Dementia and delirium Flashcards
Name 3 congnitive symptoms of Dementia and the associated lobe that is affected
Impaired : memory - temporal lobe orientation- temporal learning capacity - temporal Impaired judgement -frontal lobe involvement)
Name 5 Non-cognitive symptoms of Dementia
Behavioural - agitation , aggression , wandering and sexual disinhibition Depression and anxiety Hallucinations persecutory delusions insomnia , daytime drowsiness
name 3 Differentials for dementia
Hypothyroidism
Hypercalcaemia
B12 deficiency
Normal pressure hydrocephalus
what are some symptoms for normal pressure hydrocephalus ?
Abnormal gait
Incontinence
Confusion (Dementia like)
what is the criteria for Dementia ?
Cognitive decline = impairment of
activities of daily living
clear consciousness , progressive and chronic
what are the macroscopic features of Alzheimer’s ?
Global cortical atrophy
Sulcal widening
Enlarged ventricles (3rd and 4th)
what are microscopic changes in Alzheimer’s ? how are they made ?
Plaques - APP broken down the amyloid beta
Neurofibrally Tangles- Hyperphosphorylated tau
how do the proteins seen in Alzheimer’s disease cause disease and what neurones are affected ?
Plaques and tangles kill neurones in the CNS neurones affected: Cholinergic (treatments target this) Noradrenergic Serotonergic Somatostatin
define Vascular dementia
what makes its pathological ?
Cognitive impairment caused by ischeamia or heamorrhage secondary to cerebrovascular disease
1 area of cortex is infarcted
What is the presentation of VaD ?
Stepwise decline and inline
focal neurological signs
what is the difference between parkinsons and DLB
If movement disorder followed by dementia then we call
this Parkinson’s disease. If dementia precedes
movement disorder we call it dementia with Lewy bodies
what is the pathology of DLB ?
Aggregation of alpha synuclein: Forms spherical intracytoplasmic depostions in : Substantia nigra Temporal lobe Frontal lobe Cingulate gyrus
what is the presentation of DLB ?
Fluctuating cognition and alertness
Vivid visual hallucinations
Parkinsonian features - falls
what must not you do to patients with DLB ? what can it lead to ? describe it
Do not give antipsychotics neuroleptic malignant syndrome: Fever Encephalopathy (confusion) Vital signs instability Elevated creatine phosphokinase Rigidity
what is the second most common cause of early onset dementia ?
Frontotemporal dementia
what lobes are affected in Frontotemporal dementia?
Frontal and temporal lobe atrophy
what are the symptoms of Frontotemporal dementia ?
Behavioural disinhibition Inappropriate social behaviour Loss of motivation without depression Repetitive/ritualistic behaviours Non fluent (Broca type) aphasia
why is AIDS dementia complex on the rise ?
patients with HIV infection live longer thanks to
modern treatments, their chance of developing AIDs
associated dementia is increasing
outline the pathology of ADC
what is the onset like ?
Entry of HIV infected macrophages into the brain is
thought to lead to indirect damage to neurones
Insidious onset but rapid progression once established
What are the clinical features of ADC?
Cognitive impairment Psychomotor retardation Tremor Ataxia Dysarthria Incontinence
What is the principles of management of Dementia?
comment on the first part of this model
Bio-psycho-social model
bio: Achase inhibtors- Modest efficacy for mild to moderate Alzheimer’s disease , NMDA antagonists- Useful for treating agitation
how do you treat ADC socially ?
discuss : Explanation of disease complications and their management results of special investigations driving
arrange: day-care respite care resources for carers placement for nursing home
what is delirium ?
Insult to the brain leads to acute neuronal cell damage caused by hypoxia and/or inflammation maybe reversible
what is the presentation of delirium ?
Acute/ rapid onset Clouded consciousness (may be drowsy) • Fluctuating course • Maybe transient visual hallucinations • Often exaggerated emotional responses- aggression
how does hypoactive delirium present?
Withdrawn
• Quiet
• Sleepy
- more likely to be missed
how does hyperactive delirium present?
Restless
• Agitated
• Aggressive
what is common with both hypo and hyper active delirium ?
Mood may rapidly fluctuate
Persecutory delusions- transient
Symptoms worse at start and end of day
Name 5 ways delirium can be caused
Nutritional Vitamin deficiencie Intracranial Strokes, TIAs, epilepsy, infection etc. Extracranial infections UTI, pneumonia o Iatrogenic Infections Drugs o Alcohol Intoxication Withdrawal (including delirium tremens, caused by changes in GABA and NMDA receptors induced by long term alcohol consumption) o Endocrine Thyroid Pancreas o Metabolic Hypoxia Renal (e.g. electrolyte disturbances) Hepatic
what is the management of delirium ?
treat underlying cause
what is the prognosis of dementia ?
Increases risk of dementia
• Associated with mortality
• These patients often have lengthy hospital stays and
have a high risk of re-admission
