Delirium and Dementia Flashcards
Define delirium
• ‘Acute, transient and reversible state of confusion, usually the result of other organic processes (infection, drugs, dehydration) – onset acute and cognition of patient fluctuant over a short period of time’
Outline hyperactive delirium
- Agitation
- Delusions
- Hallucinations
- Wandering
- Aggression
Outline hypoactive delirium
- Lethargy
- Slowness with everyday tasks
- Excessive sleeping
- Inattention
What are the precipitating factors of delirium?
- Pain
- Infection
- Nutrition
- Constipation
- Hydration
- Medication
- Environmental change
NB/environmental change + sensory impairment enough to cause delirium without deeper organic cause
VULNERABILITY + NOXIOUS INSULT = ?
Delirium
Outline the confusion screen for delirium
- FBC (infection/anaemia/malignancy)
- U+E (hyponatraemia/hypernatraemia)
- LFTs (liver failure with secondary encephalopathy)
- Coagulation/INR (intracranial bleeding)
- TFTs (hypothyroidism)
- Calcium (hypercalcaemia)
- B12 + folate
- Glucose
- Blood cultures
- Urinalysis (very common – positive dipstick without clinical signs NOT enough o diagnose UTI as cause of delirium (inc. WCC/supra-pubic tenderness/dysuria/offensive urine/positive urine culture needed)
- CT-head (bleeding/ischaemia/stroke/abscess) – if concerns of intracranial pathology
- CXR (if concern of lung pathology e.g. pneumonia/pulmonary oedema)
List some screening tools for delirium
- Confusing screening assessment tool
- 4AT
- CAM variants
How is delirium managed?
- Identify and treat underlying cause
- If non-pharmacological interventions and ineffective; first-line = haloperidol (oral, IV, IM) 0.5 mg (CONTRAINDICATED IN PARKINSON’S DISEASE!)
What is dementia?
- A syndrome: a set of symptoms including memory loss, mood changes, and problems with communication and reasoning
- Memory impairment + impairment in any other domain (e.g. language/orientation/spatial ability)
- Changes reflect a decline
- Social and/or occupational functional capacity impaired
List the causes of dementia in descending order
- Alzheimer’s dementia
- Vascular dementia
- Mixed dementia
- Lewy body dementia
- Fronto-temporal dementia
Outline mild cognitive impairment
- Cognitive decline greater than expected for an individual’s age and education level but does not interfere notably with ADLs
- MMSE ≥ 24/30
- Control vascular risk factors and treat depression
What is Alzheimer’s disease?
- Neurodegenerative condition initially affecting temporal lobes but eventually spreading to adjacent and then all areas of the brain
- Microscopically: loss of synapses and neurons, intracellular proteins (neurofibrillary tangles) and extracellular proteins (amyloid plaques) develop in brain leading to death of brain cells
- Cholinergic neurones especially vulnerable
What are the risk factors for Alzheimer’s disease?
- Age
- Genetics (ApoE4)
- Female
- Significant head trauma
- Family history
- Environment
What is vascular dementia?
- Caused by vascular damage affecting small, medium, large vessels or combinations thereof
- Post-stroke dementia
- Small vessel disease
- Combination of the two
