504. Delerium and dementia Flashcards
What is delerium?
Impaired cognition leading to hyper or hypoactivity
Change in perception and conciousness may experience hallucinations
What are the risk factors for delerium?
Over 65
Dementia, previous cognitive impairement
Hip fracture
Acute illness
Pain
How do you test for delirium?
Find cause (UTI, pneumonia, MI)
Do FBC, U&E, LFT, ABG
Septic screen,
Consider ECG, maalria film, LP, EEG, CT
How do you manage delirium?
Re-orientate
Enourage visits
Monitor flui dbalance
Encourage physical activity
Practice sleep hygeine
Review meds
How do you diagnose dementia?
Global decline over an extended period of time (months)
Validated dementia scorign system (AMTS)
Exam and medication review
How do you investigate dementia?
Look for reversible- TSH, B12, folate, tiamine
MSU, FBC, ESR, U&E
MRI
Functional iamging (SPECT)
What drugs are avoided in those with vascular dementia??
Acetylcholine inhibitors
Memantine
What drugs are avoided in lewy body dementia
antipsychotics
What other considerations should be taken when diangosing dementia?
Depression- trial citalopram
Capacity
Describe the symptoms of alzheimer’s disease?
Globla impairment of cognitive funciton
may later lead to difficulty funcitoning
mood change
pyschosis
agnosmia
What are the causes of alzheimer’s disease?
Accumulation o fbeta amyloid peptide
Progressive neuronal damage
Neurofibrillary tangles
Vascular effects- 95% show signs of vascular dememntia
Disucss the acetylcholinesterase inhibitors used to treat dementia?
Donezipil, Rivagastigimine, galantamine
Primary use:alzheimer’s disease
Evidence for rivagastimine in parksinsons and lewy body
What are the side effects of the acetylcholinesterase inhibiotors?
Excaerbation of peptic ulcer disease
Exacerbation of heart block
What antiglutamergic medications can be used in dimentia?
Who are they used for
What are the side effects
Memantine
Late stage AD
Hallucinations, Confusion, Hypertonia, Hypersexuality
What antipsychotics can be used in dimentia treatment?
Only consider is secere non cognitive symptoms.
Avoid in Lewy body, AD and vascular
