Delirium, Dementia, Degenerative Disease Flashcards
Delirium Definition
- acute confusional state
- state of diffuse brain dysfunction
- rapid course
- often called toxic metabolic encephalopathy
- fluctuating LOC
- impaired attention
- incoherent speech
- toxic/metabolic causes usually found
- typically reversible
Dementia
- chronic disorder
- normal LOC
- normal attention
- aphasia
- typically irriversible
- deficits in at least three of the following: memory, language, visuospatial skills, complex cognition, emotion/personality
Differential Dx Of Delirium
- dementia
- amnesia
- aphasia
- schizophrenia
- mania
- depression
Tx of Delirium
- adequate sleep (avoid daytime naps) (trazedone, zolpidem)
- drugs for agitation (atypical antipsychotics, benzodiazepines)
Deficiency of What Vitamin Leads to Reversible Dementia?
Vitamin B12
Cortical Dementia
Alzheimer Disease
Subcortical Dementia
Parkinson Disease
White Matter
Binswanger Disease
Mixed Dementia
Multi-Infarct Dementia
Alzheimer Disease
- higher prevalence in women
- three stages with third being the worst
- cerebral atrophy
- amyloid plaques and neurofibrillary tangles in hippocampus (required for dx)
- acetylcholine deficit
Genetics of Alzheimer Disease
- APP gene on chromosome 21
- presinilin 1 on chromosome 14
- presinilin 2 on chromosome 1
- apolipoprotein E4 on chromosome 19 (APOE2 is protective)
Frontotemporal Dementia (FTD)
- cortical dementia that selectively affects the frontal/temporal lobes
- Pick Disease
- behavioral disorders occur early before memory loss
- tau (neurofibrillary tangles)
- serotonin
Parkinson Disease
- loss of dopaminergic cells in midbrain substantia nigra
- cholinergic deficit present
- sx: tremor, rigidity, bradykinesia
- synuclein
- dopamine deficit
Huntington Disease
- autosomal dominant
- dementia and chorea common
- dx with CAG repeat
- neuroleptics and tetrabenazine help chorea
- imaging shows caudate atrophy
- polyglutamine
- paternal inc. in CAG
White Matter Dementia
- genetic, demyelinative, infectious, inflammatory, toxic, metabolic, vascular, traumatic, neoplastic, hydrocephalic
- ex. binswingers disease, normal pressure hydrocephalus
Binswanger’s Disease (BD)
- vascular dementia featuring severe cerebral white matter ischemia
- apathy, confusion, memory loss, depression, anxiety, gait disorder, etc
- gradual progression
- imaging: thickened and hyalinizing penetrating arterioles, white matter volume loss
- caused by uncontrolled hypertension
Normal Pressure Hydrocephalus
- potentially reversible dementia
- wet, wacky, wobbly (dementia, gait disorder, urinary incontinence)
- high volume lumbar tap
- imaging: large ventricles
- tx: shunt
- episodic pressure inc.
Multi-Infarct Dementia (MID)
- vascular dementia
- combination of strokes
- prevention and tx of stroke are crucial
- compilation of lacunar infarcts
Creutzfeldt-Jakob Disease (CJD)
- rapidly progressive dementia
- myoclonus is sign (shock like contraction of limbs)
- cause is prion
- no tx
- sporadic (faster), infectious, inherited
- variant is mad cow disease
Lewy Body Dementia
- early Parkinsonian features, psychosis (fixed false belief), fluctuating consciousness
- acetylcholine and dopamine deficit
Progressive Supranuclear Palsy
- bradykinesia, rigidiy, falls, abnormal verticle eye movement
- tau
Amyotrophic Lateral Sclerosis
- weakness and atrohpy
- fasiculations
- both upper and lower motor neuron signs
Kuru
-prion disease in Papua New Guinea
Gerstmann-Straussler-Sheinker Syndrome
- autosomal dominant
- cerebellar findings (clumsiness, incoordination, gait ataxia)
- presence of dementia depends upon family
Fatal Familial Insomnia
- autosomal dominant
- 35-60 years of age
- progressive insomnia
- memory loss
- confusion
- hallucinations
