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yr3 medicine- geriatrics > Delirium & Dementia > Flashcards

Delirium & Dementia Flashcards

1
Q

Compare and contrast delirium and dementia, include:

  • Onset
  • Course
  • Consciousness
  • Cognitive impairment, distractability & inattention
A

Delirium

  • Acute onset
  • Flucutating course
  • Altered level of consciousness: could be increased (hyperalalert: agtiated & confused), unchanged or decreased (hypoalalert- drowsy & withdrawn)
  • Inattention and distractability

Dementia

  • Chronic onset (months-years)
  • Progressive deterioration
  • No disorder of alertness or consciousness
  • Cognitive impairment interferes with activities of daily living
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2
Q

Dementia and derlium can co-exist; true or false?

A

True (a pt with dementia is more at risk of delirium)

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3
Q

State some risk factors for developing delirium

A
  • Dementia
  • Multiple comorbidities
  • Physical frailty
  • Oler age
  • Sensory impariments
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4
Q

State some potential precipitating factors/causes of delirium

A
  • Drug initiation
  • Urinary retention
  • Constipation
  • Hypoxia
  • Systemic infection
  • Metabolic derrangement
  • Surgery
  • Pain
  • Brain disorders e.g. stroke, seizure
  • Systemic organ failure
    *
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5
Q

How long does it take for delerium to be resolved?

A

Time varies between individuals but it can take anywhere up to 3 months to resolve. Some people never get back to their baseline.

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6
Q

What do you need to know about the pt to help you determine if the pt has delirirum?

A

Need to know their baseline; if you can’t get from pt get a collateral history

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7
Q

What screening tool can you use to diangose cognitive impairment?

A

AMT10

  • Age
  • Time

**** At this point give pt the address you want them to recall

  • Year
  • Date of birth
  • Pts home address
  • What jobs do these peopel do- show two photos
  • When did WW1/WW2 start
  • Current prime minister
  • Ask to recall address given earlier on

Score 1 point for each that you get correct. Scores <7 suggest some cognitive impairment

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8
Q

The Confusion Assessment Method is 94-100% sensitive and 90-95% specific for delirium if the 3 criteria are met; state these 3 criteria

A
  • Acute onset and fluctuating course
  • Inattention
  • Disorganised thinking or altered level of consciousness
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9
Q

What investigations would you do for someone with delerium, include:

  • Bedside
  • Bloods
  • Imaging

*think about which are first line and which are second line

A

Bedside​

  • Plasma glucose
  • Urinalysis
  • ECG
  • ABG
  • Cultures (blood, urine, sputum)
  • Bladder scan
  • EEG

Bloods

  • FBC
  • U&Es
  • LFTs
  • TFTs
  • CRP
  • Calcium, B12, folate
  • Toxicology screen

Imaging

  • CXR
  • CT/MRI head
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10
Q

State some differential diagnoses for delirium

A
  • Dementia
  • Focal neurological syndromes e.g. Wernicke’s encephalopathy, frontal lobe lesions
  • Non-convulsvie status epilepticus
  • Primary psychiatric illness e.g. depression, mania, schizophrenia
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11
Q

Dicuss the management of delirium, think about:

  • Treating the underlying cause
  • Managing the environment
  • Monitoring
  • Drug management
A

Treat underlying cause

  • Polypharmacy = medication review
  • Pain = analgesia
  • Constipation = laxatives
  • Infection = antibiotics
  • Corrrect electrolytes

Managing the environment

  • Involve family
  • Clocks and calenders
  • Lighting
  • Promote nightime sleep
  • Correct sensory impairment
  • Keep mobile & active
  • Avoid multiple rooms, staff etc…
  • Minimise noise, restraints etc..

Monitoring

  • Vital signs
  • Bowels
  • Nutrition & hydration
  • Pressure areas
  • Electrolytes
  • Response to Abx
  • Re-explore diagnosis if not improving

Drug management

Drugs shold be avoided if possible and only given when pt is at significant risk to themselves or others:

  • Haloperidol (oral or IM)
  • Lorazepam (oral or IM)

*NOTE: drugs should be commenced at lowest effective dose. Avoid haloperidol in parkinsons

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12
Q

State some potential complications of delirium

A
  • Increased mortality
  • Prolonged hospital admission
  • Higher complication rates
  • Institutionalisation
  • Increased risk of developing dementia
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13
Q

Dementia has no agreed defintionl; however, try and describe what dementia is in your own words

A

Progressive, irreversible cognitive decline (involving impariment of memory and other higher cortical functions) which leads to an impaired ability to complete everyday taks.

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14
Q

Briefly remind yourself of the different types of dementia (for more detial see Sem 4 Neuro lectures)

A
  • Alzheimer’s
  • Vascular dementia
  • Lewy body dementia
  • Frontotemporal dementia
  • AIDS-dementia complex
  • Huntingdon’s disease
  • Alcohol related dementia
  • CJD
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15
Q

State some risk factors for developing dementia

A

NOTE: risk factros vary dependent on type of dementia

Modifiable

  • Smoking
  • Alcohol
  • Atherosclerosis
  • High cholesterol
  • Obesity
  • Low standard education

Non-modifiable

  • Genetics
  • Age
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16
Q

State some key differentials you must rule out when querying if a pt has dementia

A
  • Mood disorders e.g. depression (pseudodementia)
  • Metabolic e.g. hypothyroid, vit B12 deficiency
  • Trauma e.g. subdural haematoma
  • Tumour e.g. glioblastoma
  • Posions e.g. heavy metal, recreational drugs
  • Nutrition e.g. thiamine deficiency, B6 deficiency
  • Medication e.g. steroids, antidepressants
  • Other e.g. normal pressure hydrocephalus
17
Q

State some symptoms of dementia

A
  • Memory loss
  • Inability to manage complex tasks
  • Difficulty with language and words
  • Altered behaviours
  • Altered orientation
  • Altered ability to self care
  • Altered reasoning
  • Difficulty recognising familiar faces (agnosia)
18
Q

What is pseudodementia?

A

Condition that appears similar to dementia but does not have the same neurological roots/cause as dementia; often associated with mood disorders.

19
Q

State some causes of ‘reversible dementia’ (i.e. conditions that may present like dementia but it treated in timely manner they will resolve)

A

Neurological

  • Subdural haematoma
  • SOLs
  • Normal pressure hydrocephaus
  • Infection e.g. HIV, syphilis

Endocrine

  • Hypothyroidims
  • Hyperparathyroidims
  • Addison’s
  • Cushing’s

Nutrition

  • B1 (thiamine)
  • B12/folate
  • B3 (niacin)
20
Q

Discuss what cognitive tests you could do if you suspect dementia

A
  • MMSE
  • MoCA (montreal cognitive assessment)
  • ACE-R (revised Addenbrooke’s cognitive examination)
21
Q

State the 5 A’s of alzheimers dementia

A
  • Amnesia (inability to recall facts or previous experiences)
  • Agnosia (inability to recognise familiar faces)
  • Apraxia (difficulty with motor plannin & performing tasks)
  • Aphasia
  • Abstract thinking
22
Q

What investigations would you do if you suspect dementia, include:

  • Bedside
  • Bloods
  • Imaging

*Most of investigations centred around finding alernative explanation. For each, justify why.

A

Bedside

  • Urine culture
  • Glucose

Bloods

  • FBCs
  • U&Es
  • LFTs
  • TFTs
  • Calcium
  • B12, folate, niacin
  • VDRL (for neurosyphilis)
  • CRP

Imaging

  • CT or MRI head
23
Q

Discuss the management of dementia- consider how management varies for different types of dementia. Include pharmacological and non-pharmacological treatment

A

Pharmacological

  • Alzheimer’s: acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine), NDMA antagonists (e.g. memantine)
  • Dementia with Lewy bodies: same as Alzheimer’s
  • Vascular: manage risk factors
  • AIDS complex dementia: treat HIV

Non-pharmacological

  • Orientation
  • Reassurance
  • Routine
  • Complementary therapies e.g. music therapy, art therapy etc…
  • Home adaptations
  • Social support
24
Q

State some potential complications of dementia

A
  • Cause harm to themselves
  • Increased mortality
  • Strain on family members/carers
  • Institutionalisation
  • Pneumonia due to aspiration
  • Falls
  • Weight loss
  • UTIs

yr3 medicine- geriatrics (8 decks)

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