9. Dementia and delirium Flashcards
what is dementia?
a chronic, progressive syndrome of insiduous onset
what are the cognitive symptoms of dementia?
impaired memory, oritentation, learning capacity - temporal lobe
impaired judgement - frontal lobe
what are the behavioural symptoms of dementia?
agitation, aggression (frontal lobe), wandering, sexual disinhibition (frontal lobe)
what are some other non cognitive symptoms?
depression, anxiety
psychotic features - visual and auditary hallucinations, persecutory delusions
sleep symptoms - insomnia, daytime drowsiness
what diagnoses are you excluding in dementia?
hypothyroidism hypercalcaemia b12 defiency normal pressure hydrocephalus - abnormal gait, incontinence, confusion delirium
what are the macroscopic pathological features of alzheimer’s disease?
global cortical atrophy
sulcal widening
enlarged ventricles
what are the microscopic pathological features of alzheimer’s disease?
plaques - composed of amyloid beta
tangles - hyperphosphorylated tau
how are neurones killed?
plaques and tangles and because neurogenesis is limtied can not be replaced. usually affects cholinergic, noradrenergic, serotonergic and those expressing somatostain
what is vascular dementia caused by and how does it present?
cognitive impairment caused by cerebrovascular disease - previous stroke, hypertension, hypercholesterolaemia, diabetes, smoking
stepwise presentationq
what is dementia with lewy bodies?
same disease as parkinson’s
if dementia precedes movement disroder - dementia with lewy bdies
what is the pathology of dementia with lewy bodies?
aggregation of alpha synuclein forms spherical intracytoplasmic inclusions forming main deposits across the brain - substancia nigra, temporal, frontal lobe, cingulate gyrus
how do people with dementia with lewy bodies present?
fluctuating cognition and alertness, visual hallucinations, parkinsonian features,
what must you not give to people with dementia with lewy bodies?
antipsychotics (dopamine antagonists) as can lead to neuroleptic malignant syndrome which is an emergency - fever, encephalopathy, vital signs instability, elevated creatine phosphokinase, rigidity
what is frontotemporal dementia?
frontal and temporal lobe atrophy
symptoms related to frontal lobe dysfunction - behavioural disinhibition, inappropriate social behaviour, loss of motivation without depression, repetitve behaviors, non fluent aphasia
what is AIDS dementia complex?
people with HIV living longer - increasing prevalence
what is the pathology of aids dementia complex?
entry of HIV infected macrophages into the brain is though to lead to indirect damage to neurones
what are the clinical features of aids dementia complex?
insiduous onset but rapid progression
cognitive impairment, psychomotr retardation, tremour, ataxia, dysathria, incontinence
what is the management of dementia?
Ach esterase inhibitors NMDA antagonists explain diagnosis and possible problems driving fincances day care and respite care nursing home
what is delirium?
acute confusional state, often reversible, due to neuronal damage and inflammation
how are dementia and delirium linked?
dementia can predipose to episodes of delirium
what are the features of delirium?
rapid onset confusion clouded consciousness fluctuating course transient visual hallucinations often exaggerated emotional responses
what are the two types of delirium?
hypoactive - withdrawn, quiet, sleepy
hyperactive - restless, agitated, aggresive
when is delirium worse?
at start and end of day perhaps due to endogenous cortisol levels
what are the causes of delirium?
vitamin deifeincy strokes, tia, epilepsy, infection UTI, pneumonia infection, drugs, alcohol intoxication or withdrawal thyroid or pancreas dysfunction hypoxia, renal damage or hepatic dmaage leading to electrolyte distrubances
how is delirium treated?
treat underlying cause
what is the prognosis of someone with delirium?
increased risk of dementia, mortalitiy, long hospital stays and re admission
