so what the the head scratching and problem solving lead to?
Well lets go back to the old death with dignity debate. Everyone is scared of getting the disease. There is a little less shame around it. So we have more noteworthy people and families, celebrities talking about it.
Perhaps we should revisit assisted suicide, with limited resources and all.
I had a comment on a post the other day on Huffington Post about this very topic.
If a person with Alzheimer's forgets to eat the food in front of them is it time to die? The original article hinted that no nutrition may be a painless peaceful way to die.
Except it is not.
It sort of hurts to be starving to death even if you have Alzheimer's.
Now I am not being unreasonable here, I do not believe in IV's and insertion of feeding tubes when a person is at the end stages of Alzheimer's disease. But through most of the stages, a person with Alzheimer's still has feelings, right? They may not be able to cognitively express them.
Sometimes I think some of us worry about our pet's feeling more than our elderly. Of course the politically correct term for decades now has been "seniors".
We make fun of the elderly, we say "oh I was having a senior moment" the young and youthful often joke about Alzheimer's- as if they might never grow old.
We are at the point of abolishing the word "retarded" in our vocabulary, it is considered mean and very politically incorrect, we would not dare pick on a special needs child, or a person with a developmental disorder.
Do we pay that same respect, that politically correct carefulness to our elderly? -Maybe.
emerge Sir Terry Pratchett, one of the most famous best selling writers in Great Britain. He has AD. He donated a lot of money to Alzheimer's research. He does not want to live through the stages, and envisions a more romantic way to die.
I suppose that is his choice.
Here is my fear, what if a young cool person, with no medical problems has a living will-really clear nice advance health care directives. They decide that if they get Alzheimer's and the first time they forget to eat, they would like to be put to death. A Facilitated death. Suicide. Perhaps by not putting any food in front of the person anymore. A passive facilitated death. -Or scary thought, a more active facilitated suicide.
Fine good, progressive thinking right? Totally Hip.
Well what happens when that living will, advance directive comes into play, and it just so happens that the person with moderate dementia, that forgot to eat, changes their mind. What if they now want to live? No one will believe them- they are not of sound mind and competence. They can't give informed medical consent. Perhaps the family could override, but what if there is no family or legal guardian. Then the state takes over,
"too bad Alzheimer's victim, you said you wanted to die, we have no resources and you are a drain, it does not matter if you want to live now. We have your advance directive written when you were competent."
Does anyone see or care where this is going?
Who gets to decide? Some judge? A Panel of medical ethicists?
Euthanasia means "painless" death incidentally.
I am not particularly hysterical, but stranger things have happened.
And what about all that "end of life counseling" doctors would be given incentives to provide. Wow. We have not heard much about that lately, but it will be back I am sure. With the limited resources and all.
I wish there was more buzz about cures and effective treatments, rather than killing our old people with AD, couching it in some vogue, elitist, intellectual debate. some cultures actually still honor their elderly, not the norm in the narcissistic youth and beauty driven western world.
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