Cognitive Impairment Flashcards
How would you differentiate between delirium and dementia
- onset
- fluctuating course
- reversability
- consciousness
- trigger?
Delirium
- rapid onset
- fluctuating course
- reversible
- altered consciousness
- identifiable cause
Dementia
- slow onset
- progressive course
- non reversible
- conscious level unaffected
- no identifiable cause
Assessing for dementia
Forgetting
- objects
- routine chores (leaving doors open, gas on)
- poor short term memory
- self care
Disorientation
- reduced recognition of familiar individuals
- disoriented in place
Current ADLs and deterioration
MMSE or ACE3
Diagnosis of AD
Monitoring
Medical management
Progressive global memory decline
Conscious level unaffected
6 month+ duration
No evidence from history, examination or investigations for other causes
Monitor with 6 month MMSe
Mild, moderate
-ACh inh - donepezil, galantamine, rivastigmine => slows decline
SE - nausea, diarrhoea, insomnia, headache
CI - heart block, bradyarrythmias
Moderate, severe
-memantine
Conservative management of all dementia
Psychological support
- education for patient and family
- support groups
ADL support
-cleaning, meals
Care
- day centers
- respite placements
- permanent residential homes
Diagnosis of vascular dementia
Management
-conservative specific to VD
-medical
Vascular disease => brain infarct => uneven distribution of impairment
-clinical evidence of focal brain damage
-Hx/evidence of significant cerebrovascular disease
Development is faster and stepwise
Control vascular risk factors
- HTN
- Cholesterol
- Aspirin/clopidogrel
- smoking cessation
- exercise, weight loss
ACh inh if mixed with AD
Diagnosis of Lewy body dementia
Management
-medical
Fluctuations in cognition Parkinsonism -tremor -rigidity -bradykinesia Falls Visual hallucinations Labile emotions, agitation
1st line - rivastigmine
-slow cognitive decline
Agitation - short term BZ
Avoid typical antipsychotics
