Delirium And Dementia Flashcards
Delirium
Acute transient disorder of confusion, consciousness, or perception
Causes of Delirium
Drug/alcohol withdrawal, metabolic ex, hypoglycemia, inc metabolites, brain surgery, tumor, trauma, post-anesthesia, fever, elexctrolyte imbalance,
Hyperactive delirium
Acute disturbance in attention or awareness developing over 2-3 days; usually ICU, post-surg, hospitalized elderly
Risk factors for hyperactive delirium
Meds (benzos, narcotics), acute infection, surg, hypoxia, insomnia, electrolytes
Sx of hyperactive delirium
ANS overactivity—restless, confused, irritable, problems sleeping, poor appetite; WHEN FULLY DEVELOPED—hallucinate, complete inattention, altered perception, fever, diaphoretic, stress and confused
Excited delirium
Complication of ANS overactivity; combative, even death (more often with hx of mental illness, intoxication)
Tx of hyperactive delirium
Remove risk factors, get them home, Help with sleep, decrease meds that cause AMS; often self-resolves
Hypoactive delirium
Associated with right-sided frontal basal ganglia disruption; more common with metabolic ex
Symptoms of hypoactive delirium
Dec attn and alertness, altered perception, sleepy, forgetful, apathetic, slow speech
Treatment for delirium
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
Dementia effect on delirium
Ppl with dementia more likely to have delirium
Dementia
Acquired deterioration of progressive cerebral function with impaired intellectual processing in memory, language, judgement, decision-making, overall slowing, orientation causing agitation, wandering, aggression
Pathophysiology of dementia
Neuron degeneration, compressed tissue, atherosclerosis of cerebral vessels, brain trauma, infection, neuro-inflammation; genetic predispositoin
GOAL of dementia tx
No cure—restore and optimize functional capacity
Alzheimer’s disease
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
AD cause and diagnosis
Genetic association especially early AD; no specific test—rule out other causes
Risk factors for AD
65+, isolation, genetics, existing impairment, family history, Down syndrome, drinking, smoking, poor diet, previous head trauma, isolated individuals
AD sx progression
Changes begin decades before sx, begin as mild often memory loss to total loss of cognitive and executive functioning, ultimate non-verbal vegetative state
Vascular dementia
2nd most common type of dementia; related to CVD and large artery disease, cardio embolism, smoking, swollen vessel disease causing hypoperfusion to the brain
Vascular dementia risk factors
DM, smoking, HTN, HLD; tx is prevent risk factors
Frontotemporal dementia
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)
Donepezil class and MOA
Cholinesterase inhibitors; increases levels of acetylcholine by inhibiting acetylcholinesterase; for mild-moderate dementia
Donepezil SE and NC
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
Memantine (Namenda) class and MOA
NMDA receptor antagonist; blocks stimulation of NMDA receptors; moderate to severe demtnia
memantine SE and NC
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
