Delirium/Dementia

Question 1

What are the 8 signs of delirium?

Answer 1

DELIRIUM
D - disordered thinking
E - euphoric, fearful, depressed or angry
L - language impaired
I - illusions/delusions/ hallucinations
R - reversal of sleep-awake cycle
I - inattention 
U - unaware/disorientated
M - memory deficits

Question 2

What are the causes of delirium?

Answer 2

systemic infection: pneumonia, UTI, malaria, wounds, IV lines
Intracranial infections: encephalitis, meningitis
Drugs: opiates, anticonvulsants, levodopa, sedatives, recreational, post-GA
Alcohol/drug withdrawal
Metabolic: uraemia, liver failure, Na or glucose high/low, malnutrition
Hypoxia: respiratory or cardiac failure
Vascular - stroke, MI
Head injury, rasied ICP, space-occupying lesion
Epilepsy - non-convulsive status epilepticus, post-ictal
Nutritional - thiamine, nicotinic acid, B12 deficiency

Question 3

What are the differentials for delirium?

Answer 3

anxiety

primary mental illness

Question 4

How can the signs of delirium be summarised?

Answer 4

Globally impaired cognition and impaired awareness/consciousness

Question 5

What is the prevalence of dementia?

Answer 5

5-10% if >65y, 20% if >80y, 70% if >100y

Question 6

What are the commonest causes for dementia?

Answer 6

Alzheimer's
Vascular dementia - 25%
Lewy body dementia - 15-25%
Fronto-temporal (Pick's) dementia
Other: alcohol/drug abuse, repeated head trauma, pellagra, Whipple's disease, Huntington's, CJD, Parkinson's, HIV, Cryptococcosis, familial autosomal dominant Alzheimer's, CADASIL

Question 7

What are the risk factors for Alzheimer’s disease?

Answer 7

1st degree relative with AD
Down's syndrome
homozygosity for apolipoprotein e (ApoE) e4 allele
PICALM, CL1 and CLU mutations
vascular risk factors - incr BP, diabetes, dyslipidaemia, inc homocysteine, AF
decr physical/cognitive activity
depression
loneliness

Question 8

What is the management options for Alzheimer’s disease?

Answer 8

Acetylcholinesterase inhibitors such as Donepezil, rivastigmine or galantamine
Antiglutamatergic’s - memantine only useful in late stage disease
Ginkgo biloba may improve wellbeing of patients and carers

Question 9

What is the principle ppresentation in Lewy-Body dementia?

Answer 9

fluctuating cognitive impairment with vivid visual halucinations and later, parkinsonism

Question 10

What the is the principle pathology of Alzheimer’s disease?

Answer 10

Accumulation of beta-amyloid peptidee (degradation product of amyloid precursors) results in progressive neuronal damage, neurofibrilary tangles, increased amyloid plaques and loss of neurotransmitter ACh.

Question 11

What areas of the brain are selectively damaged first in Alzheimer’s disease?

Answer 11

hippocampus, amygdala, temporal neocortex and subcortical nuclei