Comprehensive exams for Mental Health Q 195
Nurse Pauline is aware that Dementia unlike delirium is characterized by:
A. Slurred speech
B. Insidious onset
C. Clouding of consciousness
D. Sensory perceptual change
Correct Answer: B. insidious onset
Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances. The pathophysiology of dementia is not understood completely. Most types of dementia, except vascular dementia, are caused by the accumulation of native proteins in the brain. History must be obtained from the patient and their family members. Patients may present with symptoms of change in behavior, getting lost in familiar neighborhoods, memory loss, mood changes, aggression, social withdrawal, self-neglect, cognitive difficulty, personality changes, difficulty performing tasks, forgetfulness, difficulty in communication, vulnerability to infections, loss of independence, etc., A detailed history should include past medical, family, drug, and alcohol history.
Option A: Physical examination should evaluate head-to-toe and vital signs to determine any possible cause. Neurologic examination should focus on evaluating new focal findings that suggest an intracranial cause, for example, a stroke. The dopamine excess contributes to hyperactive delirium and is related to decreased acetylcholine. The dopaminergic and cholinergic pathways overlap in the brain. This explains why dopamine receptors impact acetylcholine levels and explain the clinical manifestations of delirium, including hyperactive and hypoactive forms. The imbalance between neurotransmitters and the cholinergic pathway may result in delirium.
Option C: Acetylcholine is a very important neurotransmitter in attention and consciousness. It is known, acetylcholine acts as a modulator in sensory and cognitive input, so an impairment in the route leads to developing symptoms of hypoactive or hyperactive delirium, including inattention, disorganized thinking, and perceptual disturbances. Cholinergic pathways project from basal forebrain and pontomesencephalon to interneurons in the striatum and finally targets throughout the cortex.
Option D: This is also a characteristic of delirium. The DSM-5 defines delirium as the presence of all the following criteria: disturbance in attention and awareness that develops acutely and tends to fluctuate in severity; at least one additional disturbance in cognition; disturbances not better explained by preexisting dementia; disturbances that do not occur in the context of a severely reduced level of arousal or coma; or evidence of an underlying organic cause or causes.