Delirium and Dementia Flashcards
What are the causes of delirium
DELIRIUM Drugs - TCAs, opiates, benzos, antiparkinsons, steroids, alcohol withdrawal Electrolyte imbalance/Epilepsy Low oxygen/ Liver failure Infection e.g. UTI, Pneumonia Retention (urinary/faecal) Intracranial Uraemia/ underfed (malnutrition) Metabolic e.g DM, thiamine deficiency, thyroid problems
What is dementia
Describes a set of symptoms
- memory loss
- difficulties with thinking
- problem solving difficulties
- language difficulties
What are the causes of dementia
Alzeheimers disease - most common
Strokes/TIAs - vascular
What are the common types of dementia?
Alzheimers disease Vascular Lewy body Others - CJD, AIDS Dementia Mixed - more than 1 type of dementia
What are the symptoms of dementia?
Cognitive symptoms
- day to day memory impaired
- concentrating, planning, organising
- Language
- Visuospatial skills
- Oreintation
Changes in mood
hallucinatons and delusions
What is the pathophysiology behind vascular dementia
Regional cerebral blood flow is reduced Oxidative stress including free radicals Endothelial cells damaged Chronic hypoperfusion Oxygen supply to the brain is reduced
What are the clinical features of vascular dementia
Cerebrovascular disease
unilateral limb UMN defect
planter reflex extension
What are the features of Lewy Body dementia
Fluctuating memory and cognitive impairment
visual hallucinations
Parkinsonianism
What is the pathology behind Lewy Body dementia
Lewy bodys form within the brain leading to the death of brain cells
Development of abnormal collections of alpha synuclein within the cytoplasm of neurones
Loss of dopamine producing neurones in the substantia nigra like Parkinsons
What is the criteria for LB dementia
- progressive cognitive decline
- two of the following
- fluctuating cognition
- recurrent visual hallucinations (well formed and detailed)
- Spontaenous motor features of parkinsons - Supportive features
A Repeated Falls
B Syncope
C Transient LOC
D Neuroleptic sensitivity
E Systematised delusions
F Hallucinations of other modalities
What are some reversible causes of dementia
Chronic Alcohol use Deficiencies (vit B12/thiamine) Normal pressure hydrocephalus Infection - Syphilis Metabolic and endocrine Neoplasm - frontal lobe tumours
Which features need to be present and how long for to diagnose dementia
6 months or more of:
- decline in memory
- decline in other cognitive abilities
- preserved awareness of the environment i.e. absence of clouding of consciousness
- decline in emotional control/motivation or changes in behaviour
How is a patient with suspected dementia assessed?
Detailed clinical hx Personal hx incl family hx PmHx and drug hx Substance use Social hx Functional - mobility, ADLs, continence etc MSE
Investigations Bloods: FBC, TFTs, Vit B12 and folate, U&Es, LFTs, ESR Neuroimaging - CT/MRI EEG Syphilis serology HIV Heavy Metals CXR if suggested by clinical hx
What are the primary prevention measures in management of dementia
Vascular and lifestyle modifications ensuring social network frequent participation in social, physical and intellectually stiumlating activities Measures against - HTN - Cardiac failure - Obesity - diabetes - V low BP - Cerebral perfusion
What are the secondary prevention measures when managing dementia
Identify the pre clinical stage of AD for early diagnosis and intervention
- mild cognitive impairment
- biochemical markers in serum and CSF (beta amyloid and tau proteins )
- Neuroimaging - considered effective for diagnosing AD in pre clinical stage
- Volumetric MRI detecting medial temporal lobe atrophy
