Dementia and Delerium

Question 1

List the features of mild dementia

Answer 1

• Memory problems become more prominent
• Cognitive decline - difficulty with language
• ADLs may be fine but executive function is disabled - cannot financially plan

Question 2

List features of late stage dementia

Answer 2

• Severe pervasive memory problems

- Marked changes in behaviour e.g. agitation, restlessness, disinhibition, severe apathy

Question 3

What examinations can you do to assess for suspected dementia?

Answer 3

• GPCOG, AMT, MMSE

Question 4

What investigations do we do for suspected dementia?

Answer 4

• Screen the patients bloods for other active problems which may contribute to the patients symptoms
• CT/MRI
• Functional brain imaging
• EEG, LP

Question 5

Which drug would you use in Lewy body dementia? (Parkinsons disease dementia)

Answer 5

• RIvastigmine

Question 6

Which drugs would you use in Alzheimers dementia?

Answer 6

• Donepezil, Rivastigmine, Galantamine (cholinesterase inhibitors)
• Memantine is used in moderate to severe dementia (NMDA receptor antagonist)

Try to avoid the use of benzodiazepines and antipsychotics due to risk of falls and cognitive decline

Question 7

List features of delirium

Answer 7

• Impairment of cognition
• Disturbances of attention and conscious level
• Abnormal psychomotor behaviour
• Disturbed sleep-wake cycle
  ONSET IS ACUTE - hours to days and can hypo/hyperactive

Question 8

List potential causes of delirium

Answer 8

Trauma
Hypoxia
Increasing age 
NOF fracture
Smoker or alcohol withdrawal
Drugs
Environment
Lack of sleep
Imbalanced electrolytes
Retention - urinary/faecal
Infection - sepsis
Uncontrolled pain
Medical conditions - dementia, PD

Question 9

How can we generally manage patients with delirium?

Answer 9

• Treat any hypoxia, electrolyte imbalances, constipation (PR), retention (catheterise only if absolutely necessary), utilise other routes for pain management
• Avoid distress
• Avoid bed moves
• Encourage sleep at the right time and engagement in day activities
• Orientate the patient using calendars, signs, clocks
• Promote nutrition