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Geriatrics > Confusion > Flashcards

Confusion Flashcards

1
Q

What is the best way to determine whether someone is suffering an acute onset confusion or a chronic illness such as dementia?

A

Speed of onset
Collateral history useful
History of confusion
Previous mental state

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2
Q

3 types of delirium?

A

Hyperactive - physical and vocal symptoms
Hypoactive - stupor and coma
Mixed - common

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3
Q

4 cardinal symptoms of delirium?

A

Fluctuating cognitive impairment
Inattention
Disordered thinking
Fluctuation in consciousness

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4
Q

DELIRIUM pneumonic describes what symptoms of delirium?

A 
Disordered thinking
Euphoria/anger
Language impairment
Illusions/delusions
Reversal of the sleep wake cycle
Inattention
Unaware/lack insight
Memory deficit
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5
Q

What is the usual time scale to which delirium develops?

A

over 2-3 days

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6
Q

What are some causes of acute confusion?

A

(PINCH ME) - pain, infection, nutrition, constipation, hydration, medications, environement
Cerebral blood supply - cardiac conditions
Cerebral metabolism - respiratory, metabolic, nutritional, haematological

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7
Q

Risk factors for developing delirium?

A 
Aged over 65
Recent fall or hip fracture
Polypharmacy 
Visual impairment
Infection or dehydration admission
Alcohol excess 
Renal impairment
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8
Q

What is the confusion method diagnostic algorithm (CAM) used for? What 4 features are investigated and how is it done?

A

Looks into the presence of delirium
4 cardinal features:
Fluctuating condition - ask collateral history
Inattention - count back from 20
Disordered thinking - hallucinations
Fluctuating consciousness - depending if they are hypoactive or hyperactive

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9
Q

7 blood investigations can be done to investigate delirium?

A 
FBC
Haematocrit - high in dehydration
LFT
UE
CRP
Glucose
Calcium
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10
Q

What investigations would you do to investigate delirium?

A 
Bloods
CXR
ECG
Urine dipstick
Blood cultures
NEWS
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11
Q

What initial management are you interested in correcting for a delirium patient?

A 
Medications review and alteration
Correct any electrolyte imbalances that are found
Treat infection
If they are alcoholic give thiamine
Treat constipation
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12
Q

How can you make a good sensory environment for delirium patients?

A 
Good lighting
Clocks on the wall
One to one care
Encourage family and friends to visit
Encourage fluid intake
Encourage mobility, good diet and fluids to prevent constipation
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13
Q

What antipsychotic is chosen to manage delirium and what dose is initially started at? acutely disturbed?

A

0.5mg PO Haloperidol every 2 hours if needed

IM Haloperidol 1-2mg for acutely disturbed

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14
Q

What is an alternative drug to treat delirium and what kind of patients is it often used in?

A

Lorazepam PO 0.5-1mg PO

Used in Parkinson’s patients or dementia with Lewy Body

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15
Q

7 main issues that delirium patients will suffer?

A 
Pressure sores
Incontinence
Nosocomial infections
Falls
Functional impairment
Over sedation
Malnutrition
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16
Q

What is the most common type of dementia? gene that increases likelihood of developing?

A

Alzheimers

ApoE4

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17
Q

Alzheimers Dementia inheritance pattern? 2 genes it is inherited on?

A

Autosomal Dominant
APP
presenilin 1 and 2

18
Q

What is the pathology of Alzheimers dementia both intracellularly and extracellularly?
Where in the brain does Alzheimers start and where does it progress to?

A

Intracellular tau protein tangles and extracellular amyloid deposits
Starts in the temporal lobe (memory), moves to frontal lobe (behavioural) then to do the rest of the brain and neurone death

19
Q

Moderate severity Alzheimers presents with what?

A

Memory difficulties and planning issues

Spreads to speech and visuospatial problems

20
Q

Vascular dementia 7 risk factors?

A

IHD, strokes, hypertension, high cholesterol, diabetes, PVD, cigarettes

21
Q

What is the difference in decline of a patient who has Alzheimers compared to a patient who has Vascular dementia?

A 
Alzheimers = progressive decline
Vascular = step wise progression
22
Q

What type of dementias make up mixed dementia?

A

Alzheimers and Lewy body

23
Q

Difference between Lewy body dementia and Parkinsons dementia?

A

If they present with dementia first then they have lewy body but if the dementia presents more than a year after the parkinsons does then it is known as Parkinsons Dementia

24
Q

What are Lewy bodies and why do they cause dementia?

A

They are made of alpha-synuclein and act in brain cells to impair dopamine and Ach binding and therefore action

25
Q

How does Lewy body dementia present?

A

Parkinsonian symptoms
Falls
Fluctuations in cognition
REM sleep disorder

26
Q

What do patients usually die from in Lewy body?

A

Malnutrition, swallowing difficulties, immobility

27
Q

Which 2 types of dementia tend to effect people at a younger age?

A

Lewy body dementia

Frontotemporal dementia

28
Q

2 diseases that see frontotemporal dementia occuring in them?

A

Pick’s Disease

Motor Neurone Disease

29
Q

What happens in frontotemporal dementia?

A

Degeneration of the frontal and temporal lobes sparing of the others
Protein build up - tau, ubiquitin, FUS inclusions

30
Q

What tend to be 2 main presenting symptoms in frontotemporal dementia?

A

Personality changes

Dysphasia

31
Q

4 things that you must distinguish dementia from?

A

Mental retardation
Korsakoffs psychosis
Aphasia
Depression

32
Q

Of those over the age of 65 with a mild cognitive impairment, what percentage will convert into dementia?

A

10-15% conversion rate

33
Q

What changes can you expect to see in a person cognitively as they progress with dementia?

A

Intellectually regress
Behavioural changes
Impaired memory - first recent then older memories
Affective disorders
Focal neuro signs - aphasia, apraxia, apraxia of gait, agnosia

34
Q

What are memory clinics used for?

A

Streamlining diagnosis, treatment and follow up of dementia
Planning for the future
Access clinical trial

35
Q

Non-pharmacological interventions in place for patients with Dementia?

A

Education
Support services - community dementia team, community services
Cognitive rehabilitation and training
Cognitive stimulation therapy - group setting
Movement programmes
Reminiscence

36
Q

Group of drugs that are used in treatment of dementia?

A

Cholinesterase inhibitors

37
Q

How do you increase the dose of Dementia medication? When does it reach its most effectiveness? how long after diagnosis and treatment initiation do you need to have follow up appointment?

A

Titrate over 1 month
Reaches effectiveness after 3 months
Follow up after 4 months

38
Q

3 examples of cholinesterase inhibitors used in mild/moderate Dementia treatment?

A

Donepezil
Rivastagmine
Galantamine

39
Q

Main 3 side effects of cholinesterase inhibitors?

A

Nausea
Vomiting
Diarrhoea

40
Q

What drug is used in severe dementia? How does it work?

A

Memantine, antagonising NMDA glutamate receptors

41
Q

Which type of dementia should you avoid using antipsychotics?

A

Lewy body/parkinsons dementia

Geriatrics (10 decks)

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