Neurocognitive disorders begin with delirium, followed by the syndromes of Major and Mild Neurocognitive disorders and their etiological subtypes. These subtypes include Alzheimer’s disease, vascular, Lewy bodies, frontotemporal, Huntington’s disease, as well as neurocognitive disorders due to Parkinson’s disease, traumatic brain injury, HIV infection, multiple etiologies, and/or another medical condition. Although cognitive deficits are present in many if not all psychological disorders, only disorders whose core features are cognitive are included in the neurocognitive disorders category in the DSM-5.
They are the disorders in which impaired cognition has not been present since an individual’s birth and/or early life. As a result, they represent a decline from a person’s previously attained level of functioning (DSM-5, 2013, p. 602 & 603). For the purpose of this report I will be discussing how an individual with Alzheimer’s disease is affected by the development of a Urinary Tract Infection in relation to Delirium.
In diagnosing Alzheimer’s professionals should look for memory loss that disrupts daily life, challenges in planning or problem solving, difficulty in completing familiar tasks at home, or at work or leisure, confusion with time or place, difficulty understanding visual images and spatial relationships, new problems with dialect in speaking or writing, misplaced items and a loss of being able to retrace steps, decrease or poor judgment, withdrawal from occupational or social activities, and changes in mood and personality.
It causes a slow decline in an individual’s memory, reasoning, and thinking (Lyketsos,et al. , 2011). As Alzheimer’s is a form of dementia it is important that professionals understand the difference between Delirium and dementia, as well as when a change in behavior is the cause of delirium and not a part of a person’s dementia. Because delirium results in confusion, disruption in thinking and behavior, changes in perception, attention, mood and activity level, individuals living with dementia are highly susceptible to delirium (Wass, et al. 2008).
However, delirium in many has a tendency to go unrecognized because it shares many of the same symptoms as dementia. In telling the difference, dementia features changes in memory and intellect that are slowly progressing and evident over months or years; whereas, delirium symptoms tend to be more abrupt in confusion and take on more sudden changes in a person’s dementia. Over the period of days or weeks, confusion of delirium fluctuates dramatically, unlike the subtle decline of Alzheimer’s disease.
Inattention and disorganized conversations and thinking are also separating facets that differentiate delirium and dementia. If an individual has a pre-existing mental impairment, delirium causes it to worsen (Wass, et al. , 2008). Urinary Tract Infections occur when germs enter into the urethra and travel up into the bladder and kidneys. A UTI generally shows itself by producing burning with urination, abdominal pain, possible bloody urine, and occasional fever. The prevalence of a UTI increases with a person’s age, similar to dementia.
Women are more prone to developing UTIs than men as a result of the female body having shorter urethras, which makes it easier for the bacteria to travel to the bladder (Mody & Mehta, 2014). An individual who has diabetes, kidney problems, or a weakened immune system (such as the aged) has a higher risk for UTIs. Women who have gone through menopause face higher risk because of the lack of estrogen in their system that would normally help fight off the growth of bacteria. UTIs are normally diagnosed through urine tests, ultrasound exams, x-rays, and CAT scans.
However, elderly people or those with dementia may miss or dismiss these symptoms altogether (Ostaszkiewicz, et al. , 2008). While younger people experience distinct physical symptoms as a result of a UTI, such as an increased need to urinate or painful urination, seniors with a UTI may develop increased symptoms of confusion, agitation, or withdrawal. In response, many see these behavioral changes as conditions of advanced aging or dementia. If the UTI goes untreated for too long, the infection can spread to the bloodstream and become ultimately life-threatening.
Furthermore, UTIs have the ability to speed up the progression of dementia, without necessarily triggering dementia or Alzheimer’s. According to the Alzheimer’s Society, UTIs can cause distressing behavior changes in individuals with Alzheimer’s: also known as delirium. These symptoms develop quickly and can be seen as agitation or restlessness, as well as hallucination or delusions (Alzheimer’s Society, 2015, alzheimers. org). The relationship between a UTI and delirium is intricate. As the body fights to sustain a balanced equilibrium for all of its processes, bacteria takes advantage of any weakened part of the body.
By feeding off the body’s nutrients, the bacteria multiply in bodily fluids. Because bodily fluids include minerals such as sodium, potassium, calcium, phosphorus, and magnesium, we call them mineral electrolytes. The instabilities of the mineral electrolytes will then reach the brain causing a malfunction. In turn, delirium is produced (Manepalli, et al. , 1990). Because a UTI can appear without symptoms in the elderly, it is imperative that caregivers have their patients’ urine tested at the slightest sign of behavioral change.
UTIs are normally treated with antibiotics that lower the number of bacteria in the bladder and urinary tract, re-establishing the electrolytes. Once the bacterium is lowered and the body returns to a healthy state, a person’s delirium can leave as abruptly as it started (Manepalli, et al. , 1990). As a counselor or therapist is important to communicate with the individual’s primary care physician as the symptoms observed can be helpful in determining the correct diagnosis. The focus of quality dementia care should undoubtedly be on providing competent, compassionate, and person-centered care.
In this instance because there is evidence from the history, physical, and laboratory findings that the disturbance is in direct response to the psychological influences of another medical condition in relation to another neurocognitive disorder with behavioral disturbance, the delirium would be classified as being due to multiple etiologies. According to the DSM-5 the correct coding would be 293. 0 (F05) delirium due to urinary tract infection; 294. 11 (F02. 81) major neurocognitive disorder due to Alzheimer’s disease (DSM-5, 2013, p. 596-611).