Regular ArticleLanguage Function in Delirium: A Comparison of Single Word Processing in Acute Confusional States and Probable Alzheimer′s Disease
Abstract
Thirteen patients suffering from transient acute confusional states (ACS) and 11 patients with probable Alzheimer′s disease (AD) who were comparable for age and Mini-Mental State score were investigated with a naming and a comprehension task. The latter included both words that were previously included in the naming task and unfamiliar items. With five patients of each group, the assessment was repeated 1 to 3 days later. The number of misnamings was comparable for both groups. An effect of word frequency upon naming success was found only with the AD group. Unrelated misnamings were significantly more frequent in the ACS group. Closer analysis suggested that part of the unrelated misnamings in the ACS patients were caused by visual misperceptions. Behavioral strategies aiming at the target were more frequently exhibited by AD patients. Perseverations, especially of the intrusion type, were characteristic for ACS patients and only occasionally found with AD. There was an item consistency over time with naming failure in the AD, but not in the ACS group. Cross-modal performance consistency seemed greater in the ACS than in the AD group.
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Language Processes in Delirium and Dementia
2015, International Encyclopedia of the Social & Behavioral Sciences: Second EditionIn this article, we report current data on language and communication disorders in the most frequent primary progressive syndromes of dementia, namely Alzheimer's disease, vascular cognitive impairment, and dementia with Lewy bodies. Language deficits are also the core features of three variants of primary progressive aphasia, namely the nonfluent/agrammatic, semantic, and logopenic variants. This survey reveals that, like other cognitive functions, language is highly vulnerable to delirium and neurodegenerative diseases. In some of them, language deficits result from impairment to linguistic processes per se. In others, they are the direct consequence of impairments affecting working memory and executive functions.
Language and communication disorders associated with attentional deficits
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2011, Cognition and Acquired Language Disorders: An Information Processing ApproachDelirium Assessment in Older Adults
2010, Handbook of Assessment in Clinical Gerontology, Second EditionThis chapter provides contemporary information regarding the syndrome and its epidemiology, risk factors, diagnostic criteria, and psychosocial interventions. It includes a review of several of the most commonly employed clinical instruments designed to assess delirium and two case studies, to assist with assessing and understanding this complex syndrome. Clinical gerontologists consulting in hospitals and, to a lesser extent, outpatient settings, are likely to encounter delirious elderly patients. Delirium is a complex neuropsychiatric syndrome that is difficult to diagnose. This challenge is particularly concerning given prevalence rates ranging from 12 to 89%, and the many potential consequences of undiagnosed and untreated delirium (e.g., institutionalization, mortality). Although research regarding delirium has increased, measures used to screen for delirium continue to have limitations, including questionable reliability, validity, and clinical utility. Given the challenges with delirium measures, it appears that identification of delirium is a task best addressed from a multidisciplinary approach, perhaps involving physicians, nurses, and psychologists, as well as other medical staff. Assessment should include a thorough review of a patient's medical history and current medical status, and the patient's behavior should be observed over time. The combination of a brief cognitive screening measure and a longitudinally administered behavioral observation checklist is warranted. The clinical gerontologist should give careful consideration to the possibility of delirium before undertaking an extensive cognitive evaluation of an elderly hospital patient. In many cases, it might be best to briefly assess the patient with a carefully chosen delirium instrument, and then recommend that the patient have an extensive cognitive evaluation after stabilization and discharge from the hospital to avoid confounding the effects of dementia and delirium.
Delirium and Language
2006, Encyclopedia of Language & LinguisticsDelirium is an acute state of confusion characterized by disturbances in consciousness and cognitive functioning. Delirium is one of the most prevalent cognitive disorders among the elderly population. This article provides a review of the clinical presentation of delirium and provides a brief discussion of its cognitive features, especially speech and language impairment.
Delirium in the elderly
1997, Psychiatric Clinics of North AmericaDelirium is a syndrome of disturbed consciousness, attention, and cognition or perception, which develops acutely, fluctuates during the course of the day, and is attributable to a physical disorder. 6 This syndrome is the focus of increasing attention because of its enormous impact on human suffering as well as on patient care costs. 45, 71 In the elderly, delirium is common, particularly in hospitalized patients. 30 It has a high rate of associated morbidity and mortality, 20, 37, 59 and significantly extends the length of hospital stay. 71 Its presence predicts posthospitalization cognitive decline and loss of independent community living. 20, 37, 40 It has been estimated that delirium is responsible for excess annual health care expenditures of $1 to $2 billion. 30 For all these reasons, delirium is emerging as a central focus for health care cost containment.
Delirium is a medically serious condition. In elderly patients, the presence of delirium may be the only clue to an underlying life-threatening disorder such as myocardial infarction or pneumonia. 46 Delirious patients are unable to monitor even basic self-care activities such as fluid intake and output, and thus are at risk of developing secondary conditions such as dehydration. In addition, in the midst of confusion and psychotic thinking, delirious patients may do dangerous things such as performing self-extubation, pulling out central and peripheral lines, wandering out into traffic, standing for hours in the snow in bare feet, falling down stairs, and jumping down laundry chutes.
Delirium is a treatable condition, even in the elderly patient with dementia. Early recognition of the syndrome, aggressive treatment of the underlying cause(s), and appropriate management of attendant behavioral problems all result in decreased morbidity and mortality, shorter lengths of hospitalization, and reduced costs of care. Each of these topics is addressed in the discussion to follow.