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Psych > Alzheimer's/ Delirium/ Dementia > Flashcards

Alzheimer's/ Delirium/ Dementia Flashcards

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1
Q

What is the main causes of dementia?

A

Alzheimer’s disease (50-60%)

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2
Q

Why do people get alzheimer’s disease?

A
  1. Genetic predisposition
  2. Idiopathic
  3. Possible initiation factor: down’s syndrome, head trauma, genetic factor
  4. Potential promoting factor: age, depression, stress
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3
Q

Symptoms of Alzheimer’s disease

A
  1. Impaired memory
  2. Aphasia, apraxia, agnosia
  3. Reduce ability learn, solve problem
  4. Alteration in personality
  5. reduced impulse control, hyper excitability, loss of insight and confusion
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4
Q

Why do alzheimer’s disease arise?

A

Neurodegeneration: brain shrinkage, enlarged ventricles

Loss of cholinergic neurones (in hippocampus, amygdala, cortexs)

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5
Q

What are 3 hallmark features of alzheimers disease?

A
  1. Extracellular amyloid plaques
  2. Intraneuronal neurofibrillary tangles
  3. Microglial activation
  4. progressive neuronal loss
  5. Increased susceptibility to ischema, excitotoxicity and oxidative stress
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6
Q

What are some examples of anticholinesterases?

A

Donepezil, rivastigmine, galantamine

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7
Q

What are peripheral side effects of anticholinesterases?

A
  1. GIT effects: n+v,diarrhoea
  2. Insomnia, vivd dreams
  3. asthma
  4. bradycardia
  5. dizziness
  6. Muscle cramps
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8
Q

How do NMDA receptor antagonists work?

A

Block the cation channel while in the resting state or during low-level depolarisation, dissociates upon pronounced activation of the NMDA channel.
Therefore only blocks increased transmission under chronic conditions; blocks prolonged influx of ca but allows non pathological signalling to occur

Memantine: aimed at inhibiting neurodegeneration

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9
Q

What are some clinical features of delirium?

A
  1. Acute onset
  2. Fluctuating course
  3. Inattention
  4. Disorganised thinking
  5. Altered level of consciousness
  6. Cognitive defects
  7. Psychomotor disturbances
  8. Altered sleep-wake cycle
  9. Emotional disturbances
  10. Perceptual disturbances- hallucinations
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10
Q

What are some predisposing factors of delirium?

A
  1. Demographic (older age, male)
  2. Cognitive status (Dementia)
  3. Functional status (Hx of falls, immobility)
  4. Sensory (Visual/hearing impairment)
  5. Drugs
  6. Co-existing medical conditions (renal impairment)
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11
Q

What are common causes of delirium?

A
  1. Exogenous exposure (drugs, otc meds)
  2. Drug withdrawal
  3. Systemic disorders (malnutrition, hypoxia, fever, dehydration)
  4. CNS disease
  5. Environmental (admission, use of physical restraints)
  6. Prolonged sleep deprivation
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12
Q

What are some assessment tools available for delirium?

A
  1. DRS (delirium rating scale)
  2. MMSE (mini mental state evaluation)
  3. CAM (confusion assessment method)
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13
Q

What drugs can contribute to delirium?

A
  1. Anticholinergics (Oxybutyin, TCA, benztropine)
  2. Anti convulsants
  3. Antipsychotics
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14
Q

How to treat delirium?

A
  1. Treat underlying medical condition
  2. Remove medications that may be contributing
  3. Supportive measures: family members, night light, photo frames, music
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15
Q

How to treat agitation?

A

Atypical antipsychotics

  1. olanzepine
  2. risperidone
  3. quetiapine
  4. ziprasidone or aripiprazole
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16
Q

What are some symptoms of dementia?

A
  1. Cognitive impairment (memory loss, language difficulties)
  2. Visuopatial dysfunction
  3. Behavioural changes (personality change, depression, hallucinations)
  4. Functional impairment (poor performance of ADL
17
Q

How long do anticholinesterases prolong cognitive decline?

A

6months - 2 years

18
Q

What are cholinesterase inhibitors used in caution with?

A

Patients with

  1. Asthma
  2. COPD
  3. Cardiac conduction abnormalities or drugs that reduce heart rate
  4. Peptic ulcer disease
  5. Muscle relaxants
19
Q

Which anticholinesterase is available as a patch?

A

Rivastigmine

20
Q

Non pharm ways to manage behavioural issues in dementia?

A
  1. distraction (exercise, interesting tasks)

2. safe environment for wandering patients

21
Q

pharm ways to manage behavioural issues in dementia?

A
  1. Antipsychotics (haloperidol/risperodone are commonly used, quetiapine/olanzepine are newer agents- use at lower doses)
  2. Antidepressants- has to fulfil criteria

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