Dementia and Delirium

Question 1

Could it be Delirium? (Acronym…)

Answer 1

D = Drugs (withdrawal/toxicity)/Dehydration 
E = Environment/Energy 
L = Level of Pain 
I = Infection/Inflammation )post surgery) 
R = Respiratory Failure (hypoxia/hypercapnia) 
I = Impaction of Faeces 
U = Urinary retention 
M = Metabolic disorder (liver/renal failure/thyroid, hypoglycaemia)

Question 2

Treatment of Delirium

Answer 2

Aim to PREVENT
Treat underlying cause
Correct environment
Communication and reorientation (who they are, where they are, who you are, reminders of day and time, check glasses/ hearing aids)

Question 3

What is communication and reorientation?

Answer 3

who they are, where they are, who you are, reminders of day and time, check glasses/ hearing aids

Question 4

Pharmacological Treatment of Delirium (1st line vs 2nd line?)

Answer 4

Lorazepam 1st time
Haloperidol 2nd line - avoid with PD/DLB
Use lowest dose for shortest period of time
PO vs Im never IV!!

Question 5

Pharmacological Treatment of Delirium - how to deliver?

Answer 5

PO vs Im never IV

Question 6

Collateral history about cognition

Answer 6

Domains of higher cortical function - more than 2 affected in dementia

Question 7

What investigations to do in potential dementia/delirium (onset of confusion?)

Answer 7

Bloods - FBC, U&Es, LFTS, CRP, B12/folate, Cultures, ECG, imaging - look for reversible causes!!

Question 8

The ICD-10 defines dementia as follows …

• Dementia is a … due to disease of the brain,
  
  • usually of chronic or progressive nature, in which there is impairment of more than … cognitive domain, including …, language, fluency, complex attention, … function, visuospatial, perceptual, and social cognition - accompanied by … of function

Answer 8

• Dementia is a syndrome due to disease of the brain,
  
  • usually of chronic or progressive nature, in which there is impairment of more than one cognitive domain, including memory, language, fluency, complex attention, executive function, visuospatial, perceptual, and social cognition - accompanied by impairment of function

Question 9

Dementia types - most common to least common?

Answer 9

Question 10

Types of Dementia

Answer 10

Question 11

Types of Dementia

Answer 11

Question 12

Assessment, Diagnosis and Treatment of Dementia

Answer 12

Question 13

Patient Hx/ Collateral Hx - Dementia and Delirium

Answer 13

• Presenting complain > History of presenting complaint:
• Duration of onset? Rapid: 1-3 month or 3-6 month deterioration?
• Chronic: 12 months; 12-24 months; 24+ months?
• STM/LTM/variations in attention & alertness
• Memory and function?
• Attention and activities of daily living?
• Personality, behaviour and demeanour?
• Language and visuospatial (recognise faces, find objects, getting lost)?
• Executive function + problem solving?
• Neurological observations?

Question 14

Risk assessment & vulnerability review - Dementia and Delirium

Answer 14

Question 15

Attention (from ACE)
‘the ability to choose and concentrate on relevant stimuli’ - dementia and delirium

Answer 15

Question 16

Executive function - dementia and delirium (Executive function
‘behavioural regulation and decision-making processes’)

Answer 16

Question 17

Memory (from ACE)

Answer 17

Question 18

Language (from ACE)

Answer 18

Question 19

Fluency (from ACE)

Answer 19

Question 20

Visuospatial (from ACE)

Answer 20

Question 21

Addenbrooke’s Cognitive Examiantion

• What score is the cut-off?

Answer 21

• What score is the cut-off?
  
  • Below 88/100 (sensitivity =1.0; specificity =0.96)
    
    • • dementia wont get missed but may be incorrect diagnosis
  • Below 82/10 (sensitivity =0.93; specificity =1.0)
    
    • • you can be confident that this is a dementia, but some cases may get missed

Question 22

Alzheimer’s Disease - Brain Imaging

Answer 22

Question 23

Vascular dementia: Brain Imaging

Answer 23

Question 24

Dementia with Lewy Bodies - Brain Imaging

Answer 24

Question 25

Fronto-temporal dementia - Brain Imaging

Answer 25

Question 26

Dementia Assessment - which type?

Answer 26

Question 27

Dementia Assessment - which type?

Answer 27

Question 28

CT or MRI for vascular dementia?

Answer 28

either but MRI more sensitive

Question 29

What scan for dementia with lewy bodies?

Answer 29

MRI - generalised decrease in cerebral volume, enlargement of the lateral ventricals

Dopamine imaging (DaTSCAN) - ideal imaging

Question 30

What scan for fronto-temporal dementia?

Answer 30

CT or MRI (more sensitive)

frontal and temporal atrophy, asymmetric, with caudate head volume loss