2.5. Geriatrics - Elderly Confusion Flashcards
Is confusion all about the Brain?
No, it can be caused by:
- Deafness
- Dysphonia
- Dysarthria
What is the Definition of Cognition?
The Mental Action / Process of Acquiring Knowledge and Understanding through Though, Experience, and the Senses
Note - This is much more than just Memory
How is a Diagnosis of the Cause of Cognitive Impairment made?
History:
- Onset - When / How Rapid
- Course - Fluctuating / Progressive Decline
- Associated Features - Other Illness / Functional Loss
What are the Features of Delirium?
- Disturbed Consciousness
- Change in Cognition
- Acute Onset and Fluctuant
- Disturbance in Emotions / Sleep-Wake Cycles / Psychomotor Behaviour
- Delusions
What Precipitates Delirium?
- Infection - Not Always a UTI
- Dehydration / Hypoxia
- Biochemical Disturbance / Drugs / Pain
- Constipation / Urinary Retention
- Alcohol or Drug Withdrawal / Sleep Disturbance
- Brain Injury - Stroke / Tumour / Bleed etc.
How is Delirium Treated?
- Treat the Cause
- Pharmacological Management - Drug Cessation (Anticholinergics / Sedatives)
- Non-Pharmacological Treatment - Re-Orientate / Reassure / Correct Sleep-Wake Cycle
What is Dementia?
Acquired Decline in Memory and Other Cognitive Functions in an Alert Person, Sufficiently Severe to cause Functional Impairment and Present for more than 6 months:
- Forgetting to Take Tablets
- Unable to use the Phone
- Difficulty Washing / Dressing
What are the Different Types of Dementia?
- Alzheimer’s
- Vascular Dementia
- Mixed Alzheimers / Vascular Dementia
- Dementia with Lewy Bodies
- Fronto-Temporal Dementia
- “Reversible Causes” Dementia
How does Alzheimer’s present?
- Slow, Insidious Onset
- Loss of Recent Memory First
- Progressive Functional Decline
What are the Risk Factors of Alzheimer’s?
- Age
- Vascular Risk Factors
- Genetics
How does Vascular Dementia present?
- Classically Step-Weise Deterioration
- Executive Dysfunction may Predominate
- Often Associated with Gait Problems
- Previous Vascular Issues - Diabetes / A.F. / I.H.D
How does Dementia with Lewy Bodies present?
- Very Fluctuant
- Hallucinations common
- Falls common
- Link with Parkinson’s Disease - 2/3 will have involvement
How does Fronto-Temporal Dementia present?
- Onset often at Earlier Age
- Early Symptoms different from other types of Dementia:
- a) Behavioral Changes
- b) Language Difficulties
- c) Memory Early on Often not Affected
- Lack insight into Difficulties
How is Dementia Diagnosed?
- History / MMSE
2. Motreal Cognitive Assessment (MoCA)
What is the Management of Dementia?
- Non-Pharmacological - Support / Cognitive Stimulation / Exercise / Environment Design
- Pharmacological - Cholinesterase Inhibitors (Alzheimers) / Anti-Psychotics
