Delirium, Dementia

Question 1

RFs of alzheimer’s

Answer 1

FH of alzhemier’s
Smoking - toxins increase inflammation and oxidative stress
Previous Head injury

Question 2

Protective factor of alzheimer

Answer 2

being female

Question 3

examples of acetylcholinestrase inhibitors

Answer 3

donepezil
rivastigmine
galantamine

Question 4

examples of NMDA (glutamate) receptor

Answer 4

memantine

Question 5

tests used to assess cognition in clinic

Answer 5

MMSE

ACE-III - addenbrooke’s

Question 6

define delirium

Answer 6

acute, transient, global organic disorder of CNS functioning resulting in impaired consciousness and attention

Question 7

features of hypoactive and hyperactive delirium

Answer 7

Hyperactive
􏰀 Agitation, irritability, restlessness and aggression.
􏰀 Hallucinations and delusions prominent.
􏰀 May be confused with functional psychoses.

Hypoactive
- Lethargy, reduced motor activity, apathy and sleepiness.

􏰀 Can be confused with depression.

Question 8

causes of delirium

Answer 8

HE IS NOT MAAD

Hypoxia - Respiratory failure, myocardial infarction, cardiac failure, pulmonary embolism.

Endocrine - Hyperthyroidism, hypothyroidism, hyperglycaemia, hypoglycaemia, Cushing’s

Infection - pneumonia, UTI, encephalitis, meningitis

Stroke - Stroke, raised ICP, intracranial haemorrhage, space-occupying lesions, head trauma, epilepsy (post-ictal), intracranial infection.

Nutritional - Reduced Thiamine, nicotinic acid, vitamin B12.

Others - severe pain, sensory deprivation, sleep deprived

Theatre - Anaesthetic, opiate analgesics and other post-operative complications.

Metabolic - Hypoxia, electrolyte disturbance (e.g. hyponatraemia), hypoglycaemia, hepatic impairment, renal impairment.

Abdominal - Faecal impaction, malnutrition, urinary retention, bladder catheterization.

Alcohol - Intoxication, withdrawal (delirium tremens).

Drugs - Benzodiazepines, opioids, anticholinergics, anti-parkinsonian medications, steroids.

Question 9

RFs of delirium

Answer 9

Older age ≥65
Multiple co-morbidities
Dementia
Physical frailty
Renal impairment
Male sex
Sensory impairment
Previous episodes
Recent surgery
Severe illness (e.g. CCF)

Question 10

clinical features of Delirium

Answer 10

-> Disordered thinking: Slowed, irrational, incoherent thoughts.
􏰀 Euphoric, fearful, depressed or angry.
􏰀 Language impaired: Rambling speech,
repetitive and disruptive.
􏰀 Illusions, delusions (transient persecutory or delusions of misidentification) and
hallucinations (usually tactile or visual).
􏰀 Reversal of sleep-wake pattern: i.e. may be tired during day and hyper-vigilant at night.
􏰀 Inattention: Inability to focus, clouding of consciousness.
􏰀 Unaware/disoriented: Disoriented to time, place or person.
􏰀 Memory deficits.