12. Delirium and Dementia

Question 1

Hw is alzheimers different from mild cognitive impairment?

Answer 1

Alzheimers affects ability to carry out daily activities

Question 2

Wt are lewy bodies composed of?

Answer 2

Alpha synuclein

Question 3

3 characteristics of Picks disease?

Answer 3

behavior and speech problems

younger onset

Question 4

3 surgeries that can cause delirium? wn is it seen? precipitating factor?

Answer 4

orthopedic
AAA
Thoracic
seen post op day 1 or 2
associated w blood loss

Question 5

3 things that prevent delirium?

Answer 5

less tubes, restraints and drugs

Question 6

overall one year mortality for delirium?

Answer 6

35-40%

Question 7

Diagnosis of delirium?

Answer 7

Confusion Assesment Method (CAM)
1. Acute onset/fluctuating course
2. Inattention
+disorganized thinking and altered consciousness

Question 8

2 risk factors for delirium?

Answer 8

male

urinary retention

Question 9

Late stage symptoms of alzheimers?

Answer 9

Incontinence, unable to communicate/feed/dress/walk

Question 10

Time to death in end stage Alzheimer’s?

Answer 10

1 year or less

Question 11

What is the typical course for alzheimers? (4)

Answer 11

Preclinical - 20 yrs
Mild cognitive impairment - 5 years
Dymptomatic - 10 years
Death

Question 12

Another name for dementia?

Answer 12

Unspecified neurocognitive disorder

Question 13

Wt disorder shows step-wise progression (waxing and waning)?

Answer 13

Vascular type neurocognitive disorder

Question 14

when to medicates delirium patients?

Answer 14

severe agitation only

Question 15

first evaluations for delirium?

Answer 15

history
physical
CBC comp

Question 16

Genetic mutations causing early onset alzheimers?

Answer 16

Amyloid precursor protein, presenilin 1 and 2

Question 17

2 components of mini-cog? 2 results indicating impairment?

Answer 17

3 object recall and draw clock

1-2 recalled w abnormal clock –> impaired
0 recalled –> impaired

Question 18

Average time until death after alzheimers diagnosis?

Answer 18

10 years

Question 19

Biggest risk factor for AZD?

Answer 19

Age

Question 20

Wt are pick bodies composed of?

Answer 20

Tau

Question 21

2 pathologic signs of alzheimers? When do they develop?

Answer 21

Beta amyloid plaques develop during pre-clinical phase

Tau Neurofibrillary tangles develop slightly before symptomatic phase

Question 22

4 lab studies to do for dementia? Imaging?

Answer 22

CBC, Comp, B12, TSH

CT, not PET

Question 23

acronym for reversible causes of delirium?

Answer 23

DELIRIUM
Drugs
Electrolyte/Endocrine disturbance
Lack of drugs
Infection
Reduced sensory input
Intracranial
Urinay/fecal
Major organ issues

Question 24

Gene causing late onset alzheiers? # of copies and relative risk?

Answer 24

ApoE gnee e4
One copy 3X risk
Two copies 8-12 X risk

Question 25

Hw is progression of alzheimers affected by age?

Answer 25

Older age at diagnosis –> faster progression

Question 26

first line drug tx for delirium? alternative?

Answer 26

Haloperidol

atypical antipsychotics

Question 27

Dscb the memory loss in alzheimers?

Answer 27

Slow loss, short term affected more than remote memory