Dementia and Delirium Flashcards
What is dementia?
CHANGES in memory/thinking over time
A syndrome of impairment in memory or thinking severe enough to interfere with daily activities, work or social relationships
Dementia can be…
progressive, disabling, fatal
What are some of the cognitive deficits seen in dementia?
memory
apaxia
aphasia
agnosia
disturbed executive functioning- ability to think, plan, organize?
What is agnosia?
Failure to recognize objects
DSM-5 criteria for dementia?
evidence in cog. decline from a previous level of performance in one or more of following
- learning/memory
- executive func.
- complex attention
- perceptual motor
- social cognition
What can you use to assess pt if you are concerned for dementia?
mini mental status exam
up to 30 pts
MMSE score of…. is considered abnormal
24
Delirium is also known as…
acute confusional state
acute mental status change
AMS
organic brain syndrome
reversible demential
toxic or metabolic encephalopathy
Why are we concerned about delirium?
Very prevalent (1/3 of pts presenting to ED)
high morbidity and mortality
persistence of delirium results in…
poor long term outcomes
DSM 5 dx criteria for delirium?
Disturbance in attention (reduced ability to focus) and awareness (reduced orientation to the environment)
develops over a short period of time, and behavior tends to fluctuate during the course of a day
What can be used to help dx delirium?
Confusion Assessment Method (CAM)
What is included in CAM?
- Acute change in mental status and fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
need 1 + 2 + (3 OR 4) for dx
What is the spectrum of delirium?
hyperactivity or agitated delirium
hypoactive delirium
mixed
…..is an important neurotransmitter for cognitive processes
Acetylcholine
What is delirium caused by?
anticholinergic drug overdose, reversed by physostigmine
Is delirium assoc. with an increased or decreased serum anticholinergic activity?
INCREASED
What labs may be elevated in pt with delirium?
increased CRP
increased interleukin 1B
increased TNF
Effect of inflammatory aspect of delirium?
Inflammation can break down blood-brain barrier, allowing toxic medications and cytokines access to CNS
What are some predisposing factors for delirium?
Advanced age
Dementia
Func. Impairment in ADLs
Medical comorbidity
Hx of ETOH abuse
Male gender
Sensory impairment( vision/hearing)
What are some precipitating factors for delirium?
- Acute CV events
- Acute pulmonary events
- Bed rest
- Drug withdrawal (sedatives, alcohol)
- Fecal impaction
- Fluid or lyte disturbances
- Indwelling devices
- Infections (esp. respiratory, urinary)
- Meds
- Restraints
- Severe anemia
- Uncontrolled pain
- Urinary retention
Which surg. are assoc. with 50% postop delirium?
cardiac surg, AAA repair
hip fx
(others: 15%)
What are some preoperative risk factors for delirium?
Age 70+
Cognitive impairment
Physical functional impairment
Hx ETOH abuse
Abn serum chemistries
Intrathoracic and aortic aneurysm surgery
When is the peak onset for postop delirium?
on 2nd day post op
