Delirium

Question 1

delirium

Answer 1

characterized by alteration of consciousness, waxing and waning of sx, psychomotor retardation or agitation, decreased attention span

Question 2

what meds can you recommend?

Answer 2

lorazepam or halo

Question 3

causes of Delerium

Answer 3

MOVE STUPID

Question 4

MOVE

Answer 4

Metabolic-hepatic encephalopahty, thiamine deficiency, hypoglycemia

Oxygen- hypoxia, hypercapnea

V-vascular, MI

Endocrine, electrolytes- hypoN, hyperCa, fluid imbalance, thyroid issues

Question 5

STUPID

Answer 5

Sz

Trauma, tumor, temp

Uremia-acute renal failure, dehydration

Pyschogenic

Infection/intoxication-UTI, PNA, meningitis, sepsis, EToH, benzos, CO, barbiturates

Drugs/degenration

Question 6

S/X

Answer 6

hallucinations, delusions, agitation, persecutory thoughts are common

• anxiety, paranoia, or combativeness
• sx worse at night “sundowning”
• decreased attention span, decreased short term memory, reversed sleep-wake cycles

Question 7

Work up

Answer 7

everything

Question 8

rx of delirium

Answer 8

underlying cause

normalize fluids/electrolyes, appropriate sensory environment

Question 9

what meds do you want to avoid in tx of delirium?

Answer 9

Benzos!!! can make sx worse for pts

Question 10

Dementia

Answer 10

progressive impairment of intellectual functioning w/ compromise in a least 2 of the following spheres of mental activity: language, memory, visuospatial skills, emotional behaviour, personality, cognition

Question 11

what are some types of dementia?

Answer 11

alzheimer, vascular, can have dementia from PD, Huntingtons, frontotemporal dementia, HIV, creutzfeldt-jakob, toxins, depression, hydrocephalus

Question 12

Alzheimer RF

Answer 12

old age, Fmhx, lower education level, female

Question 13

what chromosomes are associated w. alzheimer

Answer 13

1, 14, 19, 21

Question 14

what is the pathology of alzheimer

Answer 14

intracellular neurofibrillary tangles and extracellular neuritic plaque

Question 15

sx of alzheimer

Answer 15

progressive memory loss (anterograde amnesia is first sign), disorientation, language difficulties, inablitly to perform complex motor activities, inattention, visual misperception, poor problem-solving abilities, inappropriate social behavior, hallucinations

Question 16

acalculia

Answer 16

inability to perform math

Question 17

tx for alzheimer

Answer 17

low doses to tx insomina, agitation depression

Question 18

memantine?

Answer 18

NMDA receptor antagoinst that is thought o regulate gluatmate, and has been apporved for use in severe AD

Question 19

Vitamin E and selegiline?

Answer 19

antioxidants- may slow cognitive deline

Question 20

what can help improve memory fxn?

Answer 20

tacrine, donepezil, galantamine, rivastigmine

acetylcholinesterase inhibitors

Question 21

vasular dementia

Answer 21

” multiinfarct dementia” includes lacunar and mult cortical infarctions

Question 22

vascular dementia associations?

Answer 22

HTN, M,

Question 23

VD sx

Answer 23

forgetfulness in the absence of depression and inattentiveness

-stepwise fashing and related to the area of the CNS affected

Question 24

cortical VD

Answer 24

speech difficulty, trouble performing routine tasks, sensory interpration difficulty, confusion, amnesia, executive dysfxn

Question 25

subcortical sx VD

Answer 25

gait problems, urinary difficulties, motor deficites, personality changes --

Question 26

other features of VD

Answer 26

social behaviors may be well maintained, **mental status

Question 27

progression of VD

Answer 27

loss of computational ability, problems w/ word finding and concentration, ADL, ultimatley complete disoreitnation and social w/drawal

Question 28

tx of VD

Answer 28

control HTN, metabolic dz

Question 29

frontotemporal dementai etiology

Answer 29

Pick dz, amyotrophic lateral sclerosis

Question 30

frontal lob sx

Answer 30

behavioral (euphoria, apathy, disinhibtion) and compulsive dx

Question 31

what are other fx of FLD

Answer 31

primitive reflexes

Question 32

work up of FLD

Answer 32

MRI-may show frontal and/or anterior temoral lobe atrophy PET- hypometabolis

Question 33

Pseudodementia

Answer 33

pts w. psychiatric illness who appear demented -MDD

Question 34

PDementaia CF

Answer 34

pts typically complain of memory problems, but attention span and concentration appear intact while appearing upset or distressed **in true dementia, pts will often give wrong answers, have poor attention and concentration, and appear indifferent or unconcerned