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What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?

Delirium in older adults with dementia may be a sign of preventable and treatable medical problems or serious underlying illnesses such as a myocardial infarction, urinary tract infection, pneumonia, pain, or dehydration (Inuoye, Westendorp, & Saczynski, 2014). Common medications causing delirium include sedative-hypnotics, benzodiazepines, anti-depressants, diphenhydramine, and antipsychotics (Inuoye et al., 2014). In this case, the most likely causes might include a urinary tract infection since the patient reports urinary incontinence. Other risk factors to consider include drug overdose resulting in decreased glomerular filtration rate, dehydration, dementia which is an independent risk factor for delirium, and depression (Isik & Grossberg, 2017).

What additional testing should you consider if any?

Other additional tests include urinalysis, CBC, serum liver function tests, arterial blood gas measurements, blood glucose test, serum electrolytes, BUN, CT Scan, and ECG to rule out and assess for infections, focal neurological deficits, electrolyte disturbances, respiratory distress, cardiovascular assessment, and dehydration (Isik & Grossberg, 2017; Kalish, Gillham, & Unwin, 2014).

What are treatment options to consider with this patient?

The initial treatment and management options in patients presenting with symptoms suggestive of delirium superimposed on dementia should focus on three priorities including the patient safety, identifying causative etiologies, and managing delirium symptoms which can be achieved by the treatment of the causative etiology (Inouye et al., 2014). In this case, the management of UTI should include the use of empiric antibiotics once the diagnosis is confirmed. Some of the recommended antibiotics in the elderly patients for the management of UTI include Nitrofurantoin 100mg oral BID for seven days, or Trimethoprim/Sulfamethoxazole 160/800mg oral BID for seven days (Rowe & Juthani-Mehta, 2014).

References

Inouye, S., Westendorp, R., & Saczynski, J. (2014). Delirium in elderly people. Lancet, 383(9920), 911-922. http://doi: 10.1016/S0140-6736(13)60688-1

Isik, A., & Grossberg, G. (2017). Delirium in the elderly patients. New York, NY: Springer Publishing.

Kalish, V., Gillham, J., & Unwin, B. (2014). Delirium in older persons: Evaluation and management. Am Fam Physician, 90(3), 150-158. Retrieved from https://www.aafp.org/afp/2014/0801/p150.html

Rowe, T. A., & Juthani-Mehta, M. (2014). Diagnosis and management of urinary tract infection in older adults. Infectious Disease Clinics of North America, 28(1), 75–89. http://doi: 10.1016/j.idc.2013.10.004