Dementia and Delirium

Question 1

Dementia vs Delirium

Answer 1

Dementia - chronic, gradual, insidious memory loss
Delirium - acute confusion, amnesia post stress/sx etc

Question 2

What is dementia, its causes?

Answer 2

Chronic organic brain syndrome
Causes:
1. Alzheimers 60% - forgetfulness first
2. Fronto-temporal lobe type - personality change first
3. Lewy body type - visual hallucination, motor parkinsons, a/w parkinsonism
Rx- Levodopa, queitapine
4. Vascular - stroke, acute onset

Question 3

Histopath of dementia

Answer 3

• extracellular amyloid plaques
• intraneuronal neurofibrillary tangles
• altered nucleus basalis of Meynert (a cholinergic nucleus)

Gross pathology
* hippocampal and temporal lobe atrophy
* hydrocephalus ex vacuo

Question 4

Tests for dementia

Answer 4

Formal memory tests
Clock-face drawing test
MMSE - score for 30
1. Orientation (place, person, date)- delirium abn
2. Registration (repeat words, short-term memory)- dementia abn
3. Recall (repeat words after a while) - dementia abn
4. Attention
5. Construction
6. Language - both abn

19-23: mild
10-18: moderate
<10 : severe - cannot consent to any medical procedure

2points decline in 1yr is significant

Question 5

Mx of dementia

Answer 5

Cholinesterase inhibitors (mild-mod dementia)
1. Rivastigmine
2. Donepezil
3. Galantamine

NMDA receptor antagonist (sev dementia)
Memantine

Question 6

Pseudodementia, DD

Answer 6

Seen in depression
Pseudo-dementia
1. Acute onset
2. Worse in mor ning
3. *Insight present
4. Orientation present
5. Response to mistakes - give up
Rx- Citalopram (SSRI)

Dementia:
1. Insidious onset
2. Worse in evenings
3. *Insight absent
4. Orientation poor
5. Response to mistakes - agitated

Question 7

What is delirium? cause?

Answer 7

Acute organic brain syndrome
Mcc- infection
drugs can cause

Question 8

Mx of delirium

Answer 8

1. Agitated, anxious
   Midazolam IM
2. Psychotic
   Haloperidol IM- best
   Olanzepine IM