Dementia and Delirium Flashcards
Could it be Delirium? (Acronym…)
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)
Treatment of Delirium
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)
What is communication and reorientation?
who they are, where they are, who you are, reminders of day and time, check glasses/ hearing aids
Pharmacological Treatment of Delirium (1st line vs 2nd line?)
Lorazepam 1st time
Haloperidol 2nd line - avoid with PD/DLB
Use lowest dose for shortest period of time
PO vs Im never IV!!
Pharmacological Treatment of Delirium - how to deliver?
PO vs Im never IV
Collateral history about cognition
Domains of higher cortical function - more than 2 affected in dementia
What investigations to do in potential dementia/delirium (onset of confusion?)
Bloods - FBC, U&Es, LFTS, CRP, B12/folate, Cultures, ECG, imaging - look for reversible causes!!
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
- 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
Dementia types - most common to least common?
Types of Dementia
Types of Dementia
Assessment, Diagnosis and Treatment of Dementia
Patient Hx/ Collateral Hx - Dementia and Delirium
- 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?
Risk assessment & vulnerability review - Dementia and Delirium
Attention (from ACE)
‘the ability to choose and concentrate on relevant stimuli’ - dementia and delirium
Executive function - dementia and delirium (Executive function
‘behavioural regulation and decision-making processes’)
Memory (from ACE)
Language (from ACE)
Fluency (from ACE)
Visuospatial (from ACE)
Addenbrooke’s Cognitive Examiantion
- What score is the cut-off?
- 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
- Below 88/100 (sensitivity =1.0; specificity =0.96)
Alzheimer’s Disease - Brain Imaging
Vascular dementia: Brain Imaging
Dementia with Lewy Bodies - Brain Imaging
Fronto-temporal dementia - Brain Imaging
Dementia Assessment - which type?
Dementia Assessment - which type?
CT or MRI for vascular dementia?
either but MRI more sensitive
What scan for dementia with lewy bodies?
MRI - generalised decrease in cerebral volume, enlargement of the lateral ventricals
Dopamine imaging (DaTSCAN) - ideal imaging
What scan for fronto-temporal dementia?
CT or MRI (more sensitive)
frontal and temporal atrophy, asymmetric, with caudate head volume loss
