Dementia Flashcards
What is a normal state of consciousness
wakefulness
awareness
alert when not asleep
if sleeping, readily awakened
What are arousal and cognition
arousal: alert- mediated by reticular activating system
cognition: oriented- properly working hemispheres
What is clouding of consciousness
mild AMS with inattention and reduced wakefulness (drunk)
What is confusional state
disoriented, bewildered, difficult to follow commands
hypoglycemia
What is lethargy
severely drowsy, aroused with moderate stimuli then drift back to sleep
(post-op)
What is obtudation
less interest
slower response
sleeps, more drowsy when awake
What is stupor
need vigorous repeat stimuli. If left alone, immediately relapse into sleep
What is a coma
unarousable, unresponsive
serious nervous system disorder
What are some things that can cause a coma
seizure metabolic disturbance hypothermia lesions (need to hospitalize all and refer to neuro)
How should you evaluate an altered patient
Determine LOC (AVPU) Evaluate cause of coma look for + or - focality (level of dysfunction, cortical or brainstem involvement)
What is the Glasgow Coma scale
points 3-15 (<8 intubate)
points for motor, verbal, and eye opening
Who should you get an HPI from (if not the patient
Nursing home staff/medical professionals
only use family as last resort (and document)
What can cause an altered mental status
DM HTN thyroid/addisons renal failure CA dementia CVD seizure psych
What is dementia
progressive intellectual decline NOT due to delerium or psych disorder
What are RF for dementia
60+ FHx Vascular disease DM serious head injury female vitamin D deficiency chronic sleep deprivation
What can possible be protective against dementia
education
ongoing intellectual stimulation
What are the types of dementia
Alzheimers dementia (MC)
Lewy body dementia
Vascular dementia
What is Lewy body dementia
progressive dementia due to microscopic protein deposits that damage brain over time
**fluctuating cognition
Lewy bodies are also found in these diseases
Parkinsons
Alzheimers
Lewy body dementia is characterized by
plaques (beta amyloid protein)
tangles (Tau protein)
Vascular dementia is caused by
impaired blood flow to brain (after CVA) with sudden onset Sx due to multifocal ischemic change
RF for vascular dementia are
smoking
HTN
HLD
What are cognitive symptoms of vascular dementia
recent memory loss inattention difficulty planning or organizing confusion poor judgement difficulty calculating or reasoning agitation, aggression, hallucinations, delusions, depression
What did they make for people with vascular dementia
Wristbands; because they frequently get lost in familiar surroundings
What is delerium
acute confused state triggered by unknown source
Common Ddx for delerium include
I watch death Infection Withdrawal Acute metabolic Trauma CNS lesion Hypoxia Deficient ntr Endocrine Acute vascular Toxins (antihistamine, BB, DM) Heavy metals
Explain dementia vs delerium
pt with dementia is susceptible to delerium
cant diagnose dementia until pt is not delerius or ill
Dementia is usually diagnosed outpatient
Delerium is usually diagnosed in the ED
How is psychosis different from dementia
Symptoms of psychosis will improve with treatment
How does dementia present
short term memory loss hard to find words apathy apraxia executive dysfunction
What can help dementia patients
journaling to keep track of subtle changes
What should the dementia work up include
Neuro MMSE ( 3 word recall)
complete PE
MRI w/ con for new progressive complaints (if + can do PET to see amyloid)
Serum B12, T4, TSH, RPR, CBC, CMP, lipids
ApoE (if +, increased risk for alzheimers)
How can you treat dementia
45 min aerobic exercise
frequent mental stimulation
SSRI, trazodone (insomnia), Ritalin (apathy)
What can help with lewy body dementia
memantine (increase mod cognition and behavior)
What can help with alzheimers dementia
ACh-inhibitor
donepezil, rivastigmine (improve cognition)
What do you AVOID in dementia patients
Paroxetine (anticholinergic)
Benzos
What dementias are rapidly progressive
Jakob-Creutzfeldt (MCC mad cow dz)
FHx (prnp mutation)
What should you stop doing if you have dementia
driving
admit if safety risk
refer all new cognitive declines
