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Neuro > 11) Confusion in Elderly Patients > Flashcards

11) Confusion in Elderly Patients Flashcards

1
Q

What are the 5 causes of Confusion in Elderly Patients ?

A

1) Delirium
2) Depression
3) Drugs - Morphine, Alcohol, Zopiclone
4) Dementia
5) Metabolic - HypoThyroidism, Hypercalcaemia , B12 Def, Normal Pressure Hydrocephalus

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2
Q

What is Dementia ?

A

Progressive decline in higher cortical function, leading to impairment of memory, intellect and personality

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3
Q

What is the presentation of dementia ?

A

1) Memory Deficit - Unable to learn new information and have short term loss
2) Behavioural Changes
3) Physical Changes - Incontinence, difficulty swallowing
4) Language Disorders - Difficulty understanding language
5) Apraxia - Difficulty carrying out motor skills which they have already learnt

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4
Q

What two categories can dementia be classified into ?

A

Early Onset and Late Onset

> Depends on whether symptoms manifest before 65 YO

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5
Q

What is the pathophysiology of Alzheimer’s

Microscopic

A

Macroscopic:
> Global Atrophy of brain lobes, typically Frontal, Parietal and Temporal Lobe
> Sulcus Widening
> Dilation of 3rd and 4th Ventricles

Microscopic:
> Senile Amyloid Plaques - derived from proteolytic breakdown from B amyloid precursor protein due to increase Acetylcholinesterase
> Neurofibrillary Tau Tangles

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6
Q

What Genetic Markers can be Observed in Alzheimer’s
> Early Onset
> Late Onset

A

Early:
> B amyloid precursor protein
> Presenilin 1 and 2

Late:
> increased expression of ApoE gene - this increases permeability of the brain to Amyloid Plaques

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7
Q

How do you treat Alzheimer;s

A

Acetylcholinesterase Inhibitor
> Donepezil
> Galantamine
> Rivastigmine

Memantine - Inhibits Glutamate action

Treatment depends on severity
- Mild to Severe
Monotherapy and then add
Give Memantine in addition

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8
Q

What is the pathophysiology of Dementia with Lewy Bodies

A

> Lewy Bodies use up Ach
- Aggregation of a - synuclein protein
Deposited in the Substania Nigra, Temporal Lobe and Frontal Lobe

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9
Q

What is the typical presentation of Dementia with Lewy Body ?

A

Triad:

1) Fluctuating Cognition with varying attention and cognition
2) Visual Hallucinations
3) Features of Parkinsons

Very similar to parkinson’s with other presentations of dementia such as Memory Loss

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10
Q

How do you treat Dementia with Lewy Body

A

Acetylcholinesterase Inhibitors

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11
Q

What is the pathophysiology of Frontal - Temporal Dementia ?

A

Atrophy of Frontal and Temporal Lobe

Peak onset 55-65

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12
Q

What is the Presenting Complaint of FT Dementia?

A 
Dependent on which lobe has been affected 
> Behaviour 
> Impaired judgement 
> Speech impairment 
> Primitive Reflexes 
- Grasp Reflex 
- Palmomental Reflex
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13
Q

What is the Pathophysiology of Vascular Dementia ?

A

Infarcts of the brain tissue due atherosclerosis

Risk factors:

1) Hypertension
2) Smoking
3) Vascular Disease
4) Diabetes

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14
Q

What is the presenting complaint of Vascular Dementia ?

A

Step wise Decline in Cognitive Function with Focal Neurological Symptoms

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15
Q

What is the pathophysiology of AIDs Dementia Complex ?

A

HIV infected macrophage enters the braid and causes indirect damage to neurones

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16
Q

What is the presenting complaint of ADC

A 
> Cognitive Impairment 
> Psychomotor retardation 
> Tremor
> Ataxia 
> Dysarthria 
> Incontinence
17
Q

What is treatment for ADC ?

A

Anti virals

18
Q

What Investigations are carried out for dementia ?

A 
> FBC 
> UEs
> CRP
> TFTs 
> LFTs
> B12 and Folate 
> MMSE 
> CT / MRI
19
Q

What common management plan is used for all dementia cases ?

A 
Using Bio Psycho Social Model 
> Mobility Problems 
> Daily Living 
> Ability to learn new skills
> Financial problems
20
Q

Define Delirium

A

Acute onset of altered mental status and fluctuating course
> If a person has 2 or more on the CAM score they have delirium
1) Acute Change or fluctuating mental status
2) Altered Consciousness
3) Inattention
4) Disorganised thinking

21
Q

List some causes of Delirium

A 
D - Drug Toxicity 
=> Withdrawal: Alcohol, Cocaine
=> Anti Cholinergics, Opiates, Anti histamines, Dopamine Agonists 
E - Endocrine 
=> Hyper/Hypo Thyroidism 
=> Addison's 
=> Cushing's 
L- Liver Failure 
I - Intracranial 
R - Renal Failure 
I - Infections 
=> Pneumonia, UTIs, Sepsis, Meningitis 
U - Urinary Retention / Faecal 
M - Metabolic 
=> Electrolyte imbalance
22
Q

What is the treatment of Delirium

A

Treat underlying cause

23
Q

Dementia vs Delirium

A 
Onset:
> Slow Vs Rapid 
Course 
> Steady Decline Vs Fluctuant 
Hallucinations
> Rare Vs Present 
Speech
> Slow Vs Slow/ Fast
GCS
> Normal Vs Reduced 
Consciousness 
> Clear Vs Impaired
24
Q

How can you assess a patient that is unconscious ?`

A 
> Check breathing / Central Pulse 
> Lie them on their left side 
> Call for Help 
> Assessing 
- Sternal Rub 
- Trapezius Squeeze 
- Fingernail pressure test 
> Assess GCS

Neuro (19 decks)

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