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Psych > Delirium and Dementia > Flashcards

Delirium and Dementia Flashcards

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1
Q

What is the onset of delirium like?

A

acute: hours to days

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2
Q

Describe some of the major presentations of delirium.

A
  • “Waxing and waning” level of consciousness.
  • altered mental status
  • clear change from baseline shortly after onset
  • impaired attention and memory deficits
  • psychosis: delusions, hallucinations, disorganized thought and speech
  • language, psychomotor, and sleep disturbances
  • change in affect: constricted or flat
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3
Q

What is one serious caution that must be taken when considering the waxing and waning nature of delirium?

A

The waning can look like resolution

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4
Q

What the arousal of a patient with delirium like?

A

at an abnormal level: from somnolence to hypervigilance

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5
Q

What part of the memory in a patient with delirium is most likely lost? What is usually intact?

A

lost: short term and remote memory
intact: autobiographical

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6
Q

What is the disorientation of a patient with delirium like?

A

disoriented to place and time, not usually to self

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7
Q

What changes in language are often observed in a patient with delirium?

A

slowed, unorganized speech, paraphasia, dysgraphia, decreased comprehension

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8
Q

What are the common sleep disturbances in a patient with delirium?

A

day time drowsiness with frequent napping, nighttime insomnia, fragmented sleep
–sundowning: symptoms of delirium get worse at night

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9
Q

What can cause delirium?

A

all the things
drugs, electrolyte abnormalities, endocrine disorders, nutrition deficiencies, infection, vascular disorders, organ failure, primary neurologic pathology, severe stress….. etc

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10
Q

What are the some risk factors for delirium?

A
  • extremes of ages
  • preexisting medical condition
  • baseline poor health or disability
  • environmental conditions
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11
Q

What manifestation of delirium correlates with the frontal and prefrontal lobes?

A

thought disorganization, psychomotor disturbances, delusions,

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12
Q

What manifestation of delirium correlates with the basal ganglia, thalamus, and hippocampus?

A

attention, memory, disturbance in affect, psychomotor disturbance

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13
Q

What manifestation of delirium correlates with the cingulate gyrus?

A

language impairment

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14
Q

What manifestation of delirium correlates with the temporal lobe?

A

memory deficits, language impairment

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15
Q

What manifestation of delirium correlates with the parietal lobe?

A

disorientation

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16
Q

What manifestation of delirium correlates with the occipital lobe?

A

perceptual disturbances

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17
Q

Name all the neurotransmitters that may be abnormal (excess or deficient) in delirium.

A

dopamine (excess), serotonin (either), ACh (deficient), GABA (either), glutamate (either), NE (excess), histamine (either), glucocorticoids (either)

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18
Q

What manifestation of delirium correlates with the brainstem?

A

altered level of consciousness and sleep disturbance

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19
Q

What is the best way to treat delirium?

A

treat the underlying cause

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20
Q

What are some common drugs used to treat delirium?

A
  • high potency typical antipsychotics
  • atypical antipsychotics
  • short acting BNZ
  • nonBNZ hypnotics (trazodone)
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21
Q

What would the EEG be expected to look like in a patient with delirium?

A
  • diffuse slowing of dominant rhythms
  • generalized delta waves
  • loss of reactivity
22
Q

Is delirium a global or localized disruption of the brain?

A

global

23
Q

What state of polarization are the affected neuronal circuits in during delirium?

A

hyperpolarized: less excitable

24
Q

Compare and contrast secondary syndromes with delirium

A

Secondary syndromes: usually space vital signs of diffuse cortical impairment and usually occur without alterations in consciousness or significant change in symptoms

25
Q

What are some major changes of dementia?

A
  • gradual slowing of thought
  • poor memory and concentration
  • loss of personality
  • loss of ability to learn and manipulate new info
  • loss of ability to perform basic tasks
26
Q

Do people with dementia have delusions and hallucinations?

A

they can, but its less common than with delirium

27
Q

Whats the most common primary cause of dementia?

A

alzheimer’s

28
Q

What risk factors are associated with alzheimer’s?

A

age, ApoE4 gene, mutation in Ch 1, 14, 21

29
Q

What part of the brain is affected first in Alzheimer’s

A

posterior

30
Q

What can be seen microscopically with Alzheimer’s?

A

neurofibrillary tangles, beta-amyloid plaques, granulovascular degeneration

31
Q

What are some early symptoms of alzheimer’s?

A
  • early short term memory loss
  • apraxia
  • confusion and inability to sequence, learn or recognize people
32
Q

What are some late symptoms of alzheimers?

A
  • personality changes
  • depression
  • paranoia
  • visual hallucinations
33
Q

What part of the brain is first affected in FTDs (frontaltemporal dementias)?

A

anterior

34
Q

What is the cause of vascular dementia? Who gets it?

A

usually old patients

-small arteries and arterioles become blocked by atherosclerosis –> decreased blood flow to the brain

35
Q

What is the course of the decline like in vascular dementia?

A

step-wise (not steady decline)

36
Q

What is Huntington’s Disease etiology? What part of the brain is affected?

A

AD, CAG repeat on Ch 4 –> increased production of huntingtin protein
–destruction of the caudate and radiations of the caudate

37
Q

What are the most common presenting symptoms of Huntington’s disease?

A

chorea, paranoia, impulsive control, memory loss, psychosis

38
Q

What does Huntington’s disease look like on neuroimaging?

A

butterfly pattern

39
Q

What dementia’s only known cause is genetic?

A

Huntington’s disease

40
Q

What is the main target of Parkinson’s disease?

A

cortical radiations of DA neurons originating in the basal ganglia

41
Q

What are the symptoms of Parkinson’s disease?

A

tremor, rigidity, akinesia, postural instability

can have apathy and aggression

42
Q

What part of the brain does Lwy Body dementia target?

A

similar to parkinson’s but spares the temporal lobe

43
Q

What are the symptoms of Lewy body dementia?

A
  • severe motor symptoms
  • visual hallucinations EARLY
  • memory loss
  • personality change
44
Q

What part of the brain does Pick’s disease affect?

A

frontal and temporal lobe atrophy

45
Q

What are the symptoms of Pick’s disease?

A
  • impulsive/disinhibited or anergic/apathetic poor hygiene
  • loss of social skills
  • aphasia
  • no insight
  • *Memory may be spared
46
Q

What dementia is often NOT associated with memory loss?

A

Pick’s disease

47
Q

What does the EEG of a dementia patient usually show?

A

nothing. its usually normal

48
Q

What are some reversible causes of dementia?

A
  • B12/thiamine deficiency (only Wernicke’s part)
  • normal pressure hydrocephalus
  • hypothyroidism
  • neurosyphilis
  • HIV
  • MS (maybe only partial)
49
Q

What happens within the brain do to thiamine deficiency causing dementia?

A

selective deterioration of mammillary bodies

50
Q

Which dementia causes early visual hallucinations?

A

Lewy Body

51
Q

Which dementia has a step-wise course?

A

vascular dementia

52
Q

Why is it important to determine the cause of dementia early?

A

Many underlying causes can be treated and at least partially restore function

Psych (12 decks)

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