15 - confusion and delirium Flashcards
Alzheimers cause?
mx?
Atrophy of brain tissue due to accumulation of amyloid protein plaques
anticholinesterase inhibitors drugs (donepezil, galantamine, rivastigmine), NMDA receptor antagonists (currently only memantine
Lewy body dementia related to? pathology? sx?
mx?
parkinsons
Accumulation of Lewy bodies in brainstem and neocortex.
Fluctuating symptoms, associated with symptoms and sleep disturbance.
Memory usually spared until later.
Presence of hallucinations WHICH DO NOT TROUBLE THE PATIENT
rivastigmine
Eg causes of delirium … name 5
stroke, drugs, thyroid disease, anaesthesia, infection, CNS malignancies, subdural haematoma, electrolyte disturbance, sleep deprivation, drug withdrawal, normal pressure hydrocephalus
features of delirium
Disorientation Reduced level of consciousness Inattention Hallucinations Fluctuating mood Altered personality
Symptoms fluctuate and are worse at night
mx of delirium
Try talking the patient down.
Treat underlying condition
Best managed with lorazepam (oral or iv) Haloperidol is usually contraindicated.
May have to resort to restraints or seclusion, though this is difficult in a non-psych setting.
Prevent by minmising sensory deficits and maintaining orientation (i.e. nurse in a well-lit room)
Delirium vs dementia
Delirium Acute onset Fluctuating course Impaired attention Decreased consciousness Usually reversible Often accompanies physical illness Hospital acquired
Dementia Chronic illness Progressive, slow Attention preserved Consciousness preserved Usually irreversible Usually without physical problems Community acquired
delirium tremens features?
Agitation, seizures, tremor, sweating, Lilliputian hallucinations, confusion, aggression, arrhythmia, hyperpyrexia.
Occurs after two days without alcohol and usually lasts as long.
Mx of delirium trememens
thimamine and benzos eg lorazepam
triad of wernickes ?
nystagmus
ataxia
confusion
