13 Confusion in the Elderly Patient Flashcards
State the 5 main (general causes) of confusion in an elderly patient. (4Ds and an M)
- Drugs
- Dementia
- Delirium
- Depression
- Metabolic
Define delirium.
- Acute onset of altered mental status and fluctuating course
- Inattention
- Disorganised thinking/confusion
- Altered level of conciousness
What is dementia?
Decline in higher cortical function
Usually of pregressive nature
Impairment of memory, intellect, personality
Failure of individual to cope with everyday affairs of life
What is zopiclone used to treat?
Insomnia (=sleeping pill)
Give some specific metabolic causes of confusion in elderly patients.
- Hyper/hypothyroidism
- Vitamin B12 deficiency
- Normal pressure hydrocephalus
What is the cut off age for classifying dementia as early or late onset?
65yrs
Before 65 yrs= early onset
After 65 yrs= late onset
What are the 5 main types of dementia?
What are the 3 macroscopic changes to the brain seen in alzheimers dementia?
What are the 2 microscopic changes we would see in alzheimer’s dementia (that result in neuronal death) ?
- Senile amyloid plaques
- Increased concentration of acetylcholinesterase enzyme
- Neurofibrillary tangles
State 3 genetic markers which predispose to early onset alzheimer’s dementia and 1 genetic marker than predisposes to late onset alzheimer’s dementia.
(genetic markers for this are not a common test)
How does alzheimer’s dementia present? (4)
What pharmacological treatment is available for alzheimer’s dementia?
AChE inhibitors- reduce breakdown of acetylcholine
What are Lewy bodies? Where are they deposited in Lewy body dementia? (4)
Lewy bodies= aggregation of alpha-synuclein protein, spherical
Where?
- Substantia nigra
- Temporal lobe
- Frontal lobe
- Cingulate gyrus
How does Lewy body dementia present? (3 core clinical features)
How can you differentiate parkinson’s from lewy body dementia?
Lewy body- parkinsonian traits=last
Parkinsons disease- parkinsonian traits first
How is fronto-temporal dementia caused?
Atrophy of frontal and temporal lobes
Peak onset= 55-65 yrs
How does fronto-temporal dementia present? (think lobe dysfunction)
What are the risk factors for vascular dementia? (same as CVD risk factors)
Vascular dementia: occurs due to cerebrovascular disease (ischaemic/haemorrhagic)
- Hypertension
- Smoking
- Diabetes
- Vascular disease
How is the deterioration in cognitive function caused by vascular dementia described? Why is this?
Step-wise deterioration of cognitive function- due to vascular incident
Should patients with vascular dementia be given AChE inhibitors?
Only if they have a suspected co-morbidity such as Alzheimer’s dementia or dementia with lewy bodies
Explain how the AIDS-dementia complex (ADC) can occur.
HIV-infected macrophages enter brain- cause indirect damage to neurones
Once established= rapid progression
How does the AIDS- Dementia complex present?
- Cognitive impairment
- Psychomotor retardation (slowing-down of thought and a reduction of physical movements)
- Tremor
- Ataxia
- Dysarthria
- Incontinence
What tests should be done within 6 months of a new diagnosis of dementia?
- FBC
- U&E
- CRP
- TFTs (thyroid function)
- LFTs
- Random blood sugar
- Vitamin B12 and folate
What allowance are those who have dementia allowed to receive from the government?
Personal independence payment (used to be disability living allowance)
What are the 2 types of delirium?
Hypoactive and hyperactive
What can cause delirium? (DELIRIUM pneumonic)
(pathophysiology: thought to be cholinergic-dopaminergic imbalance)
Drugs
Endocrine
Liver failure
Intracranial
Renal failure
Infections
Urinary retention/ constipation
Metabolic
If a patient has delirium, what investigations should be done?
What is haloperidol?
Haloperidol= an antipsychotic medication
–> to treat delirium/ schizophrenia etc
Differentiate between dementia and delirium.
How do we assess a patient who is unconcious?
