Alzheimer's disease: overview
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Dementia, itself, neither implies a specific disease nor implies a specific underlying pathology. It refers to a change in cognitive function that is severe enough to compromise an individual's daily function. The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) defines dementia as an acquired impairment of cognitive function that includes a decline in memory beyond what would be expected for age and at least one other cognitive function, such as attention, visuospatial skills or language, or a decline in executive functioning such as planning, organization, sequencing, or abstracting. The decline cannot only affect emotional abilities, but must also interfere with work or social activities. The deficits should not be accompanied by an impairment of arousal (delirium) or be accounted for by another psychiatric condition, such as depression or schizophrenia. Dementia can further be defined by a possible, probable, or definite etiologic diagnosis. A degenerative dementia implies disease progression over time.Keywords:
Depression
Cognitive Decline
Affect
Cognitive Decline
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Studies of outcome have started to challenge the assumption that delirium is a truly reversible disorder with a good prognosis. Prospective outcome studies of delirium are required to describe its prognosis. The evidence is that delirium recovers slowly and often incompletely. Delirious patients stay longer in hospital than those without delirium. High mortality rates seen in delirium may be contributed to by the delirium itself. The prognosis of delirium is almost certainly not therefore, one of early full recovery. Rather, delirium is a condition with a slow recovery and one that often fails to resolve completely.
Excess mortality
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The aim of this article is to review the association between diabetes mellitus, cognitive decline and dementia, including the effects of cognitive decline and dementia on self management of diabetes. This is a literature review of primary research articles. A number of contemporary research articles that met the inclusion criteria were selected for this review paper. These articles were selected using a number of search strategies and electronic databases, such as EBSCOhost Research and SwetsWise databases. The duration of diabetes, glycated haemoglobin levels and glycaemic fluctuations were associated with cognitive decline and dementia. Similarly, hypoglycaemia was significantly related to increased risk of developing cognitive decline and dementia. Furthermore, cognitive decline and dementia were associated with poorer diabetes management. There is evidence of the association between diabetes, cognitive decline and dementia including the shared pathogenesis between diabetes and Alzheimer’s disease. In addition, the self management of diabetes is affected by dementia and cognitive decline. It could be suggested that the association between diabetes and dementia is bidirectional with the potential to proceed to a vicious cycle. Further studies are needed in order to fully establish the relationship between diabetes, cognitive decline and dementia. Patients who have diabetes and dementia could benefit from structured education strategies, which should involve empowerment programmes and lifestyle changes. The detection of cognitive decline should highlight the need for education strategies.
Cognitive Decline
Diabetes management
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In Brief Delirium is common in older adults who have dementia, but too often nurses confuse the symptoms of delirium with those of dementia and it goes unrecognized and untreated. Delirium can signal a serious underlying condition such as infection or dehydration and can increase the risk of falling and the length of hospitalization. This article presents an algorithm meant to guide nurses in the assessment and treatment of delirium superimposed on dementia. For a free online video demonstrating the use of this algorithm, go to https://links.lww.com/A209. Too often nurses confuse the symptoms of delirium with those of dementia and it goes unrecognized and untreated. This article presents an algorithm to guide nurses in the assessment and treatment of delirium superimposed on dementia.
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Delirium is a troubling complication in hospitalized older patients with cancer. Although preventable and potentially reversible, delirium may be prolonged. Persistent delirium at the time of hospital discharge is common and associated with multiple adverse outcomes. We conducted a secondary data analysis to examine delirium resolution in 43 hospitalized older patients with cancer who had prevalent or incident delirium. We describe trajectories of delirium resolution and evaluate differences in patients with and without delirium resolution. Delirium was assessed using the NEECHAM confusion scale. Forty-one of the 43 patients had delirium during hospitalization before discharge; 2 had delirium only at the time of discharge. Although delirium resolved in 13 patients, a significant majority (70%) had delirium at discharge. Patients with delirium resolution were less functionally impaired before hospitalization and exhibited fewer etiologic risk patterns at admission. Mild delirium was more likely to resolve than severe delirium. All patients with chronic cognitive impairment had persistent delirium. Care for hospitalized older patients with cancer should incorporate delirium prevention and intervention strategies. Caregiver education, communication between providers, and follow-up are critical when delirium persists. Additional research focusing on the management and impact of persistent delirium in hospitalized older patients with cancer is needed.
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