Delirium and Dementia Flashcards
What is the onset of delirium like?
acute: hours to days
Describe some of the major presentations of delirium.
- “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
What is one serious caution that must be taken when considering the waxing and waning nature of delirium?
The waning can look like resolution
What the arousal of a patient with delirium like?
at an abnormal level: from somnolence to hypervigilance
What part of the memory in a patient with delirium is most likely lost? What is usually intact?
lost: short term and remote memory
intact: autobiographical
What is the disorientation of a patient with delirium like?
disoriented to place and time, not usually to self
What changes in language are often observed in a patient with delirium?
slowed, unorganized speech, paraphasia, dysgraphia, decreased comprehension
What are the common sleep disturbances in a patient with delirium?
day time drowsiness with frequent napping, nighttime insomnia, fragmented sleep
–sundowning: symptoms of delirium get worse at night
What can cause delirium?
all the things
drugs, electrolyte abnormalities, endocrine disorders, nutrition deficiencies, infection, vascular disorders, organ failure, primary neurologic pathology, severe stress….. etc
What are the some risk factors for delirium?
- extremes of ages
- preexisting medical condition
- baseline poor health or disability
- environmental conditions
What manifestation of delirium correlates with the frontal and prefrontal lobes?
thought disorganization, psychomotor disturbances, delusions,
What manifestation of delirium correlates with the basal ganglia, thalamus, and hippocampus?
attention, memory, disturbance in affect, psychomotor disturbance
What manifestation of delirium correlates with the cingulate gyrus?
language impairment
What manifestation of delirium correlates with the temporal lobe?
memory deficits, language impairment
What manifestation of delirium correlates with the parietal lobe?
disorientation
What manifestation of delirium correlates with the occipital lobe?
perceptual disturbances
Name all the neurotransmitters that may be abnormal (excess or deficient) in delirium.
dopamine (excess), serotonin (either), ACh (deficient), GABA (either), glutamate (either), NE (excess), histamine (either), glucocorticoids (either)
What manifestation of delirium correlates with the brainstem?
altered level of consciousness and sleep disturbance
What is the best way to treat delirium?
treat the underlying cause
What are some common drugs used to treat delirium?
- high potency typical antipsychotics
- atypical antipsychotics
- short acting BNZ
- nonBNZ hypnotics (trazodone)
What would the EEG be expected to look like in a patient with delirium?
- diffuse slowing of dominant rhythms
- generalized delta waves
- loss of reactivity
Is delirium a global or localized disruption of the brain?
global
What state of polarization are the affected neuronal circuits in during delirium?
hyperpolarized: less excitable
Compare and contrast secondary syndromes with delirium
Secondary syndromes: usually space vital signs of diffuse cortical impairment and usually occur without alterations in consciousness or significant change in symptoms
