Dementia and Delirium Flashcards
What is Delirium?
What is the:
Onset?
Course?
Progression?
Duration?
- Rapid onset decrease in cognitive function that has a reversible cause
- Resolves quickly once the cause is identified and treated
- Onset: Acute
- Course: Short
- Progression: Abrupt
- Duration: Hrs – Days
What is Dementia?
What is the:
Onset?
Course?
Progression?
Duration?
- Decline in cognitive function that slowly progresses over a period of years
- Hard to determine exactly when symptoms first started (as it begins slowly)
- Onset: Chronic
- Course: Long
- Progression: Slow
- Duration: Months – Years
Can patients with dementia experience delirium?
Patients with dementia can experience delirium – they will experience a sudden decline in cognitive function from their already impaired state and therefore the underlying cause of delirium should be identified and managed
What is the Mini Mental State Exam (MMSE)?
- Most common tool used to assess cognitive function
- Useful tool, however:
- Relatively simple and so it has some limitations such as factors such as language barriers (which can reduce the score in patients who don’t have cognitive impairment)
- Becomes important when considering PBS availability
- Relatively simple and so it has some limitations such as factors such as language barriers (which can reduce the score in patients who don’t have cognitive impairment)
What are Precipitating Factors of Delirium?
- Medical e.g. infections (UTI etc), epilepsy, cerebrovascular, renal failure
- Medications e.g. TCA, opioids, benzodiazepines, anticholinergic drugs (see anticholinergic load), diuretics
- Psychosocial e.g. depression, pain, mania
What is Anticholinergic Load?
One drug may not be a huge issue, but when taking a number of drugs with a small amount of anticholinergic activity, quite significant load overall à limitations in scoring tool used to assess anticholinergic drug load
What is a problem of dementia?
- Different causes and therefore not all dementia will respond the same way to treatment
What are the Causes of Dementia?
- Alzheimer’s Disease and Vascular (multi-infarct) are the most common
- Alzheimer’s Disease: steady decline in cognitive function over time
- Vascular Dementia: lots of little strokes where they have ischaemic event, lose some cognitive function, then they’re okay for a short period of time and the the cycle repeats
What is the Progression of Alzheimer’s Disease?
Symptoms > Diagnosis > Loss of functional Independence > Behavioural Problems > Nursing home placement > Death
- Patient’s function will decline with time
What are the Tools to assess Dementia?
- In addition to MMSE, there are other tools to assess severity
- ADAS – cog: detailed assessments of patient cognition
- CIBIC (+/- carer): subjective assessments of function based upon how the Dr. or carer perceives the patient
What are the Treatment Aims of Dementia?
- Prevent progression (not possible for Alzheimer’s)
- As disease progresses/becomes more severe, patients are heavily reliant upon their carer
- Improve cognitive function
- Still progresses and patient ends up with severe cognitive impairment
- Manage behavioural disturbances
- Reduce carer burden
How is Vascular (Multi-Infarct) Dementia managed?
Address stroke risk factors
What is the role of Non-Drug Therapy in Dementia?
- Non-drug therapy may help minimise drug exposure
- Making specific modifications to a patient’s environment and what they do during the day can result in massive improvements in their behaviour and significantly reduce the need to use antipsychotics
- Social interaction, physical activity, education etc.
