SHM's Clinical Quick Talks-Identifying and Managing Dementia in the Hospital

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The document "Identifying and Managing Dementia in the Hospital" by Alexandra Lee focuses on understanding and addressing dementia in hospitalized patients. It begins by defining dementia as a chronic or progressive syndrome marked by disturbances in multiple higher cortical functions, impacting memory, comprehension, and judgement, contrasting it with delirium, which is generally acute and reversible. Dementia's severity is categorized into mild, moderate, and severe based on the individual's independence in activities of daily living (ADLs).<br /><br />The document identifies the four most common types of dementia: Alzheimer's, vascular, Lewy body, and frontotemporal dementia. Alzheimer’s is the most prevalent, marked by amyloid plaques and tau proteins, whereas vascular dementia relates to blood flow issues following strokes. Lewy body dementia involves visual hallucinations and motor issues, and frontotemporal dementia is noted for emotional changes.<br /><br />In diagnosing dementia, outpatient settings are preferred, yet hospital assessments can be hampered by delirium. A thorough history, medication review, and physical examination, alongside necessary lab tests and imaging, are recommended to distinguish dementia from other conditions.<br /><br />For managing hospital-related complications of dementia, strategies include assisted oral feeding over feeding tubes, non-pharmacological approaches for agitation, careful medication review to prevent polypharmacy, and deprescribing where necessary. The guide underscores avoiding appetite stimulants and physical restraints.<br /><br />Clinical pearls emphasize dementia as a progressive memory decline impacting daily functioning and highlight the importance of comprehensive patient evaluation and aligning treatments with the patient’s goals of care. High-value resources from the AGS and UCSF are suggested for healthcare providers. Overall, the document aims to direct clinical interactions with hospitalized dementia patients, focusing on non-aggressive interventions and careful monitoring.

Asset Subtitle

Alexandra Lee

Keywords

dementia

hospitalized patients

Alzheimer's

vascular dementia

Lewy body dementia

frontotemporal dementia

delirium

non-pharmacological approaches

polypharmacy

patient evaluation