Dementia And Delirium

Question 1

Confusion Confused -Ds

Climical syndromes of cognition

Answer 1

Delirium-impairment >1 aspect of cognition
Dementia
Developmental disability
Deficit (Focal)
Depression- hard to make new memories + concentrate
Delusional state
Dissociative state- somatisatiom disorders- pseudoseizures, not epileptic attacks

Question 2

When are auditory hallucinations more prominent?

Answer 2

Primary psychic cases

Question 3

Whats delirium?

Answer 3

A toxic confusional state.
An acute or cpsubacute onset,
Impairement of consciousness (varies in severity and fluctuates compared to dementia) accompined by perception + mood abnormalitites.

Confusion worse at night 🌙⭐️ , accmp by hallucinations, delusions, restlmessness + aggression.

Many diseases can be accmp by delirium esp in elderly.
Commonest: infx + drugs

Question 4

Managment of delirium

Answer 4

Withdrawal of drugs,mrehydration, pain relief, sedation only if aggressive or at risk of self injury- benzodiazepines ⭐️
Altho severe: IM haloperidol.

Question 5

What is acute confusion?

Answer 5

Acute onset cognitive impairment, reversible,
Fluctuation
Poor attention: distractibility, impaired working memory, :
disorientation, disturbed diurnal rhythm,

Visual hallucinations
Behav change- withdrawal or aggitation

Question 6

How do we test for distractibility?

Answer 6

Digit span, poor verbal frequency, poor encoding

Question 7

What are some predisposing fx for delirium?

Answer 7

Demetia
Eldelry
Sedation drugs

Sensory impairment(vision, hearing, proprioception)
Unfamiliar surroundings- encironment
Severe illness
Infx, dehydration, surgery, hip fracture
Physical frality

So: systemic illness- hyperanaemia? Hepatic encephalopathy, hypoxia, paraneoplastic syndrome,…infx, post op
Circulatory: MI,mshock, arrythmia

Structural cranial lesions- neurosurgical- space occupying lesion- blood, CSF, hydrocephalus

Question 8

So acute confusion is?

Answer 8

Impaired cognitive reserve

Impaired interaction w/ env

F of body to maintain brain

Question 9

So what are some causes of delirium?

Answer 9

Systemic illness: Drugs: tricyclic antidepressants, Benzodiazepines, Opiates, Anticonvulsants,

Drug/alcohol withdrawal -Metabolic , - Hypoxia, RF, Disorders of electrolytes, Hepatic Failure,

Vit Deficiencies- B1 (Werinke-Korskoff) , Vit B12.

Brain damage: trauma, tumour, abscess, SAH,

Question 10

Whats Dementia?

Answer 10

Progressive decline of cognitive fx ie loss of mind.
No clouded comsciousness
Over 65s- 10% and 20% >80s
70% Alzheimers. **

Multiple cerebral infraction**
Dementia w/ Lewy bodies **
Xs alcohol- werinkes korsakoff syndrome
Hypothyroidism
Intracranial mass: subdural haem, hydrocephalus
Vit B12 def
Syphillis 
Huntingtons
Late Parkisnons

Question 11

What is a simple clinical assesment of the menta state?

Answer 11

Age, time , address, year
Place- name of hospital
Recognition of 2 ppl- Dr, nurse
DOB
Year of 1st world war?
Monarch?
Count backwards from 20-1

Each 1.
Healthy >8

Question 12

Whats Alzheimers?

Answer 12

1o degenerative cerebral D , unknown aetiology.
Later inset, steady progression.
Most predominant early sx: short temp memory loss
Subsequently: slow disintegration of personality and intellect, all cortical fx affected.

Question 13

What are Alzheimers plaques made of?

Answer 13

B-amyloid. + granulovacular bodies.

Question 14

How would you investigate Alzheimers?

Answer 14

Simple assesment of mental state. Exclude treatable causes.
FBC, LFTs, TFTs, B12, folate.
Brain CT in young or those w/ atypical presx.
SH+FH- how vulnerable pt is

Question 14

How would you manage Alzheimers?

Answer 14

Anxiety and depression must be tx.,
Acetylchoniesterase Inhibiors like donezepil, rivastigmine, galantamine.
Decrease ACh production
Average survival8-10Y

Question 15

Vascular (multi infract)

Answer 15

2nd most common vause of dementia.hx and CF
- stepwise deterioration with declines dollowed by short periods of stability. Hx of TIAs.
Evidence of arteriopathy

Question 16

Dementia w/ Lewy bodies

Answer 16

Characterised by fluctuating cognitiom with pronounced variation in attention + alertness.

Prominent and periststent memory loss, not early.m

Impairment in attention, frontal, subcortical and cisuospatial ability is more predominent.
Depression + sleep probs.

Visual hallucinations- frightening nightmares , strange faces
Delusioms with transient loss of consciousness occur.

Cortical lewy bodies on autopsy.

❌❌ neuroleptic drugs

Question 17

Define Dementia

Answer 17

Progressive, irriversible decline in spcognitive fx w/o i paired consciousness. Can affect all aspects of higher fx, eg concentration, memory, language, personality and emotional control.

Question 18

What happens in Lewy body dementia?

Answer 18

2 after Alzheimers.
CF: day to day fluctuations of cognitive fx, visual hallucinations,msleep disturbance, transient LOC, recurrent falls, parkinsonian features.
Prone to hallucination, antipsychotics should be avoides since cause ppsevere parkinsonism in 60%.

Question 19

What are some parkinsosnian features?

Answer 19

Trepmor,
Hypokinesia
Rigidity
Postural instability

Question 20

What are Lewy bodies?

Answer 20

Abnormalities within the cytoplasm within neurones: proteins + granular material.
Dound in the cerebral cortex of LB dementia and PD.

Question 21

Whats Creutzfeld disease?

Answer 21

CJD- rapidly progressive dementia caused by prions (infectious agents conposed only by protein) - transmitted by human pituitary hormones + neurosurgical instruments.

Pulvinar sign

Question 22

What hapoens in Vascular dementia?

Answer 22

Ischaemic disorder characterised by multiple small infracts in cortex and white matter. When >100 mL of infracts occured, dementia is clinically apparent.
Begins in 60s w/ stepwise deterioration f cognitive fx.

Other Features: focal neurology, fits, nocturnal confusion.
RFs(male, smoking, htn, dm, hypercholesterolaemia.
Death usually within 5 years due to stroke or IHD.

Question 23

Whats Picks disease?

Pick Arnold- Czechoslovakian neurologist and psychiatrist (1852-1924)

Answer 23

Frontotemporal dementia- can only be differentiated from other forms postportum.
CFs: disinhibition, inattention, antisocial behaviour, personality changes. Later, apathy, withdrawal, predominate.

Memory loss + disorientation- late.
Postmortem- atrophy of frontal + tenporal- knife blade atrophy and Picks bodies( tau proteins in cytoplasm)

Question 24

What happens in. Or al pressure hydrocephalus?

Answer 24

Triad of: 1. Dementia (mainly memory probs) 2. Gait disturbance
3. Urinary inconinence.

Cause: increased vol of CSF, but only a slight increase in pressure cz the ventricles dilate to compensate. Disruption in subarachnoid soace that does not allow CSF reabsorption but allows it to flow theough ventricles into sybaracnhoid space.

Dx- by LP to demonstrate normal CsF opening pressure
Collowed by head CT/MRI (showing wnlarged ventricles).

Tx- ventriculoperitoneal shunting.