Deliruim Flashcards
What is Delirium
- Known as acute confusional state
- transient disorder of cognitive function, consciousness, perception
- can be sudden or gradual onset
- usually accompanied by other medical conditions
what are the 2 types of Delirium
- Hyperactive
- Hypoactive
What is hyperactive delirium
- acute disturbance in attention or awareness
- develops over 2-3 days
- usually in ICU, post surgery, withdraw, and hospitalized elderly.
Risk factors of hyperactive delirium
- medications (benzos,narcotics)
- acute infection
- surgery
-hypoxia - electrolyte or metabolic dysfunction
insomnia
hyperactive manifestations
restlessness irritability difficulty concentrating insomnia tremulousness poor appetite
Fully developed hyperactive delirium
Hallucinations
completely inattentive
altered perception
treatment of hyperactive delirium
Remove Risk Factors
usually self resolves in 2-3 days but can last for weeks
what is hypoactive delirium
right sided frontal basal ganglion disruption
- more common with metabolic disorders (liver and kidney failure)
hypoactive manifestations
- decreased alertness and attention
- decreased ability to perception and interpretation of environment
- forgetful
- apathetic
- slow speech
Treatment of delirium
GOAL - identify cause and remove causation, and modify risk factors
- dementia at baseline is much higher risk of delirium
What is Dementia
Acquired deterioration and progressive failure of cerebral function
- impaired intellectual processes (memory,language, decision making, orientation)
- may present as agitation wandering and aggression
Patho of dementia
- neuron degeneration
- compression of brain tissue
- atherosclerosis of cerebral vessels
- brain trauma
- infection
- neuro-inflammation
onset of dementia
generally slow, symptoms usually irreversible
dementia manifestations
- memory loss
- decreased concentration and memory
- overall cognitive slowing
treatment of dementia
no cure
treatment based on restoring and optimizing functional capacity and accommodation for lost abilities.
Alzheimer’s Disease
-Leading cause of severe cognitive dysfunction in the elderly
-Diagnosis made by Rule Out
-Genetic more common in early onset
Late onset is most common and does not show genetic association
Risk factors for Alzheimer’s disease
-Older than 65
-Family history
-inheriting genes
-Existing mild cognitive impairment
down syndrome
unhealthy lifestyle
previous head trauma
being shut off from community
Physiology of Alzheimer’s disease
Accumulation of neurotic plaques and intraneuronal neurofibrillary tangles of tau protein.
- plaques disrupt nerve transmission and kill neurons
- centralized in cerebral cortex and hippocampus
- loss of synapses, acetylcholine and other neurotransmitters contributes to memory and cognitive decline
- brain atrophy
- decreased levels of acetylcholine
Vascular dementia
2nd most common
related to cerebrovascular disease
r/t large artery disease, cardio embolism, small vessel disease, and stroke (hypoperfusion to the brain)
Risk factors of vascular dementia
DM
HPL
HTN
smoking
Frontotemporal Dementia
known as Pick Disease
Familial association with age of onset less than 60
R/T gene mutations of encoding the tau protein
Clinical syndromes of frontotemporal dementia
Behavioral variant
progressive non-fluent behavior
semantic dementia
Name and MOA of Cholinesterase inhibitor
Donepezil (Aricept)
MOA - works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase
Indication of Donepezil
mild-moderate AD
Given PO at bedtime, with food
Donepezil Adverse Effects
Normally none to mild, resolves on own - gi upset drowsy dizzy insomnia muscle cramping bradycardia syncope reflex tachycardia
N-methyl-D-aspartate (NMDA) receptor antagonist
Memantine (namenda)
MOA of Memantine
blocks the stimulation of NMDA receptors believed to be associated with AD
indication of Memantine
moderate-severe AD
Given PO with or without food
Adverse effects of Memantine
uncommon but may result in
- confusion
- hypotension
- headache
- dizziness
- constipation
