Confusion and delirium Flashcards
modifiable risk factors with dementia?
smoking
alcohol
bp
cholestrol
delirium symptoms?
abnormal sleep wake cycle worse at night acute/subacute onset altered consciousness impaired attention disorganised thinking
why are delirium pts high risk?
less well medically and socially
future dementia risk is increased
level of care needed is also higher
define delirium?
acute onset of confusion and cognitive impairment, usually reversible
Define dementia?
chronic progressive, diffuse impairment of cognition
is diffuse impairment following brain insult?
hypoxic brain injury
focal impairement due to focal brain lesions?
stroke
mild cognitive impairment? (MCI)
mild reduction in cognition
three outcomes of MCI?
cognitive deteriorates
stable cognition
cognitive improvement
state two impairments for dementia?
language, memory, abstract thinking, praxis, visuospatial abilities, personality and social behaviour
state cognitive domains?
language, memory, abstract thinking, praxis, visuospatial abilities, personality and social behaviour
receptive dysphasia?
speech fluent but non sensical
invented words/jargon
comprehension impaired
wernicke’s area in temp lobe
expressive dysphasia?
effortful, non fluent
difficulty finding right words
broca’s area in the pre-frontal cortex
frontal executive function tests?
list as many animals as you can in one minute
cognitive estimates
dyspraxia?
unable to perform complex motor tasks
difficulty in performing and miming tasks
difficulty copying meaningless gestures
usually left frontal or parietal lobe lesions
visuospatial problems
disorientation: poor spatial memory
failure to recognise landmarks
constructional problems: identify two interlocked pentagons
personality which lobe and what happens in patients with dementia
frontal lobes
disinhibition and impulsive behaviours
apathy
fall in standards of personal hygiene
how to diagnose dementia?
single focal cognitive defecit is not dementia
long standing, static cognitive impairment do not have dementia
cognitive examination?
level of alertness
orientation to time place and person
attention and concentration
memory types?
anterograde: remembering address
retrograde: remembering ww1 dates
patients life story is autobiographical memory
visuospatial tests?
identify pics
miming and actions
reading and writing
cognitive tests?
abbreviated mental test : 10qs, quick simple and basic
montreal cognitive assessment: 30 points can be abbreviated into multiple languages
why do special tests exist?
to differentiate between poor effort and poor ability
treatable causes of dementia?
B12 deficiency hypothyroidism syphilis subdural haematoma normal pressure hydrocephalus tumours HIV
Investigating dementia?
thyroid function, b12, folate and copper
HIV and syphilis testing
CT brain scan
csf examination
Most common cause of dementia?
alzheimers disease
alzheimers disease prevalance?
at 65 years: 1.2 per 1000 affected
at 90 years: 53 per 1000
w>m
what may help with alzheimers disease?
anti cholinesterase inhibitors
what genes are main culprits of alzheimers disease?
Amyloid precursor gene, Apo E and Presenilin
what is dementia with lewy bodies?
dementia first then get parkinsons- visual hallucinations
atrophy, depigmentation of the substantia nigra
lewy bodies deposited in cortical neurons
vascular dementia? risk factors?
dementia due to multiple infarcts
risk factors: smoking, hypertension and vascular disease
fronto temporal dementia?
selective atrophy of the frontal and temporal lobes loss of word knowledge personality change lack of insight emotional and behavioural problems
rare causes of dementia?
HIV/AIDS huntingtons syphilis multiple sclerosis rare types of alzheimers: posterior cortical atrophy
alcohol effects?
acute toxication: confusion
chronic abuse: brain atrophy
wernicke korsokoff syndrome: acute brain damage due to thiamine deficiency.
