Delerium & Dementia I Flashcards
Delirium syndrome definition
- =”acute confusional state” or “toxic-metabolic encephalopathy”
- A rapidly developing disorder of attention characterized by an inability to maintain a coherent line of thought
Typical characteristics of delirium
- Fluctuating level of consciousness
- Impaired attention - cannot focus on salient aspect of environment
- Incoherent speech
- Toxic and metabolic causes can usually address
- Typically reversible
- More common: hypoaroused- lethargy and somnolence
- Less common: hyperaroused. E.g. Delirium Tremens
Percentage of patients impacted by delirium + consequences
- 10-60% of older hospitalized patients
- 60-80% of patient @ ICU
- ==> longer hospital stays
- ==> high mortality
Common causes of delirium
- drugs and toxins**
- metabolic disorders**
- infection
- inflammation
- structural lesions
- seizure disorders
- polypharmacy ==> disruptof of brain homeostasis
Differential dx for delirium
- dementia
- amnesia
- aphasia
- schizophrenia
- mania
- depression
Evaluation/approach to delirium
- Hx/PE
- mental status
- blood chemistry
- urinalysis
- ECG
- Chest XR
- Toxicology screen
- CT/MRI
- lumbar puncture
- EEG
Definition of dementia
- Acquired and persistent impairment in intellecutal functions with deficits in at least three of the following domains:
- memory
- language
- visuospatial skills
- complex cognition
- and emotion or personality
- deficits interfere with usual social and occupational function
Characteristics of dementia
- Chronic Disorder - nothing implies progressive course or irreversibility
- Normal level of consciousness
- Aphasia
- Toxic and metabolic causes usually not found
Common reversible etiologies of dementia
- = 10-20% of cases
- drugs/toxins
- mass lesions
- normal pressure hydrocephalus
- hypothyroidism
- Vit B12 deficiency
- neyrosyphilis
- systemic infection/inflammation
- mild TBI
- depression
Common irreversible causes of dementia
- = 80-90% of cases
- Alzheimer’s disease
- frontotemporal dementia
- vascular dementia
- Huntington’s disease
- Parkinson’s disease
- Lewy Body Dementia
- CJD
- MS
- AIDS dementia complex
- severe TBI
Evaluation/approach to dementia
- History and exam
- Chem survey
- MRI or CT scan of brain
- Select cases: lumbar pucture, eeg, hiv, esr…brain biopsy.
Types of dementia
Cortical - Alzheimer’s, Frontaltemporal Dimentia (Pick’s Disease)
Subcortical - Parkinson’s Disease/ Huntington’s Disease
White Matter- NPH or Binswangers Disease
Mixed - multi infarct dementia, CJD
Stages of Alzheimer’s Disease
Average patient goes down by 3 points on MMSE/year.
I - initial amnesia, anomia (can’t recall names of everyday objects), apathy
II - marked amnesia, fluent aphasia, visuospatial dysfunction, anosognosia, neurospychiatric features
III - severe dementia, global aphasia or mutism, incontinence
General principles of delirium treatment
- Prompt attention to etiology
- Environmental manipulations
- Provision of adequate sleep (no naps and daytime sedation)
- may require drugs: Trazodone, chloral hydrate
- Drugs for agitation (atypical neuroleptics, benzodiazepines)
Principles of dementia treatment
- cholinergic hypothesis
- find/fix reversible causes
- regular medical care in irreversible causes
- informed counseling/preparation for future
- avoid drugs/medical problems that worsen demention
- careful use of medications
