Delirium And Dementia

Question 1

Delirium

Answer 1

Acute transient disorder of confusion, consciousness, or perception

Question 2

Causes of Delirium

Answer 2

Drug/alcohol withdrawal, metabolic ex, hypoglycemia, inc metabolites, brain surgery, tumor, trauma, post-anesthesia, fever, elexctrolyte imbalance,

Question 3

Hyperactive delirium

Answer 3

Acute disturbance in attention or awareness developing over 2-3 days; usually ICU, post-surg, hospitalized elderly

Question 4

Risk factors for hyperactive delirium

Answer 4

Meds (benzos, narcotics), acute infection, surg, hypoxia, insomnia, electrolytes

Question 5

Sx of hyperactive delirium

Answer 5

ANS overactivity—restless, confused, irritable, problems sleeping, poor appetite; WHEN FULLY DEVELOPED—hallucinate, complete inattention, altered perception, fever, diaphoretic, stress and confused

Question 6

Excited delirium

Answer 6

Complication of ANS overactivity; combative, even death (more often with hx of mental illness, intoxication)

Question 7

Tx of hyperactive delirium

Answer 7

Remove risk factors, get them home, Help with sleep, decrease meds that cause AMS; often self-resolves

Question 8

Hypoactive delirium

Answer 8

Associated with right-sided frontal basal ganglia disruption; more common with metabolic ex

Question 9

Symptoms of hypoactive delirium

Answer 9

Dec attn and alertness, altered perception, sleepy, forgetful, apathetic, slow speech

Question 10

Treatment for delirium

Answer 10

Remove risk factors and causative agents, get good sleep and general good health; give few opioids bc often related, give antipsychotics if danger to pt or provider

Question 11

Dementia effect on delirium

Answer 11

Ppl with dementia more likely to have delirium

Question 12

Dementia

Answer 12

Acquired deterioration of progressive cerebral function with impaired intellectual processing in memory, language, judgement, decision-making, overall slowing, orientation causing agitation, wandering, aggression

Question 13

Pathophysiology of dementia

Answer 13

Neuron degeneration, compressed tissue, atherosclerosis of cerebral vessels, brain trauma, infection, neuro-inflammation; genetic predispositoin

Question 14

GOAL of dementia tx

Answer 14

No cure—restore and optimize functional capacity

Question 15

Alzheimer’s disease

Answer 15

Leading cause of severe cognitive dysfunction in the elderly; 2/3 are women; accumulation of neurotic amyloid plagues (between neurons) and neurofibrillary tangles of tau protein (in neurons) often in the cerebral cortex and hippocampus causing loss of synapses and low NTs like ACh, brain atrophy

Question 16

AD cause and diagnosis

Answer 16

Genetic association especially early AD; no specific test—rule out other causes

Question 17

Risk factors for AD

Answer 17

65+, isolation, genetics, existing impairment, family history, Down syndrome, drinking, smoking, poor diet, previous head trauma, isolated individuals

Question 18

AD sx progression

Answer 18

Changes begin decades before sx, begin as mild often memory loss to total loss of cognitive and executive functioning, ultimate non-verbal vegetative state

Question 19

Vascular dementia

Answer 19

2nd most common type of dementia; related to CVD and large artery disease, cardio embolism, smoking, swollen vessel disease causing hypoperfusion to the brain

Question 20

Vascular dementia risk factors

Answer 20

DM, smoking, HTN, HLD; tx is prevent risk factors

Question 21

Frontotemporal dementia

Answer 21

R/t mutations of tau protein; family onset associated under 60 years of age; 3 clinical symptoms—behavioral variant, progressive non-fluent behavior (lang and writing), somatic dementia (speech and forming sentences)

Question 22

Donepezil class and MOA

Answer 22

Cholinesterase inhibitors; increases levels of acetylcholine by inhibiting acetylcholinesterase; for mild-moderate dementia

Question 23

Donepezil SE and NC

Answer 23

SE: Mild or none; GI upset, drowsy, dizzy, insomnia, muscle cramp, bradycardia, reflex tachy, syncope; NC: Start slow and build up to relieve CNS symptoms; NSAIDS can worsen GI symptoms; if pt is forgetful, use family or special pills to help

Question 24

Memantine (Namenda) class and MOA

Answer 24

NMDA receptor antagonist; blocks stimulation of NMDA receptors; moderate to severe demtnia

Question 25

memantine SE and NC

Answer 25

Uncommon, confusion, hypotension, headache, dizzy, constipated; Often taken with Donepezil; can give with or without food; can give fiber or stool softener; there is extended release version