12. Delirium and Dementia Flashcards
Hw is alzheimers different from mild cognitive impairment?
Alzheimers affects ability to carry out daily activities
Wt are lewy bodies composed of?
Alpha synuclein
3 characteristics of Picks disease?
behavior and speech problems
younger onset
3 surgeries that can cause delirium? wn is it seen? precipitating factor?
orthopedic AAA Thoracic seen post op day 1 or 2 associated w blood loss
3 things that prevent delirium?
less tubes, restraints and drugs
overall one year mortality for delirium?
35-40%
Diagnosis of delirium?
Confusion Assesment Method (CAM)
1. Acute onset/fluctuating course
2. Inattention
+disorganized thinking and altered consciousness
2 risk factors for delirium?
male
urinary retention
Late stage symptoms of alzheimers?
Incontinence, unable to communicate/feed/dress/walk
Time to death in end stage Alzheimer’s?
1 year or less
What is the typical course for alzheimers? (4)
Preclinical - 20 yrs
Mild cognitive impairment - 5 years
Dymptomatic - 10 years
Death
Another name for dementia?
Unspecified neurocognitive disorder
Wt disorder shows step-wise progression (waxing and waning)?
Vascular type neurocognitive disorder
when to medicates delirium patients?
severe agitation only
first evaluations for delirium?
history
physical
CBC comp
Genetic mutations causing early onset alzheimers?
Amyloid precursor protein, presenilin 1 and 2
2 components of mini-cog? 2 results indicating impairment?
3 object recall and draw clock
1-2 recalled w abnormal clock –> impaired
0 recalled –> impaired
Average time until death after alzheimers diagnosis?
10 years
Biggest risk factor for AZD?
Age
Wt are pick bodies composed of?
Tau
2 pathologic signs of alzheimers? When do they develop?
Beta amyloid plaques develop during pre-clinical phase
Tau Neurofibrillary tangles develop slightly before symptomatic phase
4 lab studies to do for dementia? Imaging?
CBC, Comp, B12, TSH
CT, not PET
acronym for reversible causes of delirium?
DELIRIUM Drugs Electrolyte/Endocrine disturbance Lack of drugs Infection Reduced sensory input Intracranial Urinay/fecal Major organ issues
Gene causing late onset alzheiers? # of copies and relative risk?
ApoE gnee e4
One copy 3X risk
Two copies 8-12 X risk
Hw is progression of alzheimers affected by age?
Older age at diagnosis –> faster progression
first line drug tx for delirium? alternative?
Haloperidol
atypical antipsychotics
Dscb the memory loss in alzheimers?
Slow loss, short term affected more than remote memory
