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Phase 3a Geriatrics > Delirium + dementia > Flashcards

Delirium + dementia Flashcards

1
Q

What is the definition of delirium?

A

Transient (<6m) acute change in consciousness + cognition due to underlying pathology
REVERSIBLE

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2
Q

Causes of delirium?
acronym?

A

PINCH ME
Pain
Infection - UTI/URTI
Nutrition low
Constipation
Hydration low
Metabolic
Endocrine + Electrolytes

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3
Q

Rf for delirium?

A

age
pHx delirium
having dementia
all increase risk

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4
Q

Sx for delirium?

A

Clouded consciousness + inattention

Acutely (<6m) with fluctuation + disturbed sleep wake cycle + disordered thinking

often complex hallucination

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5
Q

Types of delirium?

A

hyperactive = agitation, persecutory delusions + vivid hallucinations

Hypoactive = withdrawn, low GCS

Mixed

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6
Q

Dx for delirium?
investigations

A

confusion bloods
ECG
consider CXR, Urine dip/MSU, CT head

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7
Q

What is tested in confusion bloods?

A

FBC, U+E, LFT, ESR/CRP, B12+Folate, Ca2+, TSH, Coagulation, Glucose, blood cultures

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8
Q

What screening tool is used for delirium?
what does it stand for?

A

4AT
Alertness
AMT4 (age, dob, time, place)
Attention
Acute course

88% specific

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9
Q

What is delirium confirmed with?
In GP?

A

short CAM (confusion assessment method)

GP = GPCOG

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10
Q

What does the short CAM test?

A

confusion
inattention
disorganised thinking
altered consciousness

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11
Q

Tx for orient Px with delirium?

A

reduce noise
same staff
clocks on wall
sleep wake cycle
family time

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12
Q

Tx for agitated Px with delirium?

A
  1. calm verbally
  2. PO/IM haloperidol
    (Parkinsons = benzodiazepine)
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13
Q

What are some delirium triggering medications?

A

TCA
Opiates
BB
Steroids
L-DOPA
Benzos

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14
Q

What is the definition of dementia?

A

progressive decline in cognitive function in alert Px for 6+ months, brain pathology
IRREVERSIBLE

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15
Q

Which dementias affect the cortical regions?

A

alzheimers - MC
Fronto-temporal
Vascular (+ Lewy body dementia)

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16
Q

Which diseases affect the subcortical regions?

A

Parkinsonism
Huntingtons
Alcohol
AIDS

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17
Q

Alzheimers dementia
% of dementias?
what is it caused by?

A

60% all dementia

B-amyloid plaques (phosphorylated TAU protein neurofibrillatory tangles) widespread in cortex with axon damage + low Ach

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18
Q

RF for alzheimers?
ratio F:M?

A

APP gene mutations
CVD RFs
fHx
genetic (APO-E4, Downs, PSEN1+2)
F (60%) : M high

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19
Q

Sx of alzheimers?

A

4As
Aphasia (difficulty communicating)
Agnosia (can’t recognise familiar objects/voices)
Apraxia (unable to speak/move)
Amnesia (memory loss)
in GRADUAL decline

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20
Q

Vascular dementia
% of dementias?
cause?

A

20-30%
CVD results in cortical infarct

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21
Q

RF of vascular dementia?
Sx of vascular dementia?

A

CVAs, other IHD

4As, more SEVERE in STEPWISE DECLINE

22
Q

Lewy body dementia
% of dementias?
what is it caused by?
RF?

A

5%

Deposits of eosinophilic ubiquitin + alpha synuclein in basal ganglia + cortex

Parkinsons (25%), fHx, age

23
Q

Sx of lewy body dementia?

A

REM sleep disorder
vivid visual hallucinations
Parkinsonism (after dementia)
often fluctuating consciousness

24
Q

what is the most rapid declining dementia?

A

Lewy body

25
Q

Fronto temporal dementia
% of dementias?
what is it caused by?
RF?

A

5%

Pick bodies (Tau + ubiquitin) in frontal/temporal lobes

Fix, affects 50-60y, TDP43 + C9orf72, MAPT

26
Q

Sx of frontotemporal dementia?

A

frontal:
apathy (lack of interest)
mood disorder
low executive function
hyperphagia + hypersomnia + crying

Temporal:
trouble with grammar

27
Q

What is the precursor to dementia called?

A

mild cognitive impairment

28
Q

Dx of dementia?
what investigations are done?

A

Confusion bloods, syphillis, HIV
MSE /30 (>25 good)

29
Q

What screening exam is done for dementia?

A

Addenbrooke’s cognitive examination (ACE-III)

30
Q

what is ACE-III out of?
what is a good result and what is abnormal?

A

/100
>88 = good
<82 = abnormal

31
Q

What imaging is done for dementia?
what are we trying to rule out?

A

CT (r/o SOL + NPH - normal pressure hydrocephalus)
MRI head
SPECT/DaT SCAN

32
Q

What would be seen in an MRI head in someone with Alzheimers dementia?

A

Diffuse cortical + hippocampal atrophy, succal widening and bigger ventricles

Micro: Tau, B amyloid, low Ach axons

33
Q

What would be seen in an MRI head in someone with Vascular dementia?

A

1 or more white cortical infarct

34
Q

What would be seen in an MRI head in someone with Lewy body dementia?

A

cortical deposit / BG deposit / normal

Micro: ubiquitin + alpha synuclein

35
Q

What would be seen in an MRI head in someone with fronto temporal dementia?

A

frontal and temporal deposits

Micro: Pick bodies (ubiquitin + Tau)

36
Q

When would you do a SPECT and DaT scan and what would you see?

A

SPECT = Ddx AD + FTD

DaT = LBD (2 dots instead of commas for BG)

37
Q

What MDT members are involved in the care of a Px with dementia?

A

PT
OT
SALT
Neuro
GP

38
Q

what is the medical Tx for Alzheimers dementia?

A
  1. Achase-i (Rivastigmine/galantamine/donepazil) - mild/mod dementia
  2. NDMA-i (Memantine) - mod/severe dementia
39
Q

SE of memantine?

A

dizzy, headache, SOB

40
Q

With alzheimers dementia medications, what do you not Give?

A

do not give antipsychotics

41
Q

what is the medical Tx for vascular dementia?

A

vascular RF, statins + aspirin

42
Q

what is the medical Tx for Lewy body dementia?

A

same as AD (Achase-i!!!)
do not give antipsychotics
benzos are fine to give

43
Q

what is the medical Tx for frontotemporal dementia?

A

SSRI, Antipsychotic
do not give Achase-i - worsens Sx

44
Q

What services are available for dementia Px?

A

Alzheimer’s society
Dementia UK

45
Q

Name some other types of dementia / dementia symptom diseases?

A

Prion
HAND
NHP
Alcohol
Wilsons
pseudo dementia
Neurosyphillis

46
Q

What is Prion disease?
Caused by?
Sx?

A

Creutzfeldt-Jakob disease

Caused by abnormal infectious protein in brain ‘prion’, which misfold + build up in brain

spongiform encephalitis associated with boring vaccine

Rapid dementia + <1y death

47
Q

What is HAND?
what does it stand for?

A

HIV associated neuro disorder

48
Q

What is normal pressure hydrocephalus?
Sx?
Dx? what would be seen?
Tx?

A

Excess CSF in ventricles

Wet - loss of bladder control
Wacky
Wobbly

Dx with CT (widened ventricles) in 65+y M

Tx with VP shunt

49
Q

How does alcohol cause dementia like Sx?

A

Dependence
Wernickes + Korsakoff

50
Q

What is Wilsons disease?
what Sx does it cause and why is it similar to dementia?
Dx?
Tx?

A

Auto recessive ATP 7B hypercopperaemia

Wing beating tremor, Parkinsonism, dementia, Kayser Fleischer rings (eyes)

Dx = low serum caeruloplasmin, high urine copper

Tx = D - Penicillinamine

51
Q

What is and causes pseudo dementia?

A

Depression Px
‘I don’t know’ answers
Normal MSE
Recent bereavement
No confabulation

52
Q

What is neurosyphilis?
Sx?
Tx?

A

3^ with other Sx

Tabes dorsalis, Argyll robinson pupil, dementia and psychosis

Tx = IM Penicillin V

Phase 3a Geriatrics (5 decks)

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