Dementia and delirium Flashcards
Which type of dementia is associated with visual hallucinations
LBD
3 types of delirium.
Which is the most common type
- Hypoactive (most common)
- Hyperactive
- Mixed
ICD-10 fo delirium
5 criteria
- Impairment of consciousness and attention
- Global disturbance in cognition
- Psychomotor disturbance
- Disturbance of sleep-wake cycle
- Emotional disturbance
How is the sleep-wake cycle and concentration affected in dementia vs delirium
Delirium: very disrupted
Dementia: normal
How is psychomotor activity affected in dementia vs delirium
Delirium: usually abnormal
Dementia: usually normal
Most common causes of delirium
PINCH ME
- pain
- infection
- neoplasm
- constipation
- hydration/ hypoxia
- medication
- environment
Which 4 infections are commonly associated with delirium
- UTI
- Pneumonia
- Meningitis
- Encephalitis
Common medication causes of delirium
- BZDs, narcotics
- Anticholinergics, Antiparkinsons (L-DOPA)
- Steroids
- Warfarin
- 1st gen antihistamines
How is delirium managed
- treat underlying cause
- provide appropriate environment
- low dose antipsychotics if necessary
ICD-10 for dementia
- Evidence of memory decline and cognitive decline
- Preserved awareness of environment
- Decline in emotional control, motivation or change in social behaviour
What 4 features are examples of a decline in emotional control, motivation or change in behaviour
^in someone with dementia
- Emotional lability
- Irritability
- Apathy
- Coarsening of social behaviour
For a confident diagnosis of dementia,
how long should decline in memory and cognition have lasted
At least 6 months
Name 3 main reversible causes of dementia
- Raised ICP (eg normal pressure hydrocephalus, tumours, haematoma)
- B12/folate deficiency
- Endocrine problems (Cushing’s, Hypothyroidism)
How is a CT scan useful in dementia
Identify hippocampal atrophy
How is an MRI useful in dementia
Identify posterior vascular pathology (eg in vascular dementia)
How is a SPECT scan useful in dementia
Differentiate between different types of dementia
Doperminergic cell loss seen in DLB and Parkinsons
MMSE score
Normal
Severe
25-30
<10
Pathophysiology of Alzheimer’s
Degeneration of cholinergic neurons
in nucleus basalis of Meynert
Microscopic features of brain in Alzheimer’s
- neurofibrillary tangles
- beta-amyloid plaque formation
Macroscopic features of brain in Alzheimer’s
- hippocampus atrophy
- widened sulci
- enlarged ventricles
What age is considered early onset Alzheimer’s
<65yo
Features of early onset Alzheimer’s
- <65yo
- rapid onset and progression
- aphasia
- agraphia (cannot write)
- alexia (cannot read)
- acalculia (cannot do maths)
- apraxia
Pathophysiology of vascular dementia
Multiple small strokes/ atherosclerosis in small vessels
Symptoms of vascular dementia
- emotional and personality changes (earlier onset)
- STEPWISE deterioration
- confusion
- late-onset memory loss
What type of neuro signs might someone with vascular dementia have
UMN signs
- spasticity
- extensor plantar response
Pathophysiology of Lewy Body dementia
Deposition of Lewy Bodies in neurons of brainstem, substantia nigra, neocortex
Symptoms of Lewy Body dementia
- FLUCTUATIONS in cognition from day to day
- Visual hallucinations
- Parkinsonism (tremor, rigidity, bradykinesia)
Pathophysiology of frontotemporal dementia
Atrophy of frontal and temporal lobes of brain
Symptoms of frontotemporal dementia
- language difficulties (earlier onset compared to other types of dementia)
- personality changes
- worsened social behaviour
- losing insight early on (but preserved memory)
What bloods to do in a patient with suspected dementia (to rule out other causes of similar presentations)
B12/ folate
TFTs (might be severe hypothyroidism)
ACTH levels (Cushing’s)
Ca (cerebral mets)
Also rule out depression
Note: check HbA1c levels as it accelerates vascular dementia
Types of Alzheimer’s drugs
- Ach-esterase inhibitors (eg Rivastigmine, Donepezil, Galantamine)
- NMDA receptor antagonists (eg Mementine)
Side effects of Ach-eterase inhibitors
- increases QTc interval
- urinary incontinence
- GI problems
- sleep disturbance
Specific to Donepezil
Headache
Anaemia, thrombocytopenia
Types of Parkinson’s/ LBD drugs
- Same as Alzheimer’s (Ach-esters season inhibitors, Memantine)
- Clonazepam/ melatonin for REM steel disorder
- Quetiapine/ aripriprazole for hallucinations
Risks in giving antipsychotics in LBD
Neuroleptic sensitivity reactions eg sedation, cognitive decline
Neuroleptic malignant syndrome eg high fever, confusion, muscle rigidity, tachycardia
Worsening of extrapyramidal features
Types of vascular dementia drugs
Anticoagulants + BP drugs
Ach-esterase inhibitors don’t work
How is short vs long term memory loss affected In Alzheimer’s vs vascular dementia
Alzheimer’s has problems with short term memory but long term memory is preserved
Vascular dementia has problems with both types of memory
