Confusion in the elderly Flashcards
True or false: cognitive decline is probably the most common area that a geriatrician will be consulted about?
True
What are the two types of confusion?
Acute and chronic
What is dementia?
A syndrome characterized by an impairment in two or more intellectual or cognitive functions despite a state of clear consciouness
How do you distinguish between dementia from delirium?
Dementia is persistent and stable
True or false: any acute change in mental status is delirium until proven otherwise
True
What is the first step in evaluating cognitive decline?
Comprehensive H&P
What is the Folstein mini mental exam?
Rough test of mental ability
What are the lab tests that are not obvious to get to evaluate for dementia? (3)
VDRL
B12
Homocysteine levels
What is the DEMENTIAS mnemonic?
Drugs Emotional disease Metabolic disorders Endocrine disease Nutrition & degenerative neurologic disease Trauma/tumor Ischemia and infection Anorexia/anemia/arrhythmia Sjogren's, social, sensory deprivation
What are the four daignoses that account for most cases of dementia in industrialized countries?
- Alzheimers
- Diffuse lewy body disease
- Vascular dementia
- Frontotemporal dementia
What is agnoisa?
Difficulty recognizing things
What is apraxia?
Inability to carry out motor functions
What is aphasia?
Difficulty naming familiar items
What is amnesia?
Initially short term memory
What are the pathological hallmarks of alzheimer’s?
Fibrillary tangles
What is Lewy body dementia?
Intraneuronal inclusions that contain alpha-synuclein, phosphorylated neurofilament proteins, and ubiquitin
What are the two neurotransmitters that we attempt to upregulate?
Ach
Glutamate
What are the four clinical features of Lewy body dementia?
- Dementia
- Fluctuating cognition
- Recurrent visual hallucinations
- Motor features of parkinsons
Fluctuating cognition is characteristic of what disease?
Lewy body dementia
What is the treatment of Lewy body dementia?
Ach esterase inhibitors
What is vascular dementia?
Caused by decreased blood flow to the brain with significant enough brain damage to cause cognitive impariment
What is the presentation of vascular dementia?
Stepwise deterioration
What are frontotemporal disorders?
A heterogenous group of disorders that are less common than AD, DLBD, and vascular demnentia
What are the findings of Pick’s disease, the most common frontotemporal disorder?
Focal atrophy of the frontal and temporal lobes, along with microscopic findings of argyrophilic inclusions and swollen, achromatic neurons
Disinhibition in dementia = ?
Pick’s disease
