Delirium and dementia Flashcards
1
Q
Delirium vs dementia
A
- Delirium (acute confusional state, ACS) is almost always due to metabolic problems
- Dementia (AD, lewy body dementia, frontal temporal lobe dementia) can be degenerative, vascular, or metabolic
- Dementia is usually degenerative
2
Q
DSM cirteria for delirium (ACS)
A
- Disturbance of consciousness w/ reduced ability to focus, sustain, or shift attention
- Develops over a short period of time (acute: hours to days) and tends to fluctuate
- Must not be caused by physiological consequences of a general medical condition
3
Q
ACS cause
A
- Affects all parts of the behavioral domains
- The cause is usually extrinsic to the brain
- Mostly affects attention and alertness
- Also affects (to some degree) executive function, visual/spatial, language, and episodic memory
- Major disruption to sleep-wake cycle
4
Q
DSM criteria for dementia
A
- Cognitive impairment to memory and one of the following: aphasia, apraxia (execute learned movements), agnosia (recognize objects), or executive functions
- Must be impairing social or occupational function
- Must be decline from previous level of function
- Must not be due to delirium or depression
5
Q
Causes of dementia
A
- Cause is usually intrinsic to brain and mostly only affects higher order functioning
- Executive, visual/spatial, language, and episodic memory are all mostly affected
- Its onset is usually insidious, gradually progressive (chronic)
- Pts have clear consciousness, but impaired awareness, orientation, memory, thinking, perception
6
Q
Behaviors in delirium and dementia
A
- In ACS there is attentional matrix deficit
- In AD there is episodic memory loss
- In lewy body dementia (LBD) there is loss of attention and executive control
- In right hemispheric FTD (behavioral variant) there is loss of emotional salience network
- In left hemispheric FTD (primary progressive aphasia) there is loss of the language network
7
Q
Cognitive network and attentional matrix functioning
A
- Acts in both bottom up and top down approaches
- Bottom up: reticular activating system maintains visual/spatial, language, and memory
- Top down: frontal, parietal, and limbic domains maintain visual/spatial, language, and memory
- Both are affected in delirium, only top down is affected in dementia
8
Q
Risk factors for delirium
A
- Age, comorbidities
- Pre-existing cognitive decline, ill physical condition
- Etoh, drug use/withdrawal
- Renal and liver failure
9
Q
Rx of ACS
A
- Rx the underlying cause of ACS
- Stop anticholinergics, BZDs, opiates
- Can give neuroleptics, a2 agonists
- Do NOT use BZDs
10
Q
Neurodegenerative dementia
A
- AD: tau neurofibrillary tangles (intracellular) and beta-amyloid plaques (extracellular)
- LBD: lewy bodies (composed of alpha-synuclein, intracellular)
- FTD: both tau protein and TDP43 deposits (cytoplasmic inclusions)
- The oligomers are the toxic elements
- APOE4 gene is a risk factor for AD: involved in cholesterol metabolism, brain metabolism, and clearing toxins from brain
11
Q
Progression of AD
A
- First Sx is mild cognitive impairment (MCI)
- Tau neurofibrillary tangles develop in hippocampus then spread to multi-modal areas (parietal and frontal lobes)
- Begins w/ memory loss then aphasia and higher executive functions
- Rx: CEIs (donepezil, galantamine) but they only help Sx and don’t stop progression
12
Q
Clinical criteria for LBD
A
- Dementia and 2 of the following: fluctuating cognition/attention/alertness, recurrent visual hallucinations, parkinsonism motor features
- When it comes to short term memory, giving cues may help someone w/ LBD but will never help someone w/ AD
- Affects the substantia nigra and other parts
- Rx is CEIs as well
13
Q
Frontal temporal lobe dementia (FTD)
A
- Can be left hemispheric (primary progressive aphasia) or right hemispheric (behavioral variant)
- There is sparing of parietal lobe and hippocampus (these are not spared in AD)
- Can also differentiate btwn FTD and AD by presence/absence of beta-amyloid (both have tau deposits)
- Do not Rx w/ CEI (no cholinergic deficits in FTD)
