Dementia and Delirium

Question 1

ALZHEIMER’S DISEASE

Answer 1

Progressive neurologic disorder that results in memory loss, personality changes, global cognitive dysfunction, and functional impairments.
Loss of short-term memory is most prominent early.
In the late stages of disease, patients are totally dependent upon others for ADLS.
The most common form of dementia in the elderly

Question 2

MMSE

Answer 2

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

24/30 suggestive of dementia.
Not sensitive for Mild Cognitive Impairment.
Results affected by educational level, low SES, language skills, illiteracy, impaired vision/hearing.

Question 3

Alzheimer’s Disease 3 consistent neuropathological hallmarks:

Answer 3

Amyloid-rich senile plaques
Neurofibrillary tangles
Neuronal degeneration

Question 4

Cholinesterase Inhibitors

Answer 4

curb the breakdown of acetylcholine.
Help increase the levels of acetylcholine in the brain
Donepezil (Aricept) for all stages of AD
Rivastigmine (Exelon)‏ - skin patch, not end stage
Galantamine (Reminyl),‏ Razadyne (formerly Reminy), not end stage

Question 5

NMDA receptor antagonists

Answer 5

Memantine (Namenda): Approved to treat moderate-to-severe Alzheimer’s disease.
Thought to play a protective role in the brain by regulating the activity of a glutamate. Glutamate also plays a role in learning and memory.

Question 6

Drugs to avoid

Answer 6

Benzodiazepines
Antihistamines
Anticholinergics

Question 7

VASCULAR DEMENTIA

Answer 7

onset of cognitive deficits associated with a CVA.
Abrupt onset of symptoms followed by stepwise deterioration.
Findings on neurologic examination consistent with prior stroke(s).
Infarcts on cerebral imaging.

Question 8

FRONTOTEMPORAL DEMENTIA

Answer 8

Characterized by focal atrophy of the frontal and temporal lobes in the absence of Alzheimer pathology. (Personality disorder)
Pick’s disease (a subtype) was the first recognized subtype of FTD.

Question 9

Normal-Pressure Hydrocephalus

Answer 9

condition of pathologically enlarged ventricular size with normal opening pressures on lumbar puncture.
Triad of dementia, gait disturbance, and urinary incontinence.
Wacky
Wobbly
Wet
Reversible by the placement of a ventriculoperitoneal shunt.

Question 10

Dementia with Lewy Bodies

Answer 10

Characterized by dementia accompanied by delirium, visual hallucinations, and parkinsonism. Other common symptoms include syncope, falls, sleep disorders, and depression.

Question 11

Progressive supranuclear palsy

Answer 11

AKA Steele Richardson Olszewski syndrome.
A rare syndrome that can mimic PD in its early phase.
Restricted up-and-down eye movement (vertical gaze palsy) is a hallmark of this disease.
Postural instability with unexplained falls BACKWARDS

Question 12

4 major causes of Delerium

Answer 12

Underlying medical condition
Substance intoxication
Substance withdrawal
Combination of any or all of these

Question 13

Delirium - Causes: “I WATCH DEATH”

Answer 13

I nfections
W ithdrawal
A cute metabolic
T rauma
C NS pathology
H ypoxia
D eficiencies...thaiamine, B12, niacin
E ndocrinopathies
A cute vascular
T oxins or drugs
H eavy metals

Question 14

Dementia

Answer 14

Slow, gradual onset.
Time of onset unclear, typically note changes over several months.
Due to chronic disorders, such as Alzheimer’s, etc.
Progressive process.
Attention not impaired until late stages.
No effect on consciousness until late stages.
Loss of memory esp. for recent events.

Question 15

Delirium

Answer 15

Acute onset.
Cause is usually treatable such as: infection, medications, pain, MI.
Usually reversible.
Attention impaired.
Consciousness ranges from lethargic to hyperalert.
Effect on memory varies.