Dementia and delirium

Question 1

Name 3 congnitive symptoms of Dementia and the associated lobe that is affected

Answer 1

Impaired :
memory - temporal lobe 
orientation- temporal
learning capacity - temporal 
Impaired judgement -frontal lobe involvement)

Question 2

Name 5 Non-cognitive symptoms of Dementia

Answer 2

Behavioural - agitation , aggression , wandering and sexual disinhibition 
 Depression and anxiety 
Hallucinations 
persecutory delusions 
insomnia , daytime drowsiness

Question 3

name 3 Differentials for dementia

Answer 3

Hypothyroidism
Hypercalcaemia
B12 deficiency
Normal pressure hydrocephalus

Question 4

what are some symptoms for normal pressure hydrocephalus ?

Answer 4

Abnormal gait
 Incontinence
 Confusion (Dementia like)

Question 5

what is the criteria for Dementia ?

Answer 5

Cognitive decline = impairment of
activities of daily living
clear consciousness , progressive and chronic

Question 6

what are the macroscopic features of Alzheimer’s ?

Answer 6

Global cortical atrophy
Sulcal widening
Enlarged ventricles (3rd and 4th)

Question 7

what are microscopic changes in Alzheimer’s ? how are they made ?

Answer 7

Plaques - APP broken down the amyloid beta

Neurofibrally Tangles- Hyperphosphorylated tau

Question 8

how do the proteins seen in Alzheimer’s disease cause disease and what neurones are affected ?

Answer 8

Plaques and tangles kill neurones in the CNS
neurones affected:
Cholinergic (treatments target
this)
 Noradrenergic
 Serotonergic
Somatostatin

Question 9

define Vascular dementia

what makes its pathological ?

Answer 9

Cognitive impairment caused by ischeamia or heamorrhage secondary to cerebrovascular disease
1 area of cortex is infarcted

Question 10

What is the presentation of VaD ?

Answer 10

Stepwise decline and inline

focal neurological signs

Question 11

what is the difference between parkinsons and DLB

Answer 11

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

Question 12

what is the pathology of DLB ?

Answer 12

Aggregation of alpha synuclein:
Forms spherical intracytoplasmic depostions in :
Substantia nigra
Temporal lobe
Frontal lobe
Cingulate gyrus

Question 13

what is the presentation of DLB ?

Answer 13

Fluctuating cognition and alertness
Vivid visual hallucinations
Parkinsonian features - falls

Question 14

what must not you do to patients with DLB ? what can it lead to ? describe it

Answer 14

Do not give antipsychotics
 neuroleptic malignant syndrome:
Fever
Encephalopathy (confusion)
Vital signs instability 
Elevated creatine phosphokinase
Rigidity

Question 15

what is the second most common cause of early onset dementia ?

Answer 15

Frontotemporal dementia

Question 16

what lobes are affected in Frontotemporal dementia?

Answer 16

Frontal and temporal lobe atrophy

Question 17

what are the symptoms of Frontotemporal dementia ?

Answer 17

Behavioural disinhibition
Inappropriate social behaviour
Loss of motivation without depression
Repetitive/ritualistic behaviours
Non fluent (Broca type) aphasia

Question 18

why is AIDS dementia complex on the rise ?

Answer 18

patients with HIV infection live longer thanks to
modern treatments, their chance of developing AIDs
associated dementia is increasing

Question 19

outline the pathology of ADC

what is the onset like ?

Answer 19

Entry of HIV infected macrophages into the brain is
thought to lead to indirect damage to neurones
Insidious onset but rapid progression once established

Question 20

What are the clinical features of ADC?

Answer 20

Cognitive impairment
Psychomotor retardation
Tremor
Ataxia
Dysarthria
Incontinence

Question 21

What is the principles of management of Dementia?

comment on the first part of this model

Answer 21

Bio-psycho-social model

bio: Achase inhibtors-
Modest efficacy for mild to moderate
Alzheimer’s disease
 , NMDA antagonists-
Useful for treating agitation

Question 22

how do you treat ADC socially ?

Answer 22

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

Question 23

what is delirium ?

Answer 23

Insult to the brain leads to acute neuronal cell damage caused by hypoxia and/or inflammation maybe reversible

Question 24

what is the presentation of delirium ?

Answer 24

Acute/ rapid onset
Clouded consciousness (may be drowsy)
• Fluctuating course
• Maybe transient visual hallucinations
• Often exaggerated emotional responses- aggression

Question 25

how does hypoactive delirium present?

Answer 25

Withdrawn
• Quiet
• Sleepy
- more likely to be missed

Question 26

how does hyperactive delirium present?

Answer 26

Restless
• Agitated
• Aggressive

Question 27

what is common with both hypo and hyper active delirium ?

Answer 27

Mood may rapidly fluctuate
 Persecutory delusions- transient
Symptoms worse at start and end of day

Question 28

Name 5 ways delirium can be caused

Answer 28

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

Question 29

what is the management of delirium ?

Answer 29

treat underlying cause

Question 30

what is the prognosis of dementia ?

Answer 30

Increases risk of dementia
• Associated with mortality
• These patients often have lengthy hospital stays and
have a high risk of re-admission