Dementia and Delirium Flashcards
What is Dementia?
A progressive decline in memory and at least one other cognitive area in an alert person. Cognitive areas include attention, orientation, judgment, abstract thinking and personality. Dementia is rare in under 50 years of age and the incidence increases with age; 8% in >65 and 30% in >85 years of age.
Causes and Risk Factors of dementia:
- Age
- Genetics
- Down’s Syndrome
- Female
- Fewer years of education
- Head injury
Types of Dementia caused by brain damage.
- Alzheimer’s Disease
- Stroke
- Pick’s disease
- Huntington’s
- Downs Syndrome
- Creutzfeldt-Jacob
- AIDS, alcoholism
- Parkinson’s disease and other neurodegenerations.
What are three reasons why diagnosing dementia is essential?.
- By determining the probable cause, treatable disorders can be identified, such as medication toxicity (benzos, H2 blockers and anticholinergics), and thyroid disease.
- There are symptoms and comorbidities that are treatable, such as depression, delirium, delusions, hallucinations, and agitation.
- Caregivers must be identified and environmental issues taken into consideration.
What is the diagnosis of dementia based on?
Memory loss - both in short and long-term, plus one or more of the following:
- aphasia – language problems
- apraxia – organizational problems
- agnosia – unable to recognize objects or tell their purpose
- disturbed executive function – personality and inhibition
How is dementia assessed?
- History, both from the patient and close observers
- Focused physical
- Mini Mental State Exam
- Lab work including CBC, basic metabolic profile, TSH, Vitamin B12, STS
- If brain injury or space occupying lesion such as a tumor is in question, CT, or MRI.
- PET scans are occassionally recommended in the early diagnosis of dementia although there remains some controversy as to precisely their indication and value
- Additionally, depression, delirium, agitation, hallucinations, and delusions are important comorbidities that must be taken into consideration. Behavorial issues may require a referral to a specialist.
What are some Non-pharmacologic treatments for dementia
Non-pharmacologic Interventions
- Adequate sleep
- Adequate hydration
- Adherence to a strict schedule
- Reformatting task (occupation therapy)
- Maintenance of a proper stimulation level
- Support caregivers
- Social activities
What are some Pharmacologic treatments for dementia
(course is typically 10 years, but 2-20 possible)
Prevention
- Vitamin E
- Cognitive stimulation such as education & Memory/attention
Acetylcholinesterase Inhibitors
* Tacrine
* Donepezil hydrochloride
* Rivastigmine tartrate
* Galantamine hydrochloride
NMDA antagonists
* Memantine
* Others (Ginkgo biloba, caffeine, nicotine, methylphenidate, NSAIDs)
Behavioral
* Antipsychotics
* Antidepressants
* Mood stabililizers
What must be ruled out in order to make a diagnosis of dementia?
Delirium
However, patients with dementia are at increased risk of delirium and may have both.
What is delirium?
An acute disorder of attention and global cognition (memory and perception) and is treatable. The diagnosis is missed in more than 50% of cases.
What are some risk factors for delirium?
- Medications.
- Age
- Pre-existing brain disease,
What are some common causes of delirium?
D Dementia
E Electrolyte disorders
L Lung, liver, heart, kidney, brain
I Infection
R Rx Drugs
I Injury, Pain, Stress
U Unfamiliar enviroment
M Metobolic
How could we prevent delirium?
- Avoid psychoactive drugs
- Avoid restraints.
- Quiet environment
- Daytime activity
- Dark and quiet at night
- Visual and hearing assistive devices
- Orientation devices
How is delirium diagnosed?
- Based on clinical observation; no diagnostic tests are available.
The essestial features of delirium include: (3)
- Acute onset (hours/days) and a fluctuating course
- Inattention or distraction
- Disorganized thinking or an altered level of consciousness
Non-pharmacologic management of delirium
- Optimize environment
- Personal belonging – photographs
- Quiet
- Sitter
Pharmacologic management of delirium
- Neuroleptics may be needed if the patient is having distressing hallucinations/delusions or the patient is very agitated
- High potency with low anticholinergic activity
- Low dose
- Haloperidol or risperdone
- Benzodiazepine if delirium is secondary to benzo or alcohol withdrawal
What is the incidence of dementia? (3 age categories)
Dementia is
- rare in under 50 years of age and the incidence increases with age;
- 8% in >65 and
- 30% in >85 years of age.
how often is delerium missed?
50% of the time
