Confusion, delirium and dementia

Question 1

What is delirium?

Answer 1

Acute onset of confusion and cognitive impairment. Usually reversible
Worse at night, altered consciousness, distractable, disorganised thinking, abnormal sleep wake cycles

Question 2

What is dementia?

Answer 2

Chronic progressive, diffuse impairment of cognition
Progressive impariement of at least 2 of :
memory/language/praxis/abstract thinking/visuospatial abilities/personality/social beahviour
Sever enough to cause functional impairment

Question 3

What are the common causes of confusion?

Answer 3

Lack of hearing aid / glasses
Unfamiliar environment
Drug or alcohol effects
Low blood glucose
Low O2 / high CO2

Question 4

What is mild cognitive impairement?

Answer 4

Mild reduction in cognitive memory

3 outcomes - deteriorates, stable, improves

Question 5

What are the 7 cognitive domains?

People Practise My Language to Say Angry Verbs

Answer 5

memory
language
praxis
abstract thinking
visuospatial awareness
personality 
social change

Question 6

What can cause problems with language?

Answer 6

expressive and receptive dysphasia
semantic problems
fluency problems
dyslexia
dysgraphia
dyscalculia
mutism

Question 7

What is expressive dysphasia?

Answer 7

Comprehension preserved but difficulty finding the right words
Non fluent speech
Brocas area affected

Question 8

What is receptive dysphasia?

Answer 8

Speech is fluent but nonsensic - invented words
Comprehension impaired
Wernickes area in superior temporal gyrus affected

Question 9

What is dyspraxia?

Answer 9

Unable to perform complex motor tasks despite intact motor and sensory systems, coordination and comprehension
Usually left frontal or parietal lesions

Question 10

What are visuospatial problems?

Answer 10

Disorientation - poor spatial memory and constructional problems

Question 11

How can personality and social behaviour be affected?

Answer 11

Disinhibition, impulsive behaviours, apathy, poor hygeine, hypersexuality, cant read social situations
Personality is the function of the frontal lobes

Question 12

How is dementia diagnosed?

Answer 12

Asses all cognitive domains

Exclude depression and delirium

Question 13

What are the treatable causes of dementia?

Answer 13

B12 deficiency
Hypothyroidism
Syphilis
HIV
Tumours
Subdural haematoma
Hydrocephalus

Question 14

What are the 4 most common causes of dementia?

Answer 14

Alzheimers Disease 55%
Vascular Dementia 20%
Dementia with Lewy bodies 15%
Rare causes 10%

Question 15

What is Alzheimers Disease?

Answer 15

Gradual onset of memory problems
Recent memory more affected than distant
Anti cholinesterase inhibitors help
F more than M

Question 16

What is Dementia with lewy bodies?

Answer 16

Dementia and Parkinsons features
Visual hallucinations common
Deterioration in step wise fashion
Lewy bodies in cortical neurones

Question 17

What is vascular dementia?

Answer 17

Due to multiple small infarcts
Risk factors: smoking, hypertension, vascular disease
Stepwise deterioration

Question 18

What is fronto - temporal dementia?

Answer 18

Selective atrophy of frontal and temporal lobes

Presents with loss of knowledge or speech output and behavioural changes - personality, emotional, lack insight

Question 19

What do Huntingtons, CJD, HIV, syphilis, MS have in common?

Answer 19

Rare causes of dementia

Question 20

How does alcohol cause brain injury?

Answer 20

Acute intoxication causes confusion
Chronic abuse - brain atrophy
Wernickes Korsakoff syndrome - acute brain damage due to thiamine deficiency. IRREVERSIBLE

Question 21

What are the modifyable risk factors for dementia?

Answer 21

BP
Smoking
Cholesterol
Alcohol

Question 22

How do patients with delirium present?

Answer 22

Agitated or apathetic

agitated easier to spot