Dementia and Delirium Flashcards
Dementia
Major neurocognitive disorder
Blanket term to describe a cluster of symptoms including memory loss, confusion, poor judgement, language, executive function.
Causes of dementia
Alzheimers dz Vascular: stroke, tia Parkinsons Frontotemporal dementia Normal pressure hydrocephalus Dementia with lewy bodies Delerium/depression
Alzheimers Disease
Progressive neurological disorder that results in memory loss, personality changes, global cognitive dysfxn and functional impairments.
Prominent loss of short term memory early on
Alzheimers diagnosis
Diagnosis of exclusion
Clinical diagnosis based off history
MRI may show bilateral hippocampal atrophy
MMSE grading scale for AD
20 - 26: mild functional dependence
10 - 20: moderate, more immediate dependence
<10: severe, total dependence
MMSE of 24/30 is suggestive of?
Dementia
Pathology of AD
Amyloid rich senile plaques
Neurofibrillary tangles
Neuronal degeneration
Most frequent cause of death from AD
Aspiration pneumonia.
2nd is infected decubital ulcerations
Cholinesterase Inhibitor MOA
Stop the breakdown of Acth
Increase acth levels in the brain
May slow progression of symptoms for perhaps 6-12 months
Cholinesterase Inhibitor Types
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)
Doneoezil (Aricept)
Only FDA approved tx for any stage of alzheimers dz.
Well tolerated once daily dose
Rivastigmine (Exelon)
Approved for use in mild to moderate alzheimers.
BID dosing w/ food
Slowly titrate up to avoid SE
Memantine (Namenda)
NMDA receptor antagonists
Helps regulate glutamate activity
Approved for moderate to severe alzhemiers
Selegiline (Eldepryl)
Prevents breakdown of dopamine
May not be helpful, many SE
Antidepressants for AD
SSRI’s
Zoloft, paxil, celexa
Antipsychotics for AD
reduce hallucinations, delusions, aggression, hostility.
Anxiolytics for AD
Lorazepam, oxazepam
Vascular Dementia (VD)
Onset associated with CVA
Abrupt onset followed by stepwise deterioration
Infarcts on cerebral imaging
Frontotemporal Dementia
Characterized by focal atrophy of the frontal and temporal lobes in absence of alzheimer pathology. Pick's dz was first recognized subtype Characterized by pick bodies May be familial Peak in 6th decade
Normal-pressure Hydrocephalus
Pathologically enlarged ventricle size with normal opening pressure on LP.
Triad of dementia, gair disturbance and urinary incontinence.
Normal-pressure Hydrocephalus Triad
Wacky (dementia)
Wobbly (gait disturbance)
Wet (incontinence)
Normal-pressure Hydrocephalus Tx
Ventriculoperitoneal shunt
Normal-pressure Hydrocephalus Dx
MRI
Miller fisher test - gait test before and after removal of excess CSF
Dementia with Lewy Bodies (DLB)
Second most common form of dementia after AD
Associated with parkinsonism
DLB CHaracteristics
Dementia accompanied by delerium, visual hallucinations and parkinsonism.
Parkinsons Disease
Characterized by Brady and Akinesia Rigidity Resting tremor Postural instability Dementia occurs in the last half typically
How many parkinsons patients develop dementia?
78%
Progressive supranuclear palsy
Steele richardson olszewski syndrome
Restricted up and down eye movement
fall backwards as opposed to parkinsons pt’s that fall forward
Creutzfeldt-Jacob Disease
AKA mad cow
Progressive and fatal
Caused by a prion
Rapid onset dementia, motor deficits, seizures
Dementia from syphillis and HIV
It happens.
Delirium
A sudden and significant decline in mental functioning that is not from preexisting dementia
Disturbances of conciousness
4 Major causes of delirium
Underlying medical condition
Substance intoxication
Substance withdrawal
A combo
Prodrome to delirium
Restlessness
Anxiety
Sleep disturbance
Delirium fluctuation course
Develops over hours to days
Symptoms fluctuate throughout the day
Delirium arousal/psychomotor disturbance
Hyperactive
or
Hypoactive
Delirium duration
Typically resolves in 10-12 days
May last up to 2 months
What causes delirium?
I WATCH DEATH
infxn, withdrawl, acute metabolic, trauma, CNS pathology, hypoxia
Deficiencies, endocrinopathies, acute vascular, toxins or drugs, heavy metals
