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Stage 3: EJR - Mental Health > Dementia and delirium > Flashcards

Dementia and delirium Flashcards

1
Q

Which type of dementia is associated with visual hallucinations

A

LBD

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2
Q

3 types of delirium.

Which is the most common type

A
  1. Hypoactive (most common)
  2. Hyperactive
  3. Mixed
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3
Q

ICD-10 fo delirium

5 criteria

A
  1. Impairment of consciousness and attention
  2. Global disturbance in cognition
  3. Psychomotor disturbance
  4. Disturbance of sleep-wake cycle
  5. Emotional disturbance
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4
Q

How is the sleep-wake cycle and concentration affected in dementia vs delirium

A

Delirium: very disrupted

Dementia: normal

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5
Q

How is psychomotor activity affected in dementia vs delirium

A

Delirium: usually abnormal

Dementia: usually normal

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6
Q

Most common causes of delirium

A

PINCH ME

  • pain
  • infection
  • neoplasm
  • constipation
  • hydration/ hypoxia
  • medication
  • environment
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7
Q

Which 4 infections are commonly associated with delirium

A
  1. UTI
  2. Pneumonia
  3. Meningitis
  4. Encephalitis
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8
Q

Common medication causes of delirium

A
  • BZDs, narcotics
  • Anticholinergics, Antiparkinsons (L-DOPA)
  • Steroids
  • Warfarin
  • 1st gen antihistamines
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9
Q

How is delirium managed

A
  1. treat underlying cause
  2. provide appropriate environment
  3. low dose antipsychotics if necessary
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10
Q

ICD-10 for dementia

A
  1. Evidence of memory decline and cognitive decline
  2. Preserved awareness of environment
  3. Decline in emotional control, motivation or change in social behaviour
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11
Q

What 4 features are examples of a decline in emotional control, motivation or change in behaviour

^in someone with dementia

A
  1. Emotional lability
  2. Irritability
  3. Apathy
  4. Coarsening of social behaviour
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12
Q

For a confident diagnosis of dementia,

how long should decline in memory and cognition have lasted

A

At least 6 months

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13
Q

Name 3 main reversible causes of dementia

A
  1. Raised ICP (eg normal pressure hydrocephalus, tumours, haematoma)
  2. B12/folate deficiency
  3. Endocrine problems (Cushing’s, Hypothyroidism)
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14
Q

How is a CT scan useful in dementia

A

Identify hippocampal atrophy

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15
Q

How is an MRI useful in dementia

A

Identify posterior vascular pathology (eg in vascular dementia)

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16
Q

How is a SPECT scan useful in dementia

A

Differentiate between different types of dementia

Doperminergic cell loss seen in DLB and Parkinsons

17
Q

MMSE score

Normal
Severe

A

25-30

<10

18
Q

Pathophysiology of Alzheimer’s

A

Degeneration of cholinergic neurons

in nucleus basalis of Meynert

19
Q

Microscopic features of brain in Alzheimer’s

A
  • neurofibrillary tangles

- beta-amyloid plaque formation

20
Q

Macroscopic features of brain in Alzheimer’s

A
  • hippocampus atrophy
  • widened sulci
  • enlarged ventricles
21
Q

What age is considered early onset Alzheimer’s

A

<65yo

22
Q

Features of early onset Alzheimer’s

A
  • <65yo
  • rapid onset and progression
  • aphasia
  • agraphia (cannot write)
  • alexia (cannot read)
  • acalculia (cannot do maths)
  • apraxia
23
Q

Pathophysiology of vascular dementia

A

Multiple small strokes/ atherosclerosis in small vessels

24
Q

Symptoms of vascular dementia

A
  • emotional and personality changes (earlier onset)
  • STEPWISE deterioration
  • confusion
  • late-onset memory loss
25
Q

What type of neuro signs might someone with vascular dementia have

A

UMN signs

  • spasticity
  • extensor plantar response
26
Q

Pathophysiology of Lewy Body dementia

A

Deposition of Lewy Bodies in neurons of brainstem, substantia nigra, neocortex

27
Q

Symptoms of Lewy Body dementia

A
  • FLUCTUATIONS in cognition from day to day
  • Visual hallucinations
  • Parkinsonism (tremor, rigidity, bradykinesia)
28
Q

Pathophysiology of frontotemporal dementia

A

Atrophy of frontal and temporal lobes of brain

29
Q

Symptoms of frontotemporal dementia

A
  • language difficulties (earlier onset compared to other types of dementia)
  • personality changes
  • worsened social behaviour
  • losing insight early on (but preserved memory)
30
Q

What bloods to do in a patient with suspected dementia (to rule out other causes of similar presentations)

A

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

31
Q

Types of Alzheimer’s drugs

A
  1. Ach-esterase inhibitors (eg Rivastigmine, Donepezil, Galantamine)
  2. NMDA receptor antagonists (eg Mementine)
31
Q

Side effects of Ach-eterase inhibitors

A
  • increases QTc interval
  • urinary incontinence
  • GI problems
  • sleep disturbance

Specific to Donepezil
Headache
Anaemia, thrombocytopenia

31
Q

Types of Parkinson’s/ LBD drugs

A
  1. Same as Alzheimer’s (Ach-esters season inhibitors, Memantine)
  2. Clonazepam/ melatonin for REM steel disorder
  3. Quetiapine/ aripriprazole for hallucinations
31
Q

Risks in giving antipsychotics in LBD

A

Neuroleptic sensitivity reactions eg sedation, cognitive decline
Neuroleptic malignant syndrome eg high fever, confusion, muscle rigidity, tachycardia
Worsening of extrapyramidal features

32
Q

Types of vascular dementia drugs

A

Anticoagulants + BP drugs

Ach-esterase inhibitors don’t work

33
Q

How is short vs long term memory loss affected In Alzheimer’s vs vascular dementia

A

Alzheimer’s has problems with short term memory but long term memory is preserved

Vascular dementia has problems with both types of memory

Stage 3: EJR - Mental Health (8 decks)

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