Dementia and Delirium

Question 1

What are the differences between Dementia and Delirium?

Answer 1

Question 2

What are the causes of dementia?

Answer 2

Alzheimer disease (65%)
vascular dementia (20%)

Degenerative diseases (Parkinson, Huntington, dementia with Lewy bodies [DLB])
Endocrine and many others, like Vitamin B12 deficiency

Question 3

Brain atrophy, senile plaques, and neurofibrillary tangles (NFTs), associated with substantial loss of neurons in the cerebral cortex and gliosis.

NFTs represent intracellular accumulation of phosphorylated tau protein.

Senile plaques are extracellular deposits of amyloid surrounded by dystrophic axons.

Dx?

Answer 3

Dementia due to Alzheimer disease

Question 4

Treatment of Dementia of AD?

Answer 4

Preventing or delaying progression:

Acetylcholinesterase inhibitors:
(donepezil or Rivastigmine, as well as the newer agent memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist.

Question 5

A 72-year-old patient with cognitive impairment ( severe problems of visuospatial perception and visual memory), marked fluctuations of alertness, prominent visual hallucinations (up to 80% of cases) and delusions, extrapyramidal symptoms,

an extraordinary sensitivity to neuroleptics (i.e., marked worsening with drugs like haloperidol).

Dx?

Answer 5

Dementia with Lewy bodies

Question 6

Fluctuations of alertness
visual hallucinations
an extraordinary sensitivity to neuroleptics

are the three key distinguishing features of?

Answer 6

dementia with Lewy bodies

Question 7

What is the hallmark of dementia with Lewy body?

Answer 7

The pathologic hallmark is the Lewy body (found in Parkinson disease in the substantia nigra), an eosinophilic intracellular inclusion of alpha synuclein.

In dementia with Lewy bodies (unlike in Parkinson disease), the Lewy body is found in cortical neurons.

Question 8

What is the treatment of Dementia with Lewy bodies?

Answer 8

Low doses of atypical neuroleptics such as (Risperidone) and (clozapine)
have been used to treat behavioral symptoms.

Question 9

A patient ((( neglect social and personal responsibilities ))), present failure in judgment, and show defective sequencing and organization.

The patient has Pick disease, primary progressive aphasia (a language deficits).

[Pick disease is a rare form of progressive dementia characterized by personality change, speech disturbance, inattentiveness, and sometimes extrapyramidal signs].

Abnormal tau protein with tau positive inclusions is found in neurons and glial cells.

(( tau protein without Senile plaques ))

Dx?

Answer 9

Frontotemporal dementia (FTD)

Question 10

A patient with hypertension and diabetes, have a history of stroke.

Brain imaging study showing multiple strokes, lacunes, and extensive deep white matter changes.

(( decline in cognitive functioning )) + (( stroke ))

Dx?

Answer 10

vascular dementia

Question 11

Treatment of Vascular Dementia?

Answer 11

There is no specific pharmacological treatment approved for cognitive symptoms

Only consider AChE inhibitors or “memantine” for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.

Question 12

A patient presents with acute onset of waxing and waning consciousness with lucid intervals and perceptual disturbances (hallucinations, illusions, delusions).

He is combative, anxious, paranoid, or stuporous

He has:
↓ attention span
short-term memory
a reversed sleep-wake cycle
↑ symptoms at night (sundowning)

Dx?

Answer 12

Delirium

[Best initial test: Investigate common causes of delirium. UTI and medications are common cause of delirium in the elderly]

Treat underlying causes (delirium is often reversible).
Normalize fluids and electrolytes

Question 13

Have a look at the causes of Delirium.

Answer 13

Question 14

What is the treatment of Delirium?

Answer 14