cognitive impairment-ILA

Question 1

What is delirium?

Answer 1

An acute confusional state?

Question 2

What are the causes of delirium?

Answer 2

Infection, stroke, metabolic, pain, dehydraion, hypoxia or deficiency

Question 3

What are the symptoms of delirium?

Answer 3

Worse concentration, Slow response, Hallucinations, Sleep disturbance, Drowsy, Irritable, Delusions, uncooperative

Question 4

What are the different types of delirium?

Answer 4

hypoacitve, hyperactive or mixed

Question 5

What are the differentials for delirium?

Answer 5

Withdrawal, Mania, Post-ictal, Dementia, Anxious, Psychosis

Question 6

What investigations can you do for delirium?

Answer 6

U&E, FBC, ABG, Glucose, Cultures, ECG, LFT, CT, CXR, LP

Question 7

What is the management for delirium?

Answer 7

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

Question 8

What is dementia?

Answer 8

Progressive neurological disorder impacting cognition (memory, communication and thinking), which causes functional impairment

Question 9

What are the three most common types of dementia? In order from most common to least

Answer 9

alzheimers, vascular, lewy body

Question 10

What is the onset of the different types of dementia?

Answer 10

alzheimers and lewy body is gradual

vascular is step wise

Question 11

Which of the dementias are progressive?

Answer 11

alzheimers and lewy body

Question 12

Which of the dementias has fluctuations?

Answer 12

vascular and lewy body

Question 13

Which of the dementias is known for having hallucinations?

Answer 13

lewy body

although the other can occasionally present with hallucinations also

Question 14

Which dementias involve personality changes?

Answer 14

lewy body and alzheimers

Question 15

Which dementias retain insight?

Answer 15

lewy body and vascular

Question 16

Which of the diseases has parkinonisms?

Answer 16

lewy body

Question 17

How do you differntiate between PD and LBD

Answer 17

memory problems come later in PD and present first in LBD

Question 18

What are the symptoms of dementia?

Answer 18

Behaviour: restless, repetitive, purposeless, fixed routines
Personality: disinhibited, blunted
Speech: mutism, dysphasia
Thought: slow, confabulate, muddled
Perception: hallucinations usually visual
Mood: labile, irritable, depressed

Question 19

What investigations do you do for dementia?

Answer 19

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

Question 20

How do you manage vascular dementia?

Answer 20

Treat risk factors?

Question 21

What is the pharcological management for LBD and alzheimers?

Answer 21

acetylcholinesterase inhibitors eg donepezil, glantaine/rivastigmine 1st line. Memantine (NMDA antagonist- for glutamate) is second line.

Question 22

What is the general management for dementia?

Answer 22

cut down on alcohol
SSRI, anti psychotics and hypnotics may be used
cognitive stimulation therapy
address driving and power of attorney