Delirium and dementia Flashcards
What is the key feature of delirium?
Disturbance of attention
Features of delirium?
Inattention Change in alertness Acute and fluctutating Changes in perception - visual hallucinations more common, delusions Disruption of sleep wake
2 types of delirium?
Hyperactive and hypoactive
Hypoactive - not picked up, poorer prognosis, less likely to recover
Risk of going into residential care following delirium?
3-7x increased risk from normal population
12 month mortality of delirium?
30-40%
Risk factors for delirium?
Strongest = cognitive impairment Visual impairment Severe illness Dehydration Hearing impairment Psychoactive drug use Use of restraints Malnutrition addition of 3x medications in previous 24 hours insertion of IDC *Age alone is not a risk factor for delirium
Management of delirum?
Treat cause
Increase familiarity
Orientate
Haloperidol in small doses 0.25mg - best drug for delirum
Avoid benzos as worsen prognosis unless in alcohol withdrawl
What is a limitation of MMSE?
Not good for frontal or executive function
- those with FTD often have normal MMSE scores
Key feature of Alzheimers disease on testing?
Rapid forgetting
- impaired recall and doesn’t improve with giving hints
compared with vascular dementia which improve on hints and prompting
Risk factors of AD?
Age* most important FH Female Head injury MCI vascular disease decreased B12/folate ApoE4 Downs syndrome - due to presence of APP gene on chromosome 21
Key feature of dementia with lewy bodies?
Recurrent visual hallucinations - typically people in a room
Pathology in each of the dementias?
AD - amyloid plaques, tau tangles, lewy bodies (alpha synuclein
VD - ischemic changes, often amyloid as well
DLB - lewy bodies
FTD - 50% Tau, 50% TDP 43
MRI findings in each of the dementias?
AD - generalised atrophy, decreased hippocampal volume
DLB - generalised atrophy
FTD - atrophy in frontal lobes
Side effects of cholinesterase inhibitors?
Increased GIT motility (nausea, diarrhoea, anorexia)
Increased urinary freq
Sleep disturbance, vivid dreams
Agitation and delirium
Vagotonic bradycardia (may be CI in down syndrome due to cardiac comorbidites)
Uses of cholinesterase inhibitors?
AD - good for mild to moderate, though only 30% respond - increasing evidence for MCI with amnesia, and in more severe AD VAD - of most benefit in mixed AD/VD DLB - good benefit FTD - no role
