Question

An 82 year old woman with a history of dementia presents to the emergency department accompanied by her adult daughter. The daughter states her mother has gotten much worse overnight and she is concerned about the speed of the progression of her disease. Her mother is agitated, irritable, and extremely distractible, her thinking is more disorganized than usual and she appears to be hallucinating. Which of the following statements is an accurate understanding regarding the potential cause of the decline?

A. Neurocognitive disorders progress in steps; the client has most likely moved to another step.
B. Delirium is a common cause of sudden onset change in cognition.
C. It is not possible to have both dementia and delirium.
D. Her mother is probably intoxicated.

Answer 1

The 82-year-old woman with dementia showing rapid cognitive decline is likely experiencing delirium, a common cause for sudden changes in cognition in patients with dementia.

Step-by-step explanation:

The sudden change in cognition and behavior observed in the 82-year-old woman with a history of dementia, described as being agitated, irritable, extremely distractible, disorganized in her thinking, and appearing to hallucinate, suggests that delirium is a possible cause. Delirium is characterized by rapid onset and can be differentiated from the gradual cognitive decline typically seen in dementia. In fact, it is not uncommon for individuals with dementia to experience episodes of delirium, particularly when other health changes occur, such as infections, metabolic imbalances, or reactions to medications.

Regarding the options provided, statement B: "Delirium is a common cause of sudden onset change in cognition" is the correct understanding of the potential cause for her decline. Unlike the normal progression of neurocognitive disorders, which generally occurs more gradually, delirium can lead to an acute and dramatic change. It is also possible for someone to have both dementia and delirium simultaneously, which refutes statement C. The possibility of intoxication, as mentioned in statement D, would need to be investigated but does not account for the patient's history and other symptoms.