Confusion, delirium and dementia Flashcards
What is delirium?
Acute onset of confusion and cognitive impairment. Usually reversible
Worse at night, altered consciousness, distractable, disorganised thinking, abnormal sleep wake cycles
What is dementia?
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
What are the common causes of confusion?
Lack of hearing aid / glasses Unfamiliar environment Drug or alcohol effects Low blood glucose Low O2 / high CO2
What is mild cognitive impairement?
Mild reduction in cognitive memory
3 outcomes - deteriorates, stable, improves
What are the 7 cognitive domains?
People Practise My Language to Say Angry Verbs
memory language praxis abstract thinking visuospatial awareness personality social change
What can cause problems with language?
expressive and receptive dysphasia semantic problems fluency problems dyslexia dysgraphia dyscalculia mutism
What is expressive dysphasia?
Comprehension preserved but difficulty finding the right words
Non fluent speech
Brocas area affected
What is receptive dysphasia?
Speech is fluent but nonsensic - invented words
Comprehension impaired
Wernickes area in superior temporal gyrus affected
What is dyspraxia?
Unable to perform complex motor tasks despite intact motor and sensory systems, coordination and comprehension
Usually left frontal or parietal lesions
What are visuospatial problems?
Disorientation - poor spatial memory and constructional problems
How can personality and social behaviour be affected?
Disinhibition, impulsive behaviours, apathy, poor hygeine, hypersexuality, cant read social situations
Personality is the function of the frontal lobes
How is dementia diagnosed?
Asses all cognitive domains
Exclude depression and delirium
What are the treatable causes of dementia?
B12 deficiency Hypothyroidism Syphilis HIV Tumours Subdural haematoma Hydrocephalus
What are the 4 most common causes of dementia?
Alzheimers Disease 55%
Vascular Dementia 20%
Dementia with Lewy bodies 15%
Rare causes 10%
What is Alzheimers Disease?
Gradual onset of memory problems
Recent memory more affected than distant
Anti cholinesterase inhibitors help
F more than M
What is Dementia with lewy bodies?
Dementia and Parkinsons features
Visual hallucinations common
Deterioration in step wise fashion
Lewy bodies in cortical neurones
What is vascular dementia?
Due to multiple small infarcts
Risk factors: smoking, hypertension, vascular disease
Stepwise deterioration
What is fronto - temporal dementia?
Selective atrophy of frontal and temporal lobes
Presents with loss of knowledge or speech output and behavioural changes - personality, emotional, lack insight
What do Huntingtons, CJD, HIV, syphilis, MS have in common?
Rare causes of dementia
How does alcohol cause brain injury?
Acute intoxication causes confusion
Chronic abuse - brain atrophy
Wernickes Korsakoff syndrome - acute brain damage due to thiamine deficiency. IRREVERSIBLE
What are the modifyable risk factors for dementia?
BP
Smoking
Cholesterol
Alcohol
How do patients with delirium present?
Agitated or apathetic
agitated easier to spot
