delirium and dementia Flashcards
what is the definition of delirium?
acute onset of confusion that is fluctuating, reversible and affects all cognitive domains such as (attention, memory, executive function, visuospatial, language)
what are the diagnostic criterions of delirium?
disturbance of consciouscness w/ reduced ability to focus, sustain, shift attention
not explained by dementia (developing, established, evolving)
acute onset and fluctuating over the course of the day
disturbance is caused by medical condition through history, examination, investigations
what are some causes of delirium?
medication: anticholinergic drugs, antiparkinsonian medications, opioids, anxiolytics/hypnotics, other psychotropics, steroids, drug toxicities (lithium, digoxin, anticonvulsants)
infection: UTI, cellulitis, chest infection
cvs: MI, CHF
cerebrovascular: stroke, TIA, head injury, subdural haematoma
alcohol and intoxication:
medical/electrolyte disturbances: hypo/hypernatremia, renal failure, hyper/hypoglycemia, hypercalcemia
what are the risk factors for delirium?
> 70 years old
existing foreign body: catheter, IV line
use of physical restraint
pre-existing cognitive impairment - including dementia
visual impairment
depression
polypharmacy - addition of 3 or more medications
what are the sub classifications of delirium?
hypoactive; quiet, withdrawal, depressed, lethargic, drowsy, appear sedated, responds slowly to questions, withdrawn and sluggish state
hyperactive: agitated, hyper-alert, restless, often show hallucinations and delusions
mixed picture
name some environmental strategies for the treatment of delirium?
ensure lighting is appropriate for the time of the day
ensure the use of clock and calendar
avoid room changes
quiet environment
encourage family and friends to be involved in the patient’s care
encourage carers to bring in patient’s personal and familiar objects
name some clinical practice strategies for the treatment of delirium
ensure early mobilization adequate hydration and food intake hearing and visual aids regulation of bowel habits to avoid constipation promote regular and sufficient sleep manage discomfort and pain avoid use of physical constraint avoid use of psychoactive drugs if possible
what are the pharamcotherapy for delirium?
(first line) low dose antipsychotics:
haloeperidol/risperidone IM/IO (non sedating)
chlorpromazine (sedating, neuroleptic, anti-emetic properties)
atypical second gen neuroleptics such as risperidone, olanzapine, quetiapine
(second line) benzodiazepines
what is pharmacotherapy of choice for delirium d/t alcohol withdrawal (delirum tremens)
benzodiazpines (oxazepam, diazepam)
diazepam 20mg 2 hourly until symptoms subside. a cumulative dose of 60mg daily is usually adequate.
what are the pharamcotherapy for delirium?
(first line) low dose antipsychotics
haloeperidol/risperidone IM/IO (non sedating)
chlorpromazine (sedating, neuroleptic, anti-emetic properties)
atypical second gen neuroleptics such as risperidone, olanzapine, quetiapine
(second line) benzodiazepines
what is pharmacotherapy of choice for delirium d/t alcohol withdrawal (delirum tremens)
benzodiazpines (oxazepam, diazepam)
what pharmacotherapy should Alzheimer’s dementia receive?
anti-cholinesterase
donezepil
galantamine
rivastigmine (transdermal or oral)
what is the management guideline of Alzheimer’s dementia
confirm diagnosis
give anti-cholinesterase
treat existing comorbidities (such as medical/psychiatric)
avoid medications that can worsen confusion suhc as anti-cholinergics
carer support and education
organize practical and social support
refer for driving assessment
what are the features of vascular dementia
cognitive, motor, sensory dysfunction that worsens after every attack. neurological deficit + mutiple vascular risk factors
what are the features of dementia w/ lewy bodies
hallucination that is bizzare, parkinsonism and extra pyramidal signs
what are the features of pick’s disease
frontotemporal distribution hence personality and behavioural changes first w/ relative preservation of other cognitive functions
what are the features of huntington’s disease
more motor abnormalities such as psychomotor slowing, difficulty with complex tasks, classic choreotaform movements. Language/memory/insight remains relatively intact in the early and middle stages of the illness.
what are the classical neuropathology signs of Alzheimer’s disease?
diffused atrophy w/ flattened cortical sulci and enlarged cerebral ventricles
neurofibrillary tangles
presence of amyloid plaques
what is the distribution of neuropathlogy in Alzheimer’s disease?
parieto-temporal distribution
what are some of the risk factors of dementia?
age
positive family history
down’s syndrome
what is the most common first signs and symptoms of impairment in Alzheimer’s dementia?
memory impairment (short term memory impairment), denial of memory loss and depression
later stages - change in personality and affect, loss of language, spatial deficits, reasoning deficits, agitation and sleep disorders, sun-downing (more confusion as sun goes down) dysphagia, delusions or hallucinations
what is the most common first signs and symptoms of impairment in Alzheimer’s dementia?
memory impairment (short term memory impairment), denial of memory loss and depression
later stages - change in personality and affect, loss of language, spatial deficits, reasoning deficits, agitation and sleep disorders, dysphagia, delusions or hallucinations
what is the most common first signs and symptoms of impairment in Alzheimer’s dementia?
memory impairment
what are two substances most likely to cause hallucinations when patient is intoxicated?
cocaine, amphetamines
