9 - Dementia and Delirium Flashcards
How can you distinguish between dementia and delirium:
Sleep-wake cycle
Attention
Arousal
Autonomic Features
Duration
Delusions
Course
Conscious level
Collateral history is key to distinguishing delirium from dementia!!!
How can you distinguish between dementia and delirium:
- Hallucinations
- Rate of onset
- Psychomotor activity
What are some common causes of delirium?
- Constipation
- Hypothermia
- Infections
- Metabolic disturbances
- Pain
- Environment
- Drugs
What routine investigations do you do for a patient with suspected delirium?
CONFUSION SCREEN
- Bloods
- Urinalysis
- ?Imaging
What are some of the tools for assessing cognition to screen for delirium and dementia?
- CAM (best for delirium)
- MMSE
- AMT
How do you use the CAM tool?
For a diagnosis of delirium by CAM, the patient must display:
- Acute onset and fluctuating course (Collateral History)
- Inattention (count back from 20 to 1)
AND EITHER
3. Disorganized thinking
OR
4. Altered level of consciousness
How do you do a MMSE?
Assess level of cognitive impairment
25-30 = Normal
21-24 = Mild
10-20 = Moderate
<10 = Severe
Cannot use if communication difficulties e.g learning disability
How do you do a AMTS?
Score less than 8 suggests cognitive impairment
How do you do a 4AT assessment?
Assessment for delirium
4 A’s
How do you do a 4AT assessment?
Assessment for delirium
4 A’s
What is a MoCA score?
Montreal Cognitive Assessment
26 or more = Normal
18 to 25 = Mild Cognitive Impairment
10-17 = Moderate Cognitive Impairment
<10 = Severe cognitive Impairment
How may somebody with delirium present?
- Agitated
- Disorientation
- Hallucinations
- Inattention
- Memory problems
- Change in mood or personality
- Disturbed sleep
How do you manage a patient with delirium?
- Find and treat underlying cause
- Supportive: clocks, familiar objects, visual/hearing/walking aids, side room so less noise, continuous care
- Medication: only if essential use small doses of haloperidol
- Prevention
What are some risks of using haloperidol and antipsychotics in the treatment of delirium?
- Cardiovascular issues (do ECG as can cause long QT, Vtach and sudden death)
- Extrapyramidal symptoms
- Sedation
- Anticholinergic effects including increased confusion, cardiovascular effects and tardive dyskinesia
What is the definition of dementia?
Syndrome of generalised decline in memory, intellect and personality without impairment of consciousness that leads to issues with performing ADLs
Impairment of function e.g retaining new information, managing complex tasks, language and word finding, behaviour, recognition, ability to self care, reasoning
What are some communication tips when taking a history from a dementia patient?
- Redirection not correction
- Consistent schedules
- Approach from the front
- Ensure they have their hearing and visual aids
- Keep it simple
- Avoid lots of direct questions
- Get collateral history
- Validation
What are some challenging behaviours in dementia and how can they be managed?
- Wandering
- Restlessness
- Agitation
- Incontinence
- Perseveration (repetition)
- Paranoia
- Sleeplessness/’sundowning’
- Hallucinations
- Physically or sexually inappropriate behaviour
Try to identify triggers. VERA
What are some tools that can be used to aid diagnosis of dementia?
6CIT
GPCOG
7 minute screen
Fill out the following boxes for Alzheimer’s Dementia:
- Prevalence
- Pathogenesis
- Disease progression
- Risk Factors
- Diagnostic Criteria
- Management
What are some genes associated with Alzheimer’s?
- Amyloid Precursor Protein (APP)
- Presenilin (PSEN1/PSEN2)
Neurofibrillary tangles and Senile plaques are associated with aging, what makes them different in Alzheimer’s disease?
Located mainly in hippocampus and medial temporal lobes
What are the first signs of Alzheimer’s disease and some symptoms that occur as the disease becomes established?
Early impairment of memory. Manifests as short-term memory loss and difficulty learning new information
- Cognitive impairment
- Behaviour and Psychological Symptoms of Dementia (BPSD)
What are the different cognitive domains?
- Attention and concentration
- Recent and remote memory
- Language
- Praxis: planned motor movement (e.g. perform a task)
- Executive function
- Visuospatial function
What is the ACE-III tool?