Delerium and dementia Flashcards
Define the syndrome of delirium.
A RAPIDLY DEVELOPING disorder of attention characterized by an inability to maintain a coherent line of thought.
It is also known by alternate terms, including acute confusional state.
Define the syndrome of dementia.
An acquired and persistent IMPAIRMENT IN INTELLECTUAL FUNCTION with deficits in at least three of the following areas:
memory, language, visuospatial skills, emotion and personality, complex cognition
that is sufficient to interfere with usual social and occupational activities.
By definition, dementia need NOT be progressive or irreversible.
Compare and contrast Delirium vs dementia with regard to
1) Acute/chronic
2) Level of consciousness
3) Attention
4) Speech
5) Substance
6) Reversibility
Delirium:
1) Acute 2) fluctuating level of consciousness (wildly agitated–>somnolent from moment-moment) 3) Impaired attention 4) Incoherent speech 5) Often caused by toxic/metabolic substance 6) Generally reversible
Dementia
1) Chronic 2) normal level of consciousness 3) Normal attention 4) aphasia 5) no substance 6) irreversable (90%)
What is the most important treatment strategy for delirium? What other steps should also be taken?
Treatment of the underlying cause (comprehensive workup) can result in a “gratifying” recovery.
Should also take steps to orient the person until the episode has passed (as for dementia patients) eg. TV, newspaper, clock in the room, etc.
What is a specific metabolic cause of dementia mentioned during lecture that is reversible (treatable)? (3 total)
B12 deficiency. Elderly patients can have absorption defects leaving them deficient.
Should also check for Wilson’s disease and TSH.
What are the two “cortical” diseases that cause dementia mentioned in class? What differentiates them?
Alzheimers disease and Frontotemporal Dementia (FTD)
FTD is not assx with memory loss. (Golfer/gambler example where golf game was unaffected). Presents with disinhibition, loss of executive function, and apathy. Often misdiagnosed as bipolar/schizophrenia.
Aphasia
A language disorder that affects a person’s ability to communicate.
[Global aphasia/mutism = loss of all speech]
Anomia
Loss of words
What is the most common cause of dementia?
Alz. 50-70%
What is the general gross appearance of the brain of Alzheimer patients? What might be seen on a PET? What is required for a definitive diagnosis?
Atrophy. Dramatic changes in perfusion on PET.
Bioposy (plaques and tangles).
Name the ApoE variants, along with their assx risk.
Apo e4 = bad news bears (particularly if homozygous)
Apo e3 = neutral
Apo e2 = protective
What is the evidence for treating AD patients with cholinesterase inhibitors?
The cholinergic hypothesis. Analagous to serotonin/parkinsons, AD have less Ach due to loss of cholinergic producing cells in the basal forebrain.
Standard drug treatment for AD now includes a cholinesterase inhibitor and memantine.
What are the two diseases affecting the subcortex that cause dementia?
Parkinson’s disease and Huntington’s disease.
Basic etiology of Parkinson’s disease.
Loss of cells in the substantia nigra (and Lewy body formation) leads to deficits in domapine production, as well as Ach (hence the use of AchE ibs).
Symptoms include bradykinesia, rigidity, and postural instability.
Basic etiology of Huntington’s disease. Imaging?
CAG triplet repeat (Autosomal dominant) that results in chorea (loss of balance) and dementia. Personality changes are often the first sign (infidelity, spending money, antisocial behavior).
Imaging shows atrophy of the caudate nucleus.
