This week’s content discussed common psychiatric disorders in the Adult and Older Adult client. Often times a secondary diagnosis is masked due to their psychiatric disorder. Review the following case study and answer the following questions.
Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.
Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).
- What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
- What additional testing should you consider if any?
- What are treatment options to consider with this patient?
Please use references no longer than 3-5 yrs. old. and APA format.
Expert Solution Preview
Introduction:
This case study presents us with a scenario of an older adult patient who has a history of hypertension, COPD, and moderate dementia but now presents with acute delirium. Understanding the primary cause of delirium and identifying appropriate testing and treatment options is critical for proper management and care of these patients.
1. What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
The most likely diagnosis to frequently cause acute delirium in patients with dementia is a urinary tract infection (UTI). UTIs are one of the most common causes of delirium in older adults, and patients with dementia are especially susceptible due to their impaired immune function and increased difficulty communicating symptoms. UTIs can cause a systemic inflammatory response, leading to cognitive impairment and altered mental status, which can manifest as delirium. Therefore, it is important to include a urinalysis with culture and sensitivities in the workup of any older adult with a delirium.
2. What additional testing should you consider if any?
In addition to a urinalysis, clinicians should also consider conducting a thorough medical examination to identify any other underlying medical conditions that could be contributing to the delirium. This can include a complete blood count, electrolyte panel, liver function tests, and imaging studies (such as CT or MRI) to assess for any central nervous system abnormalities. It is also important to evaluate the patient’s medications and withdrawal potential, as these can contribute to delirium as well.
3. What are treatment options to consider with this patient?
The treatment options for delirium depend on the underlying cause and severity of symptoms. In the case of a patient with dementia and acute delirium, the first step is to treat any underlying medical conditions, such as a UTI, if present. Other interventions may include providing a quiet and calming environment, reducing sensory overload, and using non-pharmacologic interventions such as reorientation and attentional focus techniques. Medications such as haloperidol or atypical antipsychotics may also be considered in cases of severe agitation or psychosis. However, caution should be exercised with these medications in older adults, especially those with dementia, due to the increased risk of adverse effects.
References:
1. Inouye SK. Delirium in older persons. N Engl J Med. 2006 Mar 16;354(11):1157-65. doi: 10.1056/NEJMra052321. PMID: 16540616.
2. Guideline for the management of delirium in older adults. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. J Am Geriatr Soc. 1999 Mar;47(3):367- 8. PMID: 10078891.
