Understanding Cognition: Dementia vs. Delirium

Mar 28, 2025

Cognition Lecture Notes - Spring 2025

Introduction

  • Instructor: Amanda Weberg
  • Focus: Differentiating between dementia and delirium
  • Student Learning Outcomes (SLOs): Review SLOs for clinical manifestations and differences between dementia and delirium

What is Cognition?

  • Definition: Mental processes involved in acquiring knowledge and understanding
  • Components:
    • Perception
    • Attention
    • Memory
    • Reasoning and decision-making
    • Language
    • Problem solving and learning
  • Influencing Factors: Age, education, health, emotional states
  • Impact: Affected by neurological conditions, mental disorders, injuries

Nursing Process in Cognition (ADPIE)

Assessment

  • Subjective Information:
    • Patient self-report
    • Family/caregiver input
  • Objective Information:
    • Direct observation and screening tools
    • General Observations:
      • Behavior, appearance, responsiveness
      • Alertness, orientation, attention, speech
      • Behavior and mood
  • Screening Tools:
    • Mini Mental State Exam
    • Clock Drawing Test
    • Blastoma Scale
    • Confusion Assessment Method
  • Key Cognitive Domains:
    • Orientation, attention and concentration, memory, language, executive functioning, visual-spatial functioning
  • Additional Tools and Tests:
    • Functional assessments
    • Imaging (CT scans, MRI)
    • Lab tests (blood glucose, thyroid function, vitamin B12)

Diagnosis

  • Examples: Impaired memory, acute confusion, chronic confusion, risk for injury

Planning

  • Goals: SMART (Specific, Measurable, Achievable, Relevant, Time-bound)
    • Short-term Goals: Orientation, responding to questions
    • Long-term Goals: Improved orientation, patient safety

Interventions

  • Environment: Calm, structured, familiar
  • Cognitive Support: Memory aids, frequent reorientation
  • Physical Needs: Hydration, nourishment, pain management
  • Safety: Non-restrictive measures, supervision
  • Family Involvement: Education, emotional support

Evaluation

  • Assess intervention effectiveness
  • Adjust based on patient response

Communicating with Patients with Impaired Cognition

  • Communication Efforts: Direct, avoid intercom
  • Patient Interaction:
    • Don't rush, reduce distractions
    • Approach directly, avoid arguing
    • Use simple, short sentences
  • Orientation and Memory Stimulation: Frequent, consistent reminders
  • Behavioral Modeling: Use gestures, avoid assumptions

Dementia vs. Delirium

Dementia

  • Course: Chronic, gradual onset
  • Awareness: Usually clear
  • Memory: Recent and remote impairment
  • Thinking: Impaired judgment, language, and abstraction
  • Sleep-Wake Cycle: Fragmented

Delirium

  • Course: Acute, abrupt onset
  • Awareness: Reduced, fluctuating
  • Memory: Immediate impairment
  • Thinking: Disorganized, fragmented speech
  • Sleep-Wake Cycle: Disturbed, day-night reversal

Case Studies

Delirium Case: Mr. Johnson

  • Symptoms: Confusion, agitation, disorientation
  • Priority Interventions:
    • Assess for causes
    • Structured environment
    • Regular sleep-wake cycle

Dementia Case: Miss Davis

  • Symptoms: Progressive memory loss, difficulty with daily activities
  • Interventions:
    • Structured routine
    • Safety measures
    • Medication management

Medications

  • Delirium: Focus on identifying and treating underlying causes
  • Dementia (Alzheimer's): Donepezil (cholinesterase inhibitor)

Conclusion

  • Delirium: Reversible with early intervention
  • Dementia: Progressive, requires supportive care
  • Discussion Board: Post-class questions and support

Note: Remember to review SLOs and additional materials for comprehensive understanding.