Delirium and Dementia

Question 1

What is the most important symptom in Delirium?

Answer 1

Impairment of consciousness

Question 2

What is the difference between Delirium and Dementia?

• Onset
• Primary feature
• Cause: Within the brain or external causes

Answer 2

Delirium onset is acute. Chronic in dementia.

Primary feature of delirium is impairment of consciousness.
Primary feature of dementia is generalised intellectual impairment.

Cause of delirium is usually external, such as alcohol withdrawal or drug intoxication. But cause of dementia is within the brain, such as degeneration in Alzheimer’s disease.

Question 3

What is the behaviour and thought process of patients with delirium?

Answer 3

Behaviour - may be overactive with nosiness or irritability, or underactive with lethargy.

Thoughts - slow and muddled thoughts. May experience hallucinations and delusions, but these are usually transient.

Question 4

What are the neurological causes of delirium?

Answer 4

Intracranial infection: Meningitis. Encephalitis,
Space-occupying lesions
Raised intracranial pressure
Following an epileptic seizure or from non-convulsive status epilepticus.

Question 5

What medications can be given to help with sleep in those with Delirium?

Answer 5

Benzodiazepines or hypnotics.

Question 6

What is the diagnostic criteria of Dementia?

Answer 6

1. A decline in memory (amnesia)
2. A decline in cognitive abilities
3. A decline in emotional control and a change in social behaviour
4. Absence of loss of consciousness (this will be seen in Delirium)
5. 5 As: Apraxia, Amnesia, Agnosia, Aphasia, Associated symptoms

Question 7

The lack of which vitamin can result in dementia?

Answer 7

Vitamin B12, folic acid and thiamine

Question 8

What is Pick’s disease?

Answer 8

Pick’s disease is a frontotemporal dementia where patients present with behavioural problems before memory decline.
It is a common cause of dementia before old age.

Question 9

What are the characteristic features of pseudodementia which separates it from dementia?

Answer 9

1. a history from another informant that the depressed mood precedes memory issues/problems
2. memory testing shows that the poor performance improves when interest is aroused
3. the patient is retarded and unwilling to cooperate, when in dementia, patients are usually willing to reply to questions but make mistakes.

Question 10

Describe presentation of Lewy body dementia.

Answer 10

Memory impairment may not be apparent in early stages.
Repeated falls, syncope and transient loss of consciousness.
Delusions and hallucinations (detailed visual hallucinations) may be present.
Later, can present with Parkinsonian movement disorders - rigidity, shuffling gait, bradykinesia.
Can also have autonomic dysfunction: difficulty swallowing, incontinence, postural hypotension and constipation.

Question 11

What are the different areas of cognitive impairment that can occur in dementia?
Which of these areas are affected in Alzheimer’s dementia?

Answer 11

1. Visuo-spatial impairment
2. Memory impairment
3. Verbal abilities
4. Executive function impairment: planning
   All are affected in Alzheimer’s dementia.