cognitive impairment-ILA Flashcards
What is delirium?
An acute confusional state?
What are the causes of delirium?
Infection, stroke, metabolic, pain, dehydraion, hypoxia or deficiency
What are the symptoms of delirium?
Worse concentration, Slow response, Hallucinations, Sleep disturbance, Drowsy, Irritable, Delusions, uncooperative
What are the different types of delirium?
hypoacitve, hyperactive or mixed
What are the differentials for delirium?
Withdrawal, Mania, Post-ictal, Dementia, Anxious, Psychosis
What investigations can you do for delirium?
U&E, FBC, ABG, Glucose, Cultures, ECG, LFT, CT, CXR, LP
What is the management for delirium?
Optimise surroundings, avoid sedation but can use anti psychotics if very agitated, prevent by giving patients clocks and calendars, keeping hydrated and addressing mobility, treat cause
What is dementia?
Progressive neurological disorder impacting cognition (memory, communication and thinking), which causes functional impairment
What are the three most common types of dementia? In order from most common to least
alzheimers, vascular, lewy body
What is the onset of the different types of dementia?
alzheimers and lewy body is gradual
vascular is step wise
Which of the dementias are progressive?
alzheimers and lewy body
Which of the dementias has fluctuations?
vascular and lewy body
Which of the dementias is known for having hallucinations?
lewy body
although the other can occasionally present with hallucinations also
Which dementias involve personality changes?
lewy body and alzheimers
Which dementias retain insight?
lewy body and vascular
Which of the diseases has parkinonisms?
lewy body
How do you differntiate between PD and LBD
memory problems come later in PD and present first in LBD
What are the symptoms of dementia?
Behaviour: restless, repetitive, purposeless, fixed routines
Personality: disinhibited, blunted
Speech: mutism, dysphasia
Thought: slow, confabulate, muddled
Perception: hallucinations usually visual
Mood: labile, irritable, depressed
What investigations do you do for dementia?
Objective assessment of cognition: ACE-III (assesses five congitive demains- attention, memory, fleuncy, language, visuospatial), MOCA
Bloods: Exclude reversible cause, Influence medication choice. Check FBC, folate and B12, U+Es and LFTs (hepatic or renal failure), HIV, gamma GT (alcohol), calcium, TFTs, syphilis
Imaging: CT, MRI, DaT, SPECT
How do you manage vascular dementia?
Treat risk factors?
What is the pharcological management for LBD and alzheimers?
acetylcholinesterase inhibitors eg donepezil, glantaine/rivastigmine 1st line. Memantine (NMDA antagonist- for glutamate) is second line.
What is the general management for dementia?
cut down on alcohol
SSRI, anti psychotics and hypnotics may be used
cognitive stimulation therapy
address driving and power of attorney
