Delirium, Dementia and Other Cognitive Disorders Flashcards
Features of Dementia
Slow to develop
Progressive
Irreversible in most cases
Pseudodementia
Condition caused by another psychiatric disorder that mimics dementia (confabulatory)
Delirious pt response to questions
Unable to answer
Confused
Frightened
Angry
Demented pt response to questions
Tries to answer
Will say, “I don’t know.”
Pseudodemented pt’s response to questioning
Will not try to answer
Will say, “I don’t know.”
Amnesic disorder
Memory impairment caused by:
A general medical condition
Persisting effects of substance use.
Amnesia
Inability to learn new information or recall old
Agnosia
An impaired ability to recognize familiar objects or people
Aphasia
Language disturbance in expressing and understanding spoken words
Apraxia:
Inability to carry out motor activities despite intact motor function
4 early signs of dementia
Amnesia
Agnosia
Aphasia
Apraxia
Most common type of dementia
Alzheimer’s
Predisposing factors for dementia
Familial form of Alz
Huntington’s is autosomal dominant on Chromosome 4:
-Risk for children is 50%
Creutzfeldt-Jakob Disease
-Genetic component appears in 10-15% of cases
Pick’s Disease
-Linked to genes on chromosomes 3 and 17
Vascular Dementia
Caused by TIAs and strokes Vascular changes related to a number of diseases with known genetic links: -HTN -DM -High cholesterol
Alz Neurobiology
Progressive, widespread brain atrophy
Dec availability of ACh
Markedly increased neuritic plaques and neurofibrillary tangles
Vascular Dementia Neurobiology
Brain has multiple vascular lesions in the cortex and subcortical areas
Pick’s Disease Neurobiology
Atrophy of the frontal and anterior temporal lobs of the brain
Swollen neurons with well-defined “Pick’s Bodies.”
Normal Pressure Hydrocephalus Neurobiology
Impaired return of cerebral spinal fluid to the brain from the spinal column
Enlarged ventricles seen on CT or MRI
Reversible if surgery performed soon enough
Vitamin B12 deficiency dementia neurobiology
Rare but potentially reversible
Inadequate B12 causes demyelination and axon loss
Parkinson’s Disease Neurobioloty
50% reduction in neurons in the substantia nigra
Remaining cells containing Lewy bodies
Diffuse Lewy Body Disease Neurobiology
Lew bodies in the frontal and temporal cortex primarily
Presence but in lesser frequency in the hippocampus and substantia nigra
Creutzfeld-Jakob’s Disease Neurobiology
Infecting agent known as a prion that causes spongiform Encephalopathy in which cells are stripped of intracellular material
Transmissible by blood and body fluid
Bovine spongiform encephalopathy is a variant
Environmental factors in dementia
Head injury Down Syndrome Chronic alcoholism "Huffing" Long-term use of BZOs and barbiturates "Rave" drugs
Nun study
Nuns donated brains to science:
- Plaques and tangles present, but no Alz
- Plaques and tangles not enough to explain Alz
Order of Sx: Alz
Memory loss
Inability to problem solve in new situations
Decline is gradual
Order of Sx: Vascular Dementia
Symptom appearance is more abrupt
Coupled with neurological symptoms
Usually stair-step detioriation
Order of Sx: Pick’s Dz
Behavioral changes appear first
Order of Sx: CJD
Personality changes
Szrs
Myoclonic movements
Course is rapid, death within a year
Order of Sx: Lewy Body Dz
Hallucinations
Fluctuating alertness
Tendency to fall appear early in 80% of those with EPS
Order of Sx: Huntington’s
Insidious behavioral changes
Disruption of attention
Personality
Choreiform movements
Order of Sx: Korsakoff’s
Wernicke’s (reversible with thiamine)
Ataxia
Nystagmus
Confabulation
AIDS/Dementia Complex
Subcortical Dementia with infiltration of infected macrophages or microglial cell into the brain
AIDS/Dementia Complex: Cognitive Deficits
Memory loss, speech problems
ADC: Motor Deficits
Loss of bladder tone is early indication Paraparesis Lower-extremity spasticity Ataxia Extensor-plantar responses in the absence of spinal cord abnormalities
ADC: Behavioral Sx
Early presentation with inability to conduct ADLs
ADC: Mood Sx
Severe changes in usual mood, with wide variation from psychosis, or mania, or depression
ADC: Differential Dx
Syphilis B12 and folate Thyroid Electrolytes BUN/Cr
Non-pharm interventions in post-TBI dementia
Safety Plan
Follow-up for one year after any suicide attempts
PT for the vestibular dysfunction
OT for traumatic vision syndrome, characterized by scanning and accommodation difficulties
Rules for treating depression in persons with dementia (or the elderly in general)
Start low and go slow
TCAs work well in the elderly, but a lot of anticholinergic activity
Fluoxetine in the elderly
Don’t use it
SIADH
Syndrome of inappropriate antidiuretic hormone:
Possible side effect of SSRIs in the elderly
EPS with SSRIs
Rare, but can occur
First-line drug therapy
Donepezil (Aricept) 5mg orally daily (max 10mg/day)
Features of Delirium
Rapid onset Altered state of consciousness Presence of a general medical condition Presence or withdrawal of a substance Generally reversible Acute medical emergency
