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OPIC > Dementia and Delirium > Flashcards

Dementia and Delirium Flashcards

1
Q

Early stage features of dementia

A
  • Poor memory esp Alzheimers
  • Subtle changes mood and behaviour
  • Minimal intrusion into day to day if these are not too demanding
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2
Q

Mild stage features of dementia

A
  • Memory problems more prominent - eg word finding problems
  • Changes in behaviour marked
  • Disability apparent - instrumental ADLs eg finance difficult (self care ok)
  • Frequent support
  • Awareness of disability diverges from reality
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3
Q

Later stages dementia

A
  • Severe memory problems - failure to recognise familiar people
  • Changes in behaviour - marked
  • Disability severe - basic aspects of personal functioning are failing, continious supervision
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4
Q

Behavioural and psychological symptoms of dementia BPSD

A
  • Non-cognitive symptoms of dementia
  • Diverse - not just aggression, can be anxiety, low mood, hallucinations, sun-downing
  • Prognostic indicator for admission to care home - challenging for patients and carers
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5
Q

Clusters of BPSD - 4 main

A
  • Affective - depression, anxiety, agitation
  • Apathetic - loss of motivation, appetite and eating problems
  • Psychotic - paranoid, delusions, hallucinations
  • Hyperactive - wandering, agitiation
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6
Q

BPSD management

A
  • Investigate and treat precipitating factors - eg pain, unfamiliar environment
  • Monitor with ABC chart (challenging behaviour chart)
  • Non-pharm - behavioural management, music therapy
  • Pharm - antipsychotic (caution with Lewy Body dementia - dopamine antagonists)
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7
Q

Dementia subtypes comparison

A
  • Ask about onset
  • First symptoms
  • Mood/behavioural problems
  • Structural brain imaging changes - can be normal
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8
Q

Define delirium

A
  • Transiet and global impairment of cognition
  • Disturbances of attention and conscious level
  • Abnormal psychomotor behaviour
  • Disturbed sleep-wake cycle
  • Emotional disturbance
  • Onset acute
  • Symptoms fluctuate
  • Can have hallucination (mostly visual) and delusions
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9
Q

Frequent misdiagnoses of delirium

A
  • Depression - hypoactive
  • Dementia
  • Manic disorder - hyperactive
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10
Q

Risk factors for delirium

A
  • Vision impairment
  • Infection
  • Aged >65 or 80
  • Cognitive impairment
  • Fracture on admission
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11
Q

Causes of delirium

A
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12
Q

Medications that can cause delirium

A
  • Anti psychotic
  • Anti-parkinsons
  • Anticholinergics eg oxybutynin
  • Opiates
  • Steroids
  • Diuretics
  • Recreational drugs or alcohol
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13
Q

Confusion assessment method

A
  • Criteria to diagnose delirium 4 features:
  • Acute onset and fluctuating
  • Inattention
  • Disorganised thinking
  • Altered level of consciousness
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14
Q

Delirium screening and assessment

A
  • THINK DELIRIUM
  • 4AT
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15
Q

Immediate action when suspect delirium

A
MH liason services is the new FOPAL
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16
Q

General management of delirium

A
  • Manage underlying cause
  • Reassure and re-orientate
  • Optimise enviroment
  • Manage distress
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17
Q

Pharm management of delirum

A
  • ONLY AS LAST RESORT
  • Haloperidol
  • Lorazepam
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18
Q

Outcome of delirium

A
  • Increased length of stay and complications eg falls/infection
  • Readmission within 1 year
  • Increased mortality at 1 year
  • Insitutionalisation
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19
Q

Delirium and persistent cognitive impairment

A
  • Do not return back to baseline or takes a long time to get back to baseline
  • Can take more than 3 months in some cases
  • Can precipitate or worsen dementia
20
Q

Dementia

A
  • Cognitive impairement
  • Decline in both memory and thinking
  • Sufficient to impair personal ADLs
  • Problems with processing of incoming information and maintaining/directing attention
  • Clear consciousness
  • Above syndrome present for 6 months or more
21
Q

Stages of dementia occuring

A

Normal ageing
Mild cognitive impairment
Dementia

Not everyone with MCI will get dementia

22
Q

What is MCI?

A
  • Memory, problem solving, planning, language and visuospatial awareness
  • Does not interfere significantly with daily life
  • 10-15% develop dementia
23
Q

What is memory clinic?

A
  • MDT
  • Aims for timely and early diagnosis
  • Assess and diagnose dementia
  • Psychosocial interventions for dementia
  • Inc community mental health teams for older people
24
Q

Why do we have memory clinic and diagnose dementia?

A
  • Relief gained
  • Optimise medical management
  • Maximise autonomy
  • Access care and services
  • Risk reduction
  • Clinical and cost effectiveness
25
Q

Assessment in GP for ?dementia

A
  • GPCOG
  • 6CIT
26
Q

How are patients managed if rapidly progressive dementia?

A
  • Refer to neurology
  • Could be something underlying eg Creutzfelt Jakob
27
Q

4 components of memory clinic

A
  • History
  • Mental state exam and physical exam
  • Cognitive assessment
  • Inv
28
Q

Memory clinic history

A
  • Specific examples of forgetfullness etc
  • ODPARA
  • Baseline function
  • Behavioural and psychological symptoms - altered behaviour (eg agression), mood changes, hallucinations
  • SH - management of ADLs, levels of social support
  • RISKS
29
Q

Risks in patients with dementia in memory clinic to assess

A
  • Self neglect
  • Wandering/getting lost
  • Driving
  • Vulnerability
  • Agitation
  • Unsafe use of appliances
  • Carer strain
30
Q

Key cognitive domains

A
31
Q

Standardised assessment tools used in memory clinic

A
  • MOCA
  • ACE3
  • 6-CIT
  • AMTS
32
Q

MOCA values

A

more 26 = normal
19-25 = mild
10-18 = moderate
less 10 - severe

33
Q

Limitations of assessment of cognition - what can affect

A
  • Insensitive to specific cognitive deficits
  • Educational achievement and undiagnosed learning issues
  • Sensory impairment
  • English as second langiage
  • Cultural
  • Disabilities
  • Enviroment
  • Anxiety
34
Q

What is MOCA

A

Out of 30
Takes 10 mins
Can be translated, braille
Need pen and paper

35
Q

ACE III

A
  • Gold standard
  • 5 domains - attention, memory, verbal fluency, language
  • Approx 20 mins
  • Mini ACE is abbreviated - 30pts (whole one 100pts)
  • Cut offs 88 or 82 or less
36
Q

INV for confusion screen

A
  • Bloods - FBC, U&E, TFT, LFT Glucose, B12 and folate, calcium
  • ECG - for prescribing
  • CT head/MRI brain (dementia subtype)
  • Sometimes HIV/syphillis
37
Q

Further specilaist inv

A
  • FDG-PET - amyloid
  • DAT Scan for ?Lewy body
  • CSF analysis
38
Q

Driving and dementia

A
  • Must inform DVLA
  • Fitness to drive depends on level of impairment (eg visuospatial), familiar drives, driving along, near misses/accidents
39
Q

Drug treatments for dementia

A
  • Vascular - no drugs, manage RF
  • Drugs for alzheimers/lewy body
40
Q

Anti-dementia medication examples

A

Acetylcholinesterase inhibitors -
* Donepezil, Rivastigmine, Galantamine
* Indicated in mild/moderate AD

NMDA antagonist
* Memantine
* Indicated in moderate/severe AD

41
Q

Side effects of antidementia drugs - anticholin

A
  • GI
  • Reduced appetite
  • Dizziness
  • Agitation
  • ECG NEEDED - check for bradycardia and PR interval
42
Q

NMDA side effects

A
  • Constipation
  • Dizzy
  • Drowsy
  • Headaches
  • eGFR - monitor and check function
43
Q

Main causes of disability later in life

A

Dementia

44
Q

What can cause dementia?

A
  • Alzheimers
  • Vascular
  • Fronto-temporal
  • Alcoholic
  • Lewy body
45
Q
A

OPIC (17 decks)

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