せん妄について解説。突然、認知症が悪化することはありますか？　#認知症　＃せん妄 / delirium

01:08 Symptoms of Delirium 02:59 People Susceptible to Delirium 04:00 Frequently Asked Questions and Treatment Today, we'll explain "delirium." "Delirium" is a physical illness that refers to a clouding of consciousness in elderly people. "Has his dementia suddenly worsened?" "My grandfather has been acting irritably lately." "He suddenly became strange after surgery." "He became strange after being admitted to the ICU." We often hear concerns like these, but this is called "delirium." Today, we'll explain the mechanism by which delirium occurs and the best treatments. ■Symptoms of Delirium The symptoms of delirium are somewhere between "conscious" and "unconscious." You feel dazed or disoriented. It's like dreaming. You may also experience decreased attention and memory loss. Even if you do remember, it may be hazy or cognitively impaired. It's as if the patient understands themselves, but doesn't, and understands others, but doesn't. Disorientation can cause people to lose track of where they are, or they can fall and break a bone. This is what happens when a patient is somewhere between conscious and unconscious. Surgeons accustomed to seeing postoperative delirium only refer to severe confusion as delirium, but doctors who actually treat dementia are well aware that there are cases of mild delirium. It can appear as if the dementia has suddenly worsened. Other symptoms are normal, but the patient may have trouble using a spoon or be unsteady on their feet. This can sometimes turn out to be delirium when a physical illness is diagnosed. Therefore, delirium is not a definitive category, but rather a somewhat spectrum, a fuzzy concept. ■ People prone to delirium ・Elderly people ・Frail people, people with dementia ・Physical illness People with physical illness. Consciousness can become clouded when there is physical damage. Alcohol and Drugs People who drink a lot of alcohol, abuse drugs, or take sleeping pills are more likely to experience clouding of consciousness. These people are also more likely to develop postoperative delirium. People who have a habit of losing consciousness through drugs or other means are more likely to become limp. I also believe they are more likely to experience spectrum-wide clouding of consciousness. ■Common Expectations and Treatment These are the kinds of questions I often hear. Q. Does their dementia suddenly seem to have worsened? Q. They seem irritable lately. Why? I often hear these two questions in my outpatient clinic. Q. Is it in the ICU, or after surgery? This is a common type of delirium. In cases like this, it's important to "reexamine the physical illness" rather than simply ignoring the family's opinion. Because the patient is clouded, they won't be able to tell you about pain or a fever. Therefore, it's important to thoroughly examine them from head to toe. These are common problems. Heart, lung, liver, or kidney problems Presence or absence of infection, fractures Alcohol, incorrect medication use Fractures are surprisingly easy to overlook, and they are often present. A simple stumble can cause a fracture, and the resulting pain can lead to delirium. Since the patient may not even realize that pain is present in various parts of the body, a thorough physical examination is important. If the patient is hospitalized, nurses will be closely monitoring them, and family members may say things like, "He's protecting his right leg more than usual," so it's easy to tell, but it's important not to overlook them. It's also important to ask questions if family members don't mention anything. Other common causes are secret alcohol use and incorrect medication use. It's also important not to overlook epilepsy. Many family members believe that only grand mal seizures, where the entire body convulses, are epilepsy, but this is not the case; sometimes there are partial seizures, where only one part of the body is trembling. Memory loss can also occur. This is also important not to overlook. Some people mistakenly believe that delirium can be treated with antipsychotics, but antipsychotics are actually medications that suppress agitation caused by delirium-related confusion. Rather than treating the patient with antipsychotics, it is important to identify and treat the underlying physical illness. Of course, this is difficult because some patients are currently undergoing treatment and some cannot be cured, but the general rule is to focus on identifying physical abnormalities and avoid medication as much as possible. While medication may be used if delirium occurs while undergoing physical treatment, the general rule is to first identify the physical illness. If you have never heard the term "delirium," I hope you will keep it in the back of your mind. Many of the viewers of this video are in their 40s and 50s, and I believe many of them have experience caring for their parents. I made this video because I believe keeping d...