Dementia and Delirium

Question 1

Dementia

Answer 1

Major neurocognitive disorder
Blanket term to describe a cluster of symptoms including memory loss, confusion, poor judgement, language, executive function.

Question 2

Causes of dementia

Answer 2

Alzheimers dz
Vascular:  stroke, tia
Parkinsons
Frontotemporal dementia
Normal pressure hydrocephalus
Dementia with lewy bodies
Delerium/depression

Question 3

Alzheimers Disease

Answer 3

Progressive neurological disorder that results in memory loss, personality changes, global cognitive dysfxn and functional impairments.
Prominent loss of short term memory early on

Question 4

Alzheimers diagnosis

Answer 4

Diagnosis of exclusion
Clinical diagnosis based off history
MRI may show bilateral hippocampal atrophy

Question 5

MMSE grading scale for AD

Answer 5

20 - 26: mild functional dependence
10 - 20: moderate, more immediate dependence
<10: severe, total dependence

Question 6

MMSE of 24/30 is suggestive of?

Answer 6

Dementia

Question 7

Pathology of AD

Answer 7

Amyloid rich senile plaques
Neurofibrillary tangles
Neuronal degeneration

Question 8

Most frequent cause of death from AD

Answer 8

Aspiration pneumonia.

2nd is infected decubital ulcerations

Question 9

Cholinesterase Inhibitor MOA

Answer 9

Stop the breakdown of Acth
Increase acth levels in the brain
May slow progression of symptoms for perhaps 6-12 months

Question 10

Cholinesterase Inhibitor Types

Answer 10

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)

Question 11

Doneoezil (Aricept)

Answer 11

Only FDA approved tx for any stage of alzheimers dz.

Well tolerated once daily dose

Question 12

Rivastigmine (Exelon)

Answer 12

Approved for use in mild to moderate alzheimers.
BID dosing w/ food
Slowly titrate up to avoid SE

Question 13

Memantine (Namenda)

Answer 13

NMDA receptor antagonists
Helps regulate glutamate activity
Approved for moderate to severe alzhemiers

Question 14

Selegiline (Eldepryl)

Answer 14

Prevents breakdown of dopamine

May not be helpful, many SE

Question 15

Antidepressants for AD

Answer 15

SSRI’s

Zoloft, paxil, celexa

Question 16

Antipsychotics for AD

Answer 16

reduce hallucinations, delusions, aggression, hostility.

Question 17

Anxiolytics for AD

Answer 17

Lorazepam, oxazepam

Question 18

Vascular Dementia (VD)

Answer 18

Onset associated with CVA
Abrupt onset followed by stepwise deterioration
Infarcts on cerebral imaging

Question 19

Frontotemporal Dementia

Answer 19

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

Question 20

Normal-pressure Hydrocephalus

Answer 20

Pathologically enlarged ventricle size with normal opening pressure on LP.
Triad of dementia, gair disturbance and urinary incontinence.

Question 21

Normal-pressure Hydrocephalus Triad

Answer 21

Wacky (dementia)
Wobbly (gait disturbance)
Wet (incontinence)

Question 22

Normal-pressure Hydrocephalus Tx

Answer 22

Ventriculoperitoneal shunt

Question 23

Normal-pressure Hydrocephalus Dx

Answer 23

MRI

Miller fisher test - gait test before and after removal of excess CSF

Question 24

Dementia with Lewy Bodies (DLB)

Answer 24

Second most common form of dementia after AD

Associated with parkinsonism

Question 25

DLB CHaracteristics

Answer 25

Dementia accompanied by delerium, visual hallucinations and parkinsonism.

Question 26

Parkinsons Disease

Answer 26

``` Characterized by Brady and Akinesia Rigidity Resting tremor Postural instability Dementia occurs in the last half typically ```

Question 27

How many parkinsons patients develop dementia?

Answer 27

78%

Question 28

Progressive supranuclear palsy

Answer 28

Steele richardson olszewski syndrome Restricted up and down eye movement fall backwards as opposed to parkinsons pt's that fall forward

Question 29

Creutzfeldt-Jacob Disease

Answer 29

AKA mad cow Progressive and fatal Caused by a prion Rapid onset dementia, motor deficits, seizures

Question 30

Dementia from syphillis and HIV

Answer 30

It happens.

Question 31

Delirium

Answer 31

A sudden and significant decline in mental functioning that is not from preexisting dementia Disturbances of conciousness

Question 32

4 Major causes of delirium

Answer 32

Underlying medical condition Substance intoxication Substance withdrawal A combo

Question 33

Prodrome to delirium

Answer 33

Restlessness Anxiety Sleep disturbance

Question 34

Delirium fluctuation course

Answer 34

Develops over hours to days | Symptoms fluctuate throughout the day

Question 35

Delirium arousal/psychomotor disturbance

Answer 35

Hyperactive or Hypoactive

Question 36

Delirium duration

Answer 36

Typically resolves in 10-12 days | May last up to 2 months

Question 37

What causes delirium?

Answer 37

I WATCH DEATH infxn, withdrawl, acute metabolic, trauma, CNS pathology, hypoxia Deficiencies, endocrinopathies, acute vascular, toxins or drugs, heavy metals