Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD3 > AC - Dementia & Delirium > Flashcards

AC - Dementia & Delirium Flashcards

1
Q

What is the definition of dementia?

A

Acquired impairment of higher mental functioning that impacts on social and occupational functioning must be associated with impairment

Difficulty in one or more of language, memory, learning, reasoning, spatial ability, behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of dementia?

A

Acquired impairment of higher mental functioning that impacts on social and occupational functioning must be associated with impairment

Difficulty in one or more of language, memory, learning, reasoning, spatial ability, behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is mild cognitive impairment?

A

MCI intermediate between normal & dementia, noticeable symptoms (patient has insight) but don’t impair function/fulfil criteria for dementia

Can impair in single or multiple domain, need to monitor as can progress to dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are risk factors for dementia?

A

Risk factors CV risk factors, increasing age, family hx (if 1st degree with early onset, Down Syndrome (AD), excess alcohol intake (+ associated B12 deficiency), syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What tools can be used to assess cognition?

A 
MMSE
RUDAS
MoCA
Clock test
NuCOG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe features of MMSE

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe features of RUDAS

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe features of the clock test

A

Not specific to distinguish between dementias but highlights significant cognitive impairment

Issues with visuospatial planning, constructional praxis and executive function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe features of the clock test

A

Not specific to distinguish between dementias but highlights significant cognitive impairment

Issues with visuospatial planning, constructional praxis and executive function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is mild cognitive impairment?

A

MCI intermediate between normal & dementia, noticeable symptoms (patient has insight) but don’t impair function/fulfil criteria for dementia

Can impair in single or multiple domain, need to monitor as can progress to dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe features of cholinesterase inhibitors in Rx dementia

A

Rivastigmine, donepezil

PBS for mild-moderate dementia

Beneficial in AD, LB dementia and PD with dementia

Symptomatic relief only no disease modification effect
Effect is individual (may not benefit, may have mild – moderate benefit)

Number to treat is the same as number to harm
Side effects Anti-SLUD bradycardia, fatigue, N+V, diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some other possible clinical features of Alzheimer’s disease?

A

Apraxia

Attention & executive function issues can happen but are rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe features of the clock test

A

Not specific to distinguish between dementias but highlights significant cognitive impairment

Issues with visuospatial planning, constructional praxis and executive function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of vascular dementia?

A

Step wise progression - abrupt deterioration with stable periods between

Subcortical (similar to delirium) - slower processing, attention/concentration impairment, perseveration, initiation issues, motor signs (i.e. gait, incontinence), motor speech issues, unlikely memory issues (if present more short term recall issue than actually laying down new memories)

Cortical

  • Frontal - executive dysfunction, aboulia, akinetic mutism
  • Temporal - anterograde amnesia
  • Left parietal - agnosia, aphasia, apraxia
  • Right parietal - hemi-neglect, cortical sensory signs (i.e. graphesthesia), confusion, visuospatial issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the main management principles of Dementia?

A
  1. Identify & modify any contributing/risk factors (i.e. drugs, alcohol, delirium, depression)
  2. Education, counselling and support
  3. Risk & driving assessment (personal safety, falls esp.)
  4. Non-pharmacological Rx - Memory aids, home&community ADL support, care in a safe, familiar environment, rationalise medications
  5. Pharm Rx - cholinesterase inhibitors, phosphodiesterase-4 inhibitors, NMDA receptor antagonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe features of cholinesterase inhibitors in Rx dementia

A

Rivastigmine, donepezil

PBS for mild-moderate dementia

Beneficial in AD, LB dementia and PD with dementia

Symptomatic relief only no disease modification effect
Effect is individual (may not benefit, may have mild – moderate benefit)

Number to treat is the same as number to harm
Side effects Anti-SLUD bradycardia, fatigue, N+V, diarrhoea

17
Q

Describe basic pathology of Alzheimer’s disease & imaging features

A
  1. alpha-beta protein forms insoluble sheets - aggregates - amyloid plaques
  2. TAU protein aggregations - neurofibrilary tangles

Begins in the HIPPOCAMPUS, later spreads to mesotemporal & parietal lobes

MRI - hippocampal atrophy, temporal lobe & cortical atrophy

PET - reduced glucose metabolism in temporal & parietal lobes, may detect amyloid plaques

18
Q

What class of medication must be avoided in Lewy body dementia?

A

Antipsychotics (esp. typical) - cause EPSE

19
Q

What is the classic clinical triad of Alzheimer’s disease?

A
  1. Memory - anterograde episodic - early and most dominant feature - late in disease long-term memory may be affected
  2. Visuospatial issues - i.e. getting lost in familiar areas
  3. Language - word finding difficulties (agnosia)
20
Q

What are some other possible clinical features of Alzheimer’s disease?

A

Apraxia

Attention & executive function issues can happen but are rare

21
Q

What are the pathological features of vascular dementia?

A

Caused by white matter lesions or stroke (cortical or subcortical)

MRI - white matter lesions, hyperintensities (T2/FLAIR), ventricle atrophy without cortical atrophy

22
Q

What are the clinical features of vascular dementia?

A

Step wise progression - abrupt deterioration with stable periods between

Subcortical (similar to delirium) - slower processing, attention/concentration impairment, perseveration, initiation issues, motor signs (i.e. gait, incontinence), motor speech issues, unlikely memory issues (if present more short term recall issue than actually laying down new memories)

Cortical

  • Frontal - executive dysfunction, aboulia, akinetic mutism
  • Temporal - anterograde amnesia
  • Left parietal - agnosia, aphasia, apraxia
  • Right parietal - hemi-neglect, cortical sensory signs (i.e. graphesthesia), confusion, visuospatial issues
23
Q

What is the basic pathology of Lewy body dementia?

A

Lewy body inclusions (made up of alpha-synuclein cytoplasmic proteins)

Distribution and density correlate to severity of clinical features

Commonly associated with amyloid pathology & AD

Cholinergic & dopamine deficits

MRI - mainly for exclusion of DDx - no clear patterns - hippocampus always spared (differentiate from AD)

24
Q

What are risk factors of Lewy body dementia?

A

None that are known!

25
Q

Clinical features of Lewy body dementia

A
  1. Fluctuations in cognition (similar to delirium) - attention and alertness
  2. Parkinsonism - often early and disabling
  3. Visual hallucinations - hallucinations of animals characteristic
26
Q

What is the basic pathology of fronto-temporal dementia?

A

Tau protein accumulation - focal atrophy - gliosis (hyperplasia of glial cells)

Gliosis responsible for most of symptoms

Starts anteriorly (usually in frontal lobe, most common) 
Frontal - anterior parietal - temporal

MRI - focal atrophy, PET - focal hypometablism, SPECT - focal hypoperfusion

27
Q

What are risk factors of fronto-temporal dementia?

A

GENETIC - strong FHx

28
Q

What are the early signs of fronto-temporal dementia?

A
  1. Emotional and mood disturbance - depression, anxiety, increased sentimentality
  2. Social conduct issues
  3. Impaired insight

Precede cognitive issues (memory, disorientation) and apraxia

29
Q

What clinical features of fronto-temporal dementia?

A

Frontal - behavioural variant - more common
Temporal - language variant - less common

Frontal - Impaired insight, judgement, disinhibition, executive dysfunction, motor signs (parkinsons, MND…), perseveration, apathy

Temporal - Broca’s aphasia, memory

30
Q

What advice about driving do you give to person with new dementia diagnosis?

A
  • May not have to give up license straight away due to slow nature of progression of disease
  • Need to inform VicRoads themselves (drs can do this ‘in good faith’ if patient refuses)
  • Doctor will initially make an assessment about their fitness to drive - may require OT assessment
  • Usually get 12 month conditional license which means it needs to be reassessed at this time +/- other restrictions i.e. driving at certain limits, certain areas, certain times
31
Q

What are predisposing factors to developing delirium?

A 
Previous delirium
FHx delirium
Cognitive impairment 
Sensory impairment 
Functional impairment
Malnourished, dehydrated, chronic alcohol use
Multiple comorbidities
Age
32
Q

What are some causes of delirium?

A

DIMES

  1. Drugs - change or withdrawal, specific drugs - benzos, PD meds, NSAIDs, anticholinergics, general anaesthetic, antidepressants, mood stabilisers
  2. Infection/illness (acute) - UTI or other infection, trauma/surgery, organ failure (hypoxia, electrolyte disturbance, uraemia), cardiac ischaemia
  3. Metabolic - electrolyte disturbance, abnormal BGLs, acidosis, malnutrition/dehydration
  4. Environmental factors - iatrogenic (IDC, restraints), disorientating environment
  5. Symptoms - pain, constipation, incontinence, immobility, sleep disturbance
33
Q

What are the main diagnostic features of delirium?

A
  1. Acute onset (hrs - days)
  2. Fluctuating conscious state throughout day - drowsy - hyperactive
  3. Inattention/distractibility
  4. Disorientation
34
Q

Other clinical features of delirium?

A

Sleep disturbance - reversal of sleep-wake cycle, usually worse at night

Disorganised speech & thought

Behavioural & mood issues - wandering, agitated/aggressive, confused, repetitive behaviours

Psychotic features - paranoid delusions and hallucinations

Consequences - falls, incontinence, deterioration of function

35
Q

What is the natural hx of delirium?

A

Transient and reversable - usually lasting days-weeks
Can last longer (up to ~1 year) and/or may not return to baseline function - more likely if predisposing factors
Increased risk of mortality, can be early warning sign to serious underlying pathology

36
Q

What is the best screening tool for delirium?

A

CAM - confusion assessment method
Highly sensitive and specific for delirium

  1. Acute onset AND fluctuating course
  2. Inattention AND
  3. Disorganised thinking OR altered GSC

Need both 1 and 2 and one of 3 to diagnosis delirium

37
Q

What are routine Ix and ones to consider in diagnosing delirium?

A

Routine - O2 sats, U&Es, LFTs, CMP, BGLs, TFTs, urine analysis + MCS, CRP, ESR, FBE

Consider - CT, cardiac ischaemia Ix, septic screen, drug levels (digoxin, lithium)

38
Q

What are important management principles for delirium?

A
  1. Identify and Rx/remove precipitating factors of delirium i.e. pain, constipation, electrolyte imbalance, infection
  2. Medication review and rationalisation
  3. Non-pharm Rx - low stimulus, 1:1 nursing, single room, reorientation aids and communication, reduce changes & increase familiarity, avoid restraints & iatrogenic devices
  4. Actively monitor - behaviour charts, regular physical and visual observations
  5. Pharm Rx of behaviour - only when really necessary
    Haloperidol 1st line. Avoid benzos - worsen delirium

MD3 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions