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Clinical Disciplines II- Exam 1 (Melicia) > Dementia and Delirium > Flashcards

Dementia and Delirium Flashcards

1
Q

What is dementia?

A

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

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2
Q

Dementia can be…

A

progressive, disabling, fatal

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3
Q

What are some of the cognitive deficits seen in dementia?

A

memory

apaxia

aphasia

agnosia

disturbed executive functioning- ability to think, plan, organize?

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4
Q

What is agnosia?

A

Failure to recognize objects

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5
Q

DSM-5 criteria for dementia?

A

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
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6
Q

What can you use to assess pt if you are concerned for dementia?

A

mini mental status exam

up to 30 pts

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7
Q

MMSE score of…. is considered abnormal

A

24

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8
Q

Delirium is also known as…

A

acute confusional state

acute mental status change

AMS

organic brain syndrome

reversible demential

toxic or metabolic encephalopathy

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9
Q

Why are we concerned about delirium?

A

Very prevalent (1/3 of pts presenting to ED)

high morbidity and mortality

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10
Q

persistence of delirium results in…

A

poor long term outcomes

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11
Q

DSM 5 dx criteria for delirium?

A

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

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12
Q

What can be used to help dx delirium?

A

Confusion Assessment Method (CAM)

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13
Q

What is included in CAM?

A
  1. Acute change in mental status and fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. Altered level of consciousness

need 1 + 2 + (3 OR 4) for dx

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14
Q

What is the spectrum of delirium?

A

hyperactivity or agitated delirium

hypoactive delirium

mixed

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15
Q

…..is an important neurotransmitter for cognitive processes

A

Acetylcholine

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16
Q

What is delirium caused by?

A

anticholinergic drug overdose, reversed by physostigmine

17
Q

Is delirium assoc. with an increased or decreased serum anticholinergic activity?

A

INCREASED

18
Q

What labs may be elevated in pt with delirium?

A

increased CRP

increased interleukin 1B

increased TNF

19
Q

Effect of inflammatory aspect of delirium?

A

Inflammation can break down blood-brain barrier, allowing toxic medications and cytokines access to CNS

20
Q

What are some predisposing factors for delirium?

A

Advanced age

Dementia

Func. Impairment in ADLs

Medical comorbidity

Hx of ETOH abuse

Male gender

Sensory impairment( vision/hearing)

21
Q

What are some precipitating factors for delirium?

A
  • 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
22
Q

Which surg. are assoc. with 50% postop delirium?

A

cardiac surg, AAA repair

hip fx

(others: 15%)

23
Q

What are some preoperative risk factors for delirium?

A

Age 70+

Cognitive impairment

Physical functional impairment

Hx ETOH abuse

Abn serum chemistries

Intrathoracic and aortic aneurysm surgery

24
Q

When is the peak onset for postop delirium?

A

on 2nd day post op

25
Q

Postop delirium is assoc with?

A

postop pain

postop anemia

use of benzos and opioids (esp. meperidine)

26
Q

What is recommended to prevent postop delirium?

A

limit sedation

provide adequate analgesia

27
Q

What should be included in hx for dementia/delirium?

A

time course of cognitive changes

med review

alcohol

28
Q

What labs should you check for dementia/delirium?

A

based on H&P

+/- CBC, lytes, renal func. test

+/- UA, LFTs, serum drug levels, ABGs, CXR, ECG, cultures

29
Q

Should you order cerebral imaging if you are concerned for delirium or dementia?

A

NO

rarely helpful unless head trauma or new focal neuro findings

30
Q

Should you order EEG and CSF if you are concerned for delirium or dementia?

A

NO

rarely helpful except with assoc. seizure activity or signs of meningitis

31
Q

management for dementia/delirium?

A

interdisciplinary effort

multifactoral approach

failure to dx/manage delirium –> costly, life threatening comps/loss of func.

32
Q

keys to effective management?

A

identify/tx reversible conditions

maintain behavioral control

anticipate/prevent complications

restore func.

33
Q

What are some drugs to reduce/eliminate?

A

anticholinergics, anticonvulsants, antidepressants, antihistamines, antipsychotics, H2 blocking agents, etc.

34
Q

If absolutely necessary what can be used to help with behavioral problems?

A

Haloperidol

Use lorazepam in sedative and alcohol withdrawal, and history of neuroleptic malignant syndrome

35
Q

What should you assess for if you give a pt Haloperidol?

A

akathisia and extrapyramidal effects

monitor for QT interval prolongation

36
Q

What can you use to help rehabilitate pt?

A

use orienting stimuli (clocks/calender)

adequate socialization

use of eyeglasses/hearing aids

mobilize ASAP

ensure adequate nutrition/fluids

educate fam

Clinical Disciplines II- Exam 1 (Melicia) (3 decks)

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