Pathophysiology
Clinical meaning
The clinician managing delirium and dementia makes complex diagnostic and prescriptive decisions: differentiating delirium from dementia (and identifying delirium superimposed on dementia), prescribing targeted pharmacotherapy, managing behavioral symptoms with attention to safety, implementing prevention protocols, and guiding goals-of-care conversations. Advanced delirium management: the clinician orders and interprets the diagnostic workup, identifies and treats the precipitating cause, minimizes medication-related delirium risk (anticholinergic burden assessment using tools like the Anticholinergic Cognitive Burden scale), and prescribes symptom management judiciously. For dementia, the clinician prescribes cholinesterase inhibitors and memantine, manages behavioral symptoms using the DICE approach, navigates the complex antipsychotic risk-benefit discussion (black box warning), initiates advance care planning, and manages end-of-life decisions specific to dementia (feeding tube futility, comfort-focused care, hospice referral). Emerging dementia therapeutics: anti-amyloid monoclonal antibodies (lecanemab, donanemab) represent the first disease-modifying treatments for early Alzheimer disease, targeting and clearing amyloid-beta plaques. Lecanemab (Leqembi) received FDA approval in 2023 for early AD with confirmed amyloid pathology; it slows cognitive decline by 27% over 18 months but carries risks of ARIA (amyloid-related imaging abnormalities: brain edema and microhemorrhages, occurring in 12-21% of...