dementia and delirium Flashcards
what is delirium?
Delirium is an acute confusional state, with a sudden onset and fluctuating course.
It develops over 1-2 days and is recognised by a change in consciousness either hyper or hypoalert and inattention.
what causes delirium?
caused by either an underlying medical problem, substance intoxication, substance withdrawal or a combination of those.
very common in older persons admitted to hospital and more common in patients who are frailer, have sensory impairment, cognitive impairment. Those having surgery or that have hip fractures in addition to those with severe infections are at risk.
what causes of delirium are important to exclude?
Delirium can be caused by almost anything. Important things to exclude are: Infection, electrolyte imbalance, hypoxia, drugs including opiates, urinary retention, constipation and uncontrolled pain.
how long does delirium take to resolve?
Delirium can take time to resolve and can take anywhere up to 3 months to get back to previous levels of functioning. Some people never get back to their baseline.
what is delirium associated with?
increased mortality, prolonged hospital admission, higher complication rates, institutionalisation and increased risk of developing dementia
how is delirium treated?
Delirium is on the whole managed with supportive care by treating the underlying cause and orientating them to time and place. Remember that most behaviour in someone who is confused can be explained.
Pharmacological treatment should be reserved for extreme cases where the patient is at significant risk to themselves or to others.
how can delirium be defined?
Delirium can be defined as hyperactive (agitated and confused), hypoactive (withdrawn and drowsy) or mixed.
NB: A collateral history is key to distinguishing between a delirium and a dementia.
what is dementia?
Dementia is a progressive decline in cognitive functioning usually occurring over several months.
It affects many different areas of function including: Retention of new information, managing complex tasks, language and word finding difficulty, behaviour, orientation, recognition, ability to self care, and reasoning.
what is Alzheimers dementia?
most common.
Insidious onset with slow progression. Behavioural problems are common.
Diagnosed on clinical history but brain imaging may show disproportionate hippocampal atrophy.
what is vascular dementia?
Second most common. Suggested by vascular risk factors. Imaging is suggestive of vascular disease. Often has a step wise progression.
what is dementia with Lewy body?
Gradually progressive. Prominent auditory or visual hallucinations. Delusions are well formed and persistent. Parkinsonism commonly present but not severe.
what is Parkinson’s disease with dementia?
Typical features of parkinson’s disease are present and precede confusion by over a year
what is frontotemporal dementia?
Onset often early and have complex behavioural problems, language dysfunction may occur.
what is mixed dementia?
Alzheimers and Vascular type.
how are Alzheimers and vascular dementia treated respectively?
Cholinesterase inhibitors are available for the treatment of Alzheimer’s to slow its progression, for vascular dementia there is only the ability to modify risk factors.
