Confusion / Dementia / Delirium Flashcards
Confusion / Dementia / Delirium
Dementia Definition
Dementia is a syndrome rather than a diagnosis, referring to a progressive and (usually) irreversible global deterioration of higher cortical functioning in clear consciousness (i.e. in the absence of delirium).
Confusion / Dementia / Delirium
Dementia Types
- Alzheimer’s Disease (50%)
- Vascular dementia (15%)
- Mixed vascular and Alzheimer’s dementia
- Lewy Body dementias (15%)
- Other include
- Frontotemporal (Pick’s disease)
- NPH
- Alcoholic
- Infectious dementias
- Parkinson’s disease
Confusion / Dementia / Delirium
Alzheimer’s Disease Defintion
- Gradual onset
- Unknown cause
- Hallmark of the disease is amyloid plaques and neurofibrillary tangles (NFTs).
- Can be up to 50% loss of neurone in the cortex and hippocampus.
- Diagnosis by exclusion
Confusion / Dementia / Delirium
Alzheimer’s Pharmacological Management
Cholinesterase inhibitors
- Donepezil, Rivastigmine or Galantamine
- Provide mild cognitive improvement for mild to moderate dementia
OR
NMDA Antagonist
- Memantine
- Modest effect for the treatment of moderate to severe AD
Confusion / Dementia / Delirium
Vascular Dementia Defintion
- Sudden onset
- Cortical areas of infarction from small to medium vessels.
- Cardiovascular disease is the main risk factor
Confusion / Dementia / Delirium
Vascular Dementia Subtypes
1) Cognitive defects following a single stroke
- Severe with midbrain or thalamic strokes.
2) Multi-infarct dementia
- Multiple stokes lead to a stepwise deterioration
3) Progressive small-vessel disease
- Multiple infarcts of perforating vessels leads to intellectual decline and motor problems
Confusion / Dementia / Delirium
Dementia with Lewy Bodies Definition
Shares the clinical and pathological features of both Alzheimer’s and Parkinson’s disease. Two of the following core features are essential
- Fluctuating cognition with variations in attention and alertness
- Recurrent visual hallucinations
- Spontaneous motor features of parkinsonism
Confusion / Dementia / Delirium
Vascular Dementia Pharmacological Management
- Low dose aspirin OR - Clopidogrel WITH - Assessment of vascular risk factors
Confusion / Dementia / Delirium
Dementia Prognosis
- Die prematurely even taking into account comorbidity.
- Commonly bronchopneumonia in those with severe dementia.
- Worse prognosis with vascular dementia than Alzheimer’s.
- 7-10 years between diagnosis and death, less for early onset.
Confusion / Dementia / Delirium
Delirium Definition
- Acutely disturbed state of mind
- Characterised by restlessness, illusions, and incoherence
- Occurring in intoxication, fever, and other disorders.
Confusion / Dementia / Delirium
Delirium Criteria
- Attention & awareness disturbance
- Rapid development from baseline with severe fluctuations
- Additional disturbance in cognition
- (1) & (3) are not better explained by a neurocognitive disorder/condition.
- Direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin, or is due to multiple aetiologies
Confusion / Dementia / Delirium
Types of Delirium
- Delirium due to a medical condition
- Substance intoxication delirium
- Medication induced delirium
- Substance withdrawal delirium
- Delirium due to multiple aetiologies
- Delirium not otherwise specified
Confusion / Dementia / Delirium
Delirium Risk Factors
Present in 50%
- Dementia
- Previous stroke
- Parkinson’s disease
Confusion / Dementia / Delirium
Delirium Screen
Bloods
- UEC, FBC, ABG, BGL, appropriate culture, LFT
Bedside
- ECG
Imaging
- CXR with consideration of LP and CT/MRI scan
Confusion / Dementia / Delirium
Delirium Management
Short-term - Active surveillance - For aggressive patients -- Antipsychotic - haloperidol Long-term - Specific therapy to underlying condition
