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4 Neurology > 13 Confusion in the Elderly Patient > Flashcards

13 Confusion in the Elderly Patient Flashcards

1
Q

State the 5 main (general causes) of confusion in an elderly patient. (4Ds and an M)

A
  1. Drugs
  2. Dementia
  3. Delirium
  4. Depression
  5. Metabolic
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2
Q

Define delirium.

A
  • Acute onset of altered mental status and fluctuating course
  • Inattention
  • Disorganised thinking/confusion
  • Altered level of conciousness
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3
Q

What is dementia?

A

Decline in higher cortical function

Usually of pregressive nature

Impairment of memory, intellect, personality

Failure of individual to cope with everyday affairs of life

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4
Q

What is zopiclone used to treat?

A

Insomnia (=sleeping pill)

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5
Q

Give some specific metabolic causes of confusion in elderly patients.

A
  • Hyper/hypothyroidism
  • Vitamin B12 deficiency
  • Normal pressure hydrocephalus
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6
Q

What is the cut off age for classifying dementia as early or late onset?

A

65yrs

Before 65 yrs= early onset

After 65 yrs= late onset

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7
Q

What are the 5 main types of dementia?

A
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8
Q

What are the 3 macroscopic changes to the brain seen in alzheimers dementia?

A
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9
Q

What are the 2 microscopic changes we would see in alzheimer’s dementia (that result in neuronal death) ?

A
  1. Senile amyloid plaques
    1. Increased concentration of acetylcholinesterase enzyme
  2. Neurofibrillary tangles
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10
Q

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)

A
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11
Q

How does alzheimer’s dementia present? (4)

A
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12
Q

What pharmacological treatment is available for alzheimer’s dementia?

A

AChE inhibitors- reduce breakdown of acetylcholine

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13
Q

What are Lewy bodies? Where are they deposited in Lewy body dementia? (4)

A

Lewy bodies= aggregation of alpha-synuclein protein, spherical

Where?

  • Substantia nigra
  • Temporal lobe
  • Frontal lobe
  • Cingulate gyrus
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14
Q

How does Lewy body dementia present? (3 core clinical features)

How can you differentiate parkinson’s from lewy body dementia?

A

Lewy body- parkinsonian traits=last

Parkinsons disease- parkinsonian traits first

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15
Q

How is fronto-temporal dementia caused?

A

Atrophy of frontal and temporal lobes

Peak onset= 55-65 yrs

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16
Q

How does fronto-temporal dementia present? (think lobe dysfunction)

A
17
Q

What are the risk factors for vascular dementia? (same as CVD risk factors)

Vascular dementia: occurs due to cerebrovascular disease (ischaemic/haemorrhagic)

A
  • Hypertension
  • Smoking
  • Diabetes
  • Vascular disease
18
Q

How is the deterioration in cognitive function caused by vascular dementia described? Why is this?

A

Step-wise deterioration of cognitive function- due to vascular incident

19
Q

Should patients with vascular dementia be given AChE inhibitors?

A

Only if they have a suspected co-morbidity such as Alzheimer’s dementia or dementia with lewy bodies

20
Q

Explain how the AIDS-dementia complex (ADC) can occur.

A

HIV-infected macrophages enter brain- cause indirect damage to neurones

Once established= rapid progression

21
Q

How does the AIDS- Dementia complex present?

A
  • Cognitive impairment
  • Psychomotor retardation (slowing-down of thought and a reduction of physical movements)
  • Tremor
  • Ataxia
  • Dysarthria
  • Incontinence
22
Q

What tests should be done within 6 months of a new diagnosis of dementia?

A
  • FBC
  • U&E
  • CRP
  • TFTs (thyroid function)
  • LFTs
  • Random blood sugar
  • Vitamin B12 and folate
23
Q

What allowance are those who have dementia allowed to receive from the government?

A

Personal independence payment (used to be disability living allowance)

24
Q

What are the 2 types of delirium?

A

Hypoactive and hyperactive

25
Q

What can cause delirium? (DELIRIUM pneumonic)

(pathophysiology: thought to be cholinergic-dopaminergic imbalance)

A

Drugs
Endocrine
Liver failure
Intracranial
Renal failure
Infections
Urinary retention/ constipation
Metabolic

26
Q

If a patient has delirium, what investigations should be done?

A
27
Q

What is haloperidol?

A

Haloperidol= an antipsychotic medication

–> to treat delirium/ schizophrenia etc

28
Q

Differentiate between dementia and delirium.

A
29
Q

How do we assess a patient who is unconcious?

A

4 Neurology (22 decks)

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