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Summer 2 > Delerium/dementia > Flashcards

Delerium/dementia Flashcards

1
Q

What is dementia

A

Umbrella term for a syndrome of impairment in memory or thinking severe enough to interfere w/ ADL, work, or relationships
AKA: changes in memory or thinking over time

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2
Q

Examples of cognitive deficits in dementia are

A 
Memory 
Apraxia (motor activities) 
Aphasia (speech) 
Agnosia (fail to recognize objects) 
Disturbed executive function (think, plan, organize)
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3
Q

DSM5 for dementia is

A
  1. Significant cognitive decline in 1+ domain (learning and memory, language, executive fxn, complex attention, perceptual motor, social cognition)
  2. Cognitive deficits interfere w/ independence (assistance needed for IADL)
  3. Cognitive deficits occur when NOT delirious
  4. Cognitive deficits not better explained by another mental d/o
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4
Q

What is the MMSE

A

Max score is 30, takes 7-10 min
<24 is abnormal
(<24 for education= abn for college education)
<21= increased odds of dementia

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5
Q

Dementia is

A

Progressive and slow to present

disabling and fatal

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6
Q

Delirium is also known as

A 
ACUTE confusional state 
acute mental status change 
AMS 
organic brain syndrome (reversible dementia) 
Toxic or metabolic encephalopathy
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7
Q

What morbidity is associated with delirium

A

10x increased risk of death in hospital
3-5x increase risk of nosocomial complications, long stay, nursing home placement
Poor functionsl recovery and increased risk of death up to 2 years sp discharge
Persistence of delirium (poor long term outcome)

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8
Q

Who recognized delirium

A

Nurses more than docs (<50% vs 20%)

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9
Q

What is DSM5 for delirium

A
  1. Disturbance in attention and awareness
  2. Develops over short period of time (hr-day), change from baseline, fluctuates thru day
    • disturbance in cognition (memory, disorientation, language, perception)
  4. Not 2/2 neurocognitive d/o
  5. Evidence that disturbance is directly 2/2 another medical condition (toxin, intoxicated, etc.)
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10
Q

Delirium is more likely to have this symptom than dementia

A

Hallucinations

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11
Q

How do you diagnose delirium

A

DSM5 is difficult, so most use CAM (confusion assessment method)
Clinically more useful with >95% Sn/Sp

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12
Q

What is the CAM

A
  1. Acute change in mental status and fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. ALOC
    - Need 1 and 2, and 3 or 4
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13
Q

What is the delerium spectrum

A 
Hyperactive or agitated delirium 
Hypoactive delirium (MC and worst prognosis)
Mixed
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14
Q

What is the pathologic disturbance in delirium

A

Ach is needed for cognitive process. Cholinergic deficiency can cause delirium
-Anticholinergic drug OD (high serum anticholinergic activity), or high anti-Ach levels if not even taking anti-chol drugs

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15
Q

How do you reverse anticholinergic drug OD

A

Physostigmine!

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16
Q

Delirium is associated with what physiologic changes

A

Increased CRP, IL-1B, and TNF

Non-specific markers of inflammation

17
Q

What can inflammation do

A

Breakdown BBB and allow toxic meds and cytokines into CNS

18
Q

Predisposing factors of delirium include

A 
Advanced age 
Dementia 
Impaired ADL 
Comorbidities 
Hx of EtOH abuse 
Male 
Sensory impairment
19
Q

Precipitating factors of delirium are

A 
Acute cardiac event 
acute pulmonary event 
bed rest 
drug withdrawal 
fecal impaction 
fluid/lyte imbalance 
indwelling cath
infections (resp/urinary) 
meds
restraints
severe anemia 
uncontrolled pain 
urinary retention
20
Q

Pre-operative RF for Pst-op delirium include

A 
70+
Cognitive impairment 
Physical funcitonal impairment 
Hx EtOH abuse 
Abn serum chemistries 
ntrathoracic and aortic aneurysm surgery 
(3+ RF has 50% increased risk) 
(cardiac surgery/AAA repair/ hip Fx repair have highest risk)
21
Q

Keys to preventing post-op delirium include

A

Limit sedation
Provide adequate analgesia (delirium is associated with post-op pain AND use of benzos and opioids)
Peak onset is 2nd post-op day

22
Q

Post-op delirium is associated with

A

Post-op pain
Post-op anemia
Use of benzos and opioids (meperidine)

23
Q

In your delirium history, focus on

A

Time course! med review (including OTC and alcohol)

24
Q

Delirium PE should include

A

vitals
O2 sat
Gen medical eval
neuro and MSE

25
Q

Lab tests for evaluating delirium include

A

CBC, electrolytes, renal fxn tests
+/- UA, LFT, serum drug level, BG, CXR, ECG, cultures
THEN the rarely helpful- cerebral imaging (trauma or FND), EEG, and CSF (meningitis or sz activity)

26
Q

General principles for managing delirium include

A 
Interdisciplinary efforts (PA, MD, nurse, family, etc.) 
Multifactorial approach 
Diagnose ASAP- failure to diagnose and manage= life threatening complications and loss of fxn
27
Q

Keys to effectively managing delirium are

A
  • ID and Tx reversible contributors: Optimize meds, Treat infx, pain, fluid balance, sensory deprivation
  • Maintain behavior control (pharm; restraints last resort)
  • Anticipate and prevent complications (maintain urnary continence, mobility, fall prevention, pressure ulcers, sleep disturbance, and feeding d/o)
  • Restore fxn (hospital, cognitive recondition, ADL, family ed, dc planning)
28
Q

Reduce/Eliminate these drugs

A 
alcohol
anticholinergics 
anticonvulsants 
antidepressants 
antihistamines 
antiparkinsons drug
antipsychotics 
barbituates 
benzos
chloral hydrate
H2 blockers 
opioids (meperidine)
29
Q

How do you manage behavioral problems in delirium

A 
Social restraints (sitter or family) 
Avoid physical or pharm restraints 
Haloperidol IF necessary 
Lorazepam to sedate alcohol withdrawal (or Hx of neuroleptic malignant syndrome)
30
Q

Cautions in giving haloperidol are

A

Assess for akathisia and extrapyramidal effects
NO in elderly with parkinsons
Monitor for QT prolongation, Torsades, neuroleptic malignant syndrome, and withdrawal dyskinesias

31
Q

Rehab options for delirium

A

Orienting stimuli (clock, calendar, radio)
Socialization
Eyeglasses and hearing aids (if needed)
Mobilize ASAP
Ensure adequate nutrition and fluids (hand feed if needed)
Educate and support family

32
Q

Best management for delirium is

A

PREVENTION
PREVENTION
PREVENTION

Summer 2 (8 decks)

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