Dementia and delirium Flashcards
What is the definition of delirium?
Temporary disturbance in the normal functioning of the brain
What are the causes of delirium?
PINCH ME
P - pain I - infection N - nutrition C - constipation H - hydration M - medications*/metabolic disturbance E - environment
- Medications:
- TCAs
- Benzodiazepines
- Opiates
- Anticonvulsants
What are the clinical features of delirium?
Patients may present with hyperactive delirium or hypoactive delirium (or fluctuate between the two)
Hyperactive delirium:
- Agitation/aggression
- Delusions, hallucinations
Hypoactive delirium:
- Drowsiness
- Impaired consciousness
Describe the investigation of delirium
‘Confusion screen’ bloods:
- FBC
- U&E
- LFTs
- TFTs
- Coagulation
- Calcium
- B12
- Blood glucose
- Blood cultures
Medication/social history review
Also, depending on presentation…
- Urine dip and culture
- CXR
- CT head
Describe the management of delirium
- Treat underlying cause
- Sedation if required (e.g. IM lorazepam or haloperidol)
When would you avoid using haloperidol for acute psychomotor agitation in delirium?
Parkinson’s disease/parkinsonism
What is the main difference between delirium and dementia?
In delirium there can be impaired consciousness, whereas in dementia there is not
Which condition is the most common type of dementia?
Alzheimer’s disease
Describe the aetiology, pathophysiology and course of Alzheimer’s disease
- Idiopathic
- Degeneration/atrophy of the cerebral cortex, usually first affecting the hippocampus (responsible for short term memory)
- Gradual onset, steady progression
What are the clinical features of Alzheimer’s disease?
4 A’s:
- Amnesia (memory loss)
- Aphasia (inability to comprehend and/or formulate language)
- Apraxia (inability to perform skilled motor tasks, e.g. tying shoelaces, fastening buttons)
- Agnosia (inability to recognise objects, places, people, sounds etc.)
In a patient with suspected dementia, what are the differentials?
- Dementia
- Delirium
- Depression
- Normal, age-related memory problems
Describe the investigation/diagnosis of dementia
Diagnosis:
- Clinical; based on history
Investigations:
- Cognitive testing (MMSE, AMT, ACE)
- Neuroimaging
Describe the conservative and pharmacological management of Alzheimer’s disease
Conservative:
- Healthier lifestyle
- Adequate social support
Pharmacological:
- Acetylcholinesterase inhibitor, e.g. donepezil, rivastigmine
- NMDA receptor antagonist, e.g. memantine
Other than Alzheimer’s disease, what are the other types of dementia?
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
Vascular dementia presents with…
Stepwise deterioration
