9.1 dementia and delirium Flashcards
what is dementia?
a chronic, progressive syndrome of insidious onset
what are the cognitive symptoms of dementia?
- impaired memory (temp lobe)
- impaired orientation (temp lobe)
- impaired learning capacity (temp lobe)
- impaired judgement (frontal lobe)
what are the behavioural symptoms of dementia?
agitation aggresion wandering sexual disinhibition depression and anxiety
what are the psychotic symptoms of dementia?
visual and auditory hallucinations
persecutory delusions
what are the sleep symptoms of dementia?
insomnia, daytime drowsiness
what differential diagnosis would you use to conclude the person has dementia?
hypothyroidism hypercalcaemia vit b12 deficiency normal pressure hydrocephalus (abnormal gait, incontinence, confusion) exclude delerium
cognitive decline + resulting impairment in activities of daily living + clear consciousness = dementia?
what are the
- macroscopic
- microscopic
features of Alzheimers dementia?
macroscopic
- global cortical atrophy
- sulcal widening
- enlarged ventricles (3rd and 4th)
microscopic
- plaques of amyloid beta
- tangles of hyperphosphorylated tau
- plaques and tangles kill neurones, particularly cholinergic, noradrenergic, serotonergic, those expressing somatostatin
what is vascular dementia and what are the risk factors?
cognitive impairment caused by cerebrovascular disease (multiple small strokes) = see areas of cortical infarction
risk factors
- previous stroke/MI
- hypertension
- hypercholesterolaemia
- diabetes
- smoking
what is the difference between Parkinson’s and dementia with lewy bodies?
if movement disorder is followed by dementia = Parkinson’s
if dementia is followed by a movement disorder = Lewy body dementia
what is the pathology of lewy body dementia?
aggregations of alpha synuclein, forms spherical intracytoplasmic inclusions
main deposits found across the brain
- substantia nigra
- temporal lobe
- frontal lobe
- cingulate gyrus
how do people with LBD present?
- fluctuating cognition and alertness
- vivid visual hallucinations
- Parkinson’s features e.g repeated falls
why would you NOT give antipsychotics to LBD patients?
antipsychotics = dopamine antagonists
can cause neuroleptic malignant syndrome due to a sudden drop in dopamine
FEVER
F - fever E - encephalopathy (confusion) V - vital signs instability (tachycardia, tachypnoea, fluctuation of BP) E - elevated crating phosphokinase R - rigidity
what is and what are the symptoms of frontotemporal dementia?
the atrophy of the frontal and temporal lobes
symptoms
- behavioural disinhibition
- inappropriate social behaviour
- loss of motivation without depression
- repetitive/ ritualistic behaviours
- non fluent (broca’s type) aphasia
what is AIDS dementia complex?
patients of HIV infection live longer due to medicines, but their chances of developing AIDS associated dementia increases
HIV infected macrophages going into the brain is thought to lead to indirect damage to neurones
what are the clinical features of AIDS associated dementia?
- cognitive impairement
- psychomotor retardation
- tremor
- ataxia
- dysarthria
- incontinence
what management can be used for dementia, using the biopsychosocial model?
BIOLOGICAL
drugs
- acetylcholinesterase inhibitors, best for Alzheimers mild to moderate
- NMDA antagonists for treating agitation
PSYCHOLOGICAL
- few available due to progressive nature
SOCIAL
- explain diagnosis sensitively
- talk about problems that will arise and management
- give results of investigation
- finances
- day care and respite care
- residential/nursing home placement
what is delirium?
insult to the brain which leads to acute neuronal cell damage caused by hypoxia and/or inflammation
often reversible due to organic cause. its sometimes Called an acute confused state.
how is dementia related to delirium?
can predispose to episodes of delirium
what are the features of delirium?
- rapid onset confusion
- clouded consciousness/drowsy
- fluctuating course
- transient visual hallucinations
- exaggerated emotional response
what are the symptoms of hyperactive and hyperactive delirium?
hypoactive
- withdrawn
- quiet
- sleepy
hyperactive
- restless
- agitated
- aggressive
what are some causes of delirium?
- vitamin deficiencies
- intracranial e.g strokes
- extra cranial e.g UTI, pneumonia
- iatrogenic e.g drugs, infections
- alcohol e.g intoxication or withdrawal
- endocrine
- metabolic
what is the management for delirium?
treat underlying cause!!
prognosis
- increased dementia risk
- associated with mortality
