Dementia and Delerium Flashcards
Used up until the 19th century to mean various forms of mental derangement
-But, identified specifically with old age as early as the 1st or 2nd century CE by the poet Juvenal
Dementia
Used for both delusions and brain diseases (phrenitis) through the 19th century
Delerium
Two words to describe a break-down (failure) in brain function
Dementia and Delirium
A general term denoting the patient’s incapacity to think with customary speed, clarity, and coherence
Acute Confusional State
Its most conspicuous attributes are impaired attention and power of concentration, disorientation—which may be manifest or is demonstrated only by direct questioning, an inability to properly register immediate events and to recall them later, a diminution of all mental activity, including the normally constant inner ideation and sometimes by the appearance of bewilderment
Acute confusional state
Where “agitation, hallucinations, and sometimes convulsions and tremor accompany the core confusional state.”
Delerium
A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)
Delerium
The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day
Delerium
DSM-5 classifies delirium as an additional disturbance in
Cognition
Delerium is a disturbance of
Arousal and/or attention
Subjective decline in functioning from baseline not normal for age affecting one or more cognitive domains
Mild Cognitive Impairment
Mild Cognitive Impairment is NOT associated with significant
Funcitonal Impairment
An acquired disturbance in cognition without impairment in daily functioning
Mild Cognitive Impairment (MCI)
Approximately what percentage of ED patients are delerious on presentation?
10-16%
Delerium patients over 65 have a 12 month mortality rate of?
40%
Failure of the cells of the brain to function appropriately generally due to failure in cerebral metabolism
Delirium
Failure in availability or distribution of necessary fuels for metabolism (i.e Glucose, Water, and Oxygen)
Failure of Cerebral Metabolism
Look for PE findings that might point to a particular etiology. For instance: asterixis and myoclonus for
Hepatic encephalopathy
Look for PE findings that might point to a particular etiology. For instance: Wide pupils, lack of sweating, increased HR, mumbling and picking for
Anticholinergic Delerium
A medical emergency (i.e. acute brian failure) that requires urgent medical care
Delirium
Preferred over benzodiazepines and anticholinergics for agitation
Neuroepileptics
Females are at a higher risk than males for
Dementia
Decreased daily exercise or physical activities and decreased mental stimulation are risk factors for
Dementia
Mainly functional, metabolic, infectious, or paraneoplastic/autoimmune causes
Reversible dementia
Mainly due to structural lesions
Arrestable but non-reversible dementia
What are the two types of cognitive enhancer medications?
Acetylcholinesterase inhibitors and NMDA receptor antagonists
What are the three acetylcholinesterase inhibitors?
Donepazil, Rivastigmine, and Galantamine
What is an example of an NMDA receptor antagonist?
Mementine
Acute brain failute
Delirium
Chronic brain failure
Dementia
Cause an atypical Alzheimer’s syndrome
Lewy bodies
Has the clinical characteristics of prominent motor symptoms (Parkinsonism) and behavioral symptoms (Visual Hallucinations and altered sensorium) early on
Lewy Body Dementia (LBD)
Memory difficulties and language dysfunction are usually less severe then AD early in the disease. Relatively more visuo-spatial, attention, and executive dysfunction early compared to AD
LBD
100% fatal. More rapid mortality and more functional difficulties relative to AD
LBD
Deficits characterized by a loss of cholinergic neurons in the nucleus basalis of Meynert, decreased cortical choline acetyltransferase, and depletion of dopaminecontaining neurons
Lewy Body Dementia
The main difference between LBD and PD is whether the dementia comes
Early (within 1st year) or later
A dementia syndrome with prominent behavioral symptoms, featuring characteristic patterns of atrophy and later confirmed by Alzheimer to have an absence of plaques and tangles
Frontotemporal Dementia (Pick’s Disease)
Characterized by left frontal degeneration and the development of primary language problems before rpogressing into a more typical dementia pattern
Primary Progressive Aphasia
Characterised by anterior temporal atrophy and primary language and memory problems that differ from Mesulam’s PPA and typical AD
Semantic Dementia (SD)
The primary deficit in SD is
Semantic knowledge
Third most common degenerative dementia after AD and DLB
-Accounts for nearly 5-10% of all dementia
Frontotemporal Dementia (FTD)
As common or more common than AD in patients in the 45-65 age group. Usually occurs at ages less then 65
FTD
Varying degrees of argyrophilic Pick Bodies, Astrocytic plaques, Cytoplasmic inclusions, and Ballooned Neurons, depending on subtype
FTD
Most cases of FTLD present with protein accumulations involving either:
TDP-43, Tau, or FUS
40% of FTLD cases have a genetic heritability pattern with 10% being
Autosomal Dominant
Mutations to microtubual-associated protein tau (MAPT) on chromosome 17 causes autosomal dominant syndrome called “FTDP-17” cause accumulations of
Tau
Mutations to the Progranulin gene (PGRN) on chromosome 17 and C9orf72 on chromosome 9 have the highest association cause accumulation of
TDP-43
Mutations to the FUS gene on chromosome 16 cause the accumulation of
FUS
