9. Dementia and delirium

Question 1

what is dementia?

Answer 1

a chronic, progressive syndrome of insiduous onset

Question 2

what are the cognitive symptoms of dementia?

Answer 2

impaired memory, oritentation, learning capacity - temporal lobe
impaired judgement - frontal lobe

Question 3

what are the behavioural symptoms of dementia?

Answer 3

agitation, aggression (frontal lobe), wandering, sexual disinhibition (frontal lobe)

Question 4

what are some other non cognitive symptoms?

Answer 4

depression, anxiety
psychotic features - visual and auditary hallucinations, persecutory delusions
sleep symptoms - insomnia, daytime drowsiness

Question 5

what diagnoses are you excluding in dementia?

Answer 5

hypothyroidism
hypercalcaemia 
b12 defiency 
normal pressure hydrocephalus - abnormal gait, incontinence, confusion
delirium

Question 6

what are the macroscopic pathological features of alzheimer’s disease?

Answer 6

global cortical atrophy
sulcal widening
enlarged ventricles

Question 7

what are the microscopic pathological features of alzheimer’s disease?

Answer 7

plaques - composed of amyloid beta

tangles - hyperphosphorylated tau

Question 8

how are neurones killed?

Answer 8

plaques and tangles and because neurogenesis is limtied can not be replaced. usually affects cholinergic, noradrenergic, serotonergic and those expressing somatostain

Question 9

what is vascular dementia caused by and how does it present?

Answer 9

cognitive impairment caused by cerebrovascular disease - previous stroke, hypertension, hypercholesterolaemia, diabetes, smoking
stepwise presentationq

Question 10

what is dementia with lewy bodies?

Answer 10

same disease as parkinson’s

if dementia precedes movement disroder - dementia with lewy bdies

Question 11

what is the pathology of dementia with lewy bodies?

Answer 11

aggregation of alpha synuclein forms spherical intracytoplasmic inclusions forming main deposits across the brain - substancia nigra, temporal, frontal lobe, cingulate gyrus

Question 12

how do people with dementia with lewy bodies present?

Answer 12

fluctuating cognition and alertness, visual hallucinations, parkinsonian features,

Question 13

what must you not give to people with dementia with lewy bodies?

Answer 13

antipsychotics (dopamine antagonists) as can lead to neuroleptic malignant syndrome which is an emergency - fever, encephalopathy, vital signs instability, elevated creatine phosphokinase, rigidity

Question 14

what is frontotemporal dementia?

Answer 14

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

Question 15

what is AIDS dementia complex?

Answer 15

people with HIV living longer - increasing prevalence

Question 16

what is the pathology of aids dementia complex?

Answer 16

entry of HIV infected macrophages into the brain is though to lead to indirect damage to neurones

Question 17

what are the clinical features of aids dementia complex?

Answer 17

insiduous onset but rapid progression

cognitive impairment, psychomotr retardation, tremour, ataxia, dysathria, incontinence

Question 18

what is the management of dementia?

Answer 18

Ach esterase inhibitors
NMDA antagonists 
explain diagnosis and possible problems
driving
fincances
day care and respite care
nursing home

Question 19

what is delirium?

Answer 19

acute confusional state, often reversible, due to neuronal damage and inflammation

Question 20

how are dementia and delirium linked?

Answer 20

dementia can predipose to episodes of delirium

Question 21

what are the features of delirium?

Answer 21

rapid onset confusion
clouded consciousness
fluctuating course
transient visual hallucinations 
often exaggerated emotional responses

Question 22

what are the two types of delirium?

Answer 22

hypoactive - withdrawn, quiet, sleepy

hyperactive - restless, agitated, aggresive

Question 23

when is delirium worse?

Answer 23

at start and end of day perhaps due to endogenous cortisol levels

Question 24

what are the causes of delirium?

Answer 24

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

Question 25

how is delirium treated?

Answer 25

treat underlying cause

Question 26

what is the prognosis of someone with delirium?

Answer 26

increased risk of dementia, mortalitiy, long hospital stays and re admission