Delerium & Dementia

Question 1

Delirium DSM definition

Answer 1

• disturbance in attention and awareness
• disturbance develops over a short period of time
  
  • change from baseline attention
  • tends to fluctuate during course of day
• additional cognitive disturbance
• evidence that disturbance is a direct consequence of another medical condition
  
  • substance intoxication/withdrawal
  • toxin
  • multifactorial

Question 2

Possible underlying causes of delirium

Answer 2

• infection
• electrolyte abnormalities
• hypoglycemia
• cardiac/pulmonary/hepatic/renal failure
• endocrine
• medications
• drugs, withdrawal
• trauma
• epilepsy

Question 3

Delirium mechanism

Answer 3

• Disrupted ascending activation from reticular activating system and thalamus to the cortex
  
  • both very sensitive to metabolic stress
• •Potentially involving multiple transmitter systems: dopamine, acetylcholine, norepinephrine, and serotonin

Question 4

Management of delirium

Answer 4

• •Low dose Haldol; IV form
• •May use low dose atypicals if PO
• •Donepezil
• •Unless EtOH withdrawal, avoid pitfalls of benzos and paradoxical agitation
• •Physical restraints only during acute agitation and promptly removed

Question 5

Dementia DSM definition

Answer 5

A.Evidence of significant cognitive decline from a prior level of performance in one or more cognitive domains

B.Cognitive deficits interfere with independence in everyday activities

C.Do not occur exclusively in context of delirium

D.Not better explained by another mental disorder (i.e., depression, schizophrenia)

Question 6

General characteristics of dementia

Answer 6

• “top-down” cognitive fxnl impairment
  
  • i.e. isolated memory problems w/out attention issues
• decline from previous baseline
• changes in personality, mood, perception
• numerous causes:
  
  • neurodegenrative: Alzheimers
  • vascular
  • obstructive
  • neoplastic
  • infectious
  • trauma
• depression can present as dementia