Delirium and dementia Flashcards
What’s the difference between dementia and delirium?
Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function.
Delirium is an acute, usually temporary condition characterized by disorientation, hallucinations, anxiety, incoherent speech, restlessness and delusions.
What are the different forms of dementia?
Lewy body dementia Alzheimer's Fronto-temporal dementia Prion diseases Vascular dementia 'Others' eg HIV associated dementia (can be partially reversed with HAART therapy)
How can you define dementia?
- Short term memory impairment may be the start of dementia, but it is not itself dementia
- Dementia has to be both global and progressive to be worthy of the name
- Dementia is not defined by a Folstein Mini-Mental State, nor any other test for that matter
- We need both an informant’s description and some psychometric testing: and some other tests
What is Alzheimer’s disease?
- A gradually progressive dementia with short term memory loss and progressive global change in another domain such as language, apraxia,
- Behavioural and psychiatric changes may occur
- Often loose insight
- CT brain may show medial temporal lobe changes but is often normal
What is Lewy body dementia ?
A form of dementia with some overlap with Alzheimer’s disease.
Characterised by some features of Parkinsonism.
Often, have gait instability and falls at an early stage. Formed visual hallucinations (usually non-frightening). Marked fluctuation within and between days Daytime sleepiness with sleep reversal and bad dreams Extreme sensitivity to neuroleptics.
What is vascular dementia?
Overlaps with Alzheimers
Due to multiple strokes, large or small
Extensive MRI evidence of strokes can exist with little clinical evidence of dementia. But it’s a poor prognostic sign.
May have clinical evidence of previous strokes, arteriopathy elsewhere
Mood disorders frequent: in fact, a high “white matter burden” indicates a poorer prognosis in depression
Characterisitic “stepwise” progression is possible but a slow “slide” is commoner.
What is stroke related dementia?
Symptoms may appear suddenly. Over a period of time a person may have further strokes which result in cognitive and frequently physical disabilities.
What is small vessel disease related dementia?
Tends to be more like Alzheimer’s, developing slowly over time.
What are Prion diseases?
Creutzfeldt-Jakob Disease
- older people: uncommon: incidence about 1 in a million
- 85% sporadic, 15% familial
New Variant CJ disease
- younger people, behavioural problems at onset
- BSE agent: uncommon: peak reached ?
Fatal Familial insomnia
Kuru
- rare, largely hereditary - transmission through eating neural tissue
Gertsmann-Sträussler-Scheinker (GSS) disease
- v rare: all familial
Alcohol abuse is very common indeed and is associated with subdural haematomas as well as cerebral atrophy and W-K syndrome
What is Pick’s disease?
Fronto-temporal dementia
Presents with disinhibition language disorder
loss of social skills poor judgment abulia personality change overeating, hyperorality unable to use everyday objects
Arnold Pick, 1892
Short-term memory often not too bad: FMMSE fails to pick up Imaging may show atrophy of fronto-temporal lobes
What is common in a dementia patient’s medical history?
• Shortterm-memory
- Forgettingthings - Forgettingpeople - Repetitive questions - Forgetting what just happened
Story of getting lost in a familiar place Getting up in the night and thinking it’s day Getting lost whilst driving Missing appointments, etc.
• Languageability - inability to manipulate language to express
themselves - inability to understand requests.
• Constructionalability/apraxia - can’t get dressed in sequence - unable to do sequence tasks.
What tests can be performed on a possible dementia patient?
Test immediate and delayed recall: - Ball, Flag, Tree
- Name and address - Details of a story or picture - Things in their life of note
• Test their Orientation
- in place - in time - in person
To test language ability: Listen to speech carefully Name objects (Pen, Watch, Keys) Describe what’s happening in a picture.
To test apraxia:
Draw complex shapes (double pentagon) Follow instructions (3-step test) Watching someone dress or do a task Clock-face drawing.
To test frontal lobe (executive) function - social and personal behaviour - ability to look after self:
Sequencing tasks/series Interpretation of abstract concepts (proverbs) Language fluency and content Cognitive rigidity Verbal fluency.
What is The Folstein Mini-Mental State?
plusses: Easy Quick (5-10 mins) Very widely used Assesses several domains Robust (not much inter-observer variation) Useful best screen available negatives: Crude Sensitive to educational level Insensitive to mild cognitive impairment Does not test frontal lobe function well Confounded by language (in)ability
How do you estimate premorbid intelligence? (what to look at to measure intelligence before disease kicked in)
Vocabulary: Over-learned Wide vocabulary is associated with a high IQ (National Adult Reading Test) What job they held when working Educational achievement Assortive mating
Which Dementia types are associated with gait disorder?
- Lewy Body disease
- Vascular dementia
- Normal pressure hydrocephalus
- Mass lesion (tumour/haematoma)
- Co-incidence of dementia plus another cause of gait disturbance
- “Parkinsons-plus” disorders
