Cognition, delerium and dementia Flashcards
What is delirium?
An acute state of impaired cognition that is usually caused by acute illness.
What test should be used for delirium?
The 4 AT test Alertness - ask name and address AMT4 Attention - months of year backwards Acute change - in last 2 weeks, still evident
What are the components of the AMT4 test?
Age
Date of birth
Place (e.g. hospital)
Current year
What are the components of the abbreviated mental test score (AMTS)? what is the cut off?
Time of day Place Date of birth Year Address Age Identify two people Name of monach Date of start of first world war Count backwards from 20-1 If scores less than 7 then indicates possible dementia
What are the two most common causes of delirium?
Infection Surgery (delirium is most common post surgical complication in the elderly)
What is the key cognitive deficit in delirium?
Attention
How should delirium be managed?
Important to recognise and treat the underlying cause
Comprehensive examination of relevant systems
When would a delirium patient be given sedation and what would be used?
Can be used if the patient is at risk to themselves or others or is severely distressed.
Haloperidol 0.5mg orally and titrate up to 5mg to relieve symptoms
Lorazepam 0.5mg in parkinsons
Benzodiazepines good for alcohol withdrawl
What are the causes of dementia?
Alzheimer’s - most common cause (50%)
Vascular dementia (20%)
Lewy body dementia (20%)
What are the features of Alzheimer’s disease?
Insidious onset with impaired short term memory and cognitive function decline. Diagnosis made on clinical features.
What are the features of vascular dementia?
Stepwise decline with sudden intellectual decline followed by period of improvement.
What are the characteristics of lewy body dementia?
Characterised by fluctuations in mental state, hallucinations and often falls
How do you diagnose dementia?
Using history and tools such as the informant questionaire of cognitive decline (IQCODE)
Neuroimaging can be used to differentiate mimics such as space occupying lesions
How do you manage dementia?
Some people benefit from donepezil and rivastigmine(acetylcholinesterase inhibitors) and memantine (NMDA antagonist) also has a role as second line
What parts of cognition does clock drawing help assess?
It helps assess executive functioning (paying attention, planning), frontal lobe and visuospatial ability
What test can be used to assess depression in the elderly? what values are significant?
Geriatric depression scale
15 questions - 5-10 is mild depression >10 is severe depression
How does onset differ between dementia and delirium?
Acute onset in delirium, slow onset in depression
How does the fluctuation of cognition differ between delirium and dementia?
High fluctuation in delirium and low in dementia
How does attention differ between dementia and delirium?
Poor attention in delirium, often good in dementia
How does conscious level differ between delirium and dementia?
It is often reduced in delirium and normal in dementia
How does emotional instability differ between delirium and dementia?
In delirium there is high emotional instability, in dementia it is only present in later stages
How does sleep differ between delirium and dementia?
In delirium sleep is disturbed whereas it is usually normal in dementia
How do short term and long term memory differ in delirium and dementia?
In delirium both are poor in dementia long term memory is often good
What MRI features would be present in Alzheimer’s?
Cortex atrophy, ventricular enlargement and severe degeneration of the hippocampus
