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Clinical Neuroscience > Dementia and Delirium > Flashcards

Dementia and Delirium Flashcards

1
Q

Dementia is a chronic, progressive syndrome of insidious onset.

List 4 cognitive symptoms and the associated brain lobe

A
  • Impaired memory, Temporal
  • Impaired orientation, Temporal
  • Impaired learning capacity, Temporal
  • Impaired judgment, Frontal
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2
Q

List 4 types of non-cognitive symptoms of Dementia

A
  • Behavioural (Agitation, Aggression, Wandering, Sexual disinhibition)
  • Depression + Anxiety
  • Psychotic features (V+A Hallucinations, Delusions)
  • Sleep symptoms (Insomnia, daytime drowsiness)
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3
Q

Describe the diagnosis of Dementia by exclusion

What features do you look for?

A
  • Exclude delirium
  • Exclude organic causes of cognitive decline
  • Progressive cognitive decline
  • Impairment of activities of daily living
  • Normal consciousness level
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4
Q

List 4 organic causes of cognitive decline

A
  • Hypothyroidism
  • Hypercalcaemia
  • B12 deficiency
  • Normal pressure hydrocephalus (Abnormal gait, Incontinence, Confusion)
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5
Q

List 5 types of Dementia

A
  • Alzheimer’s (50-70%)
  • Vascular dementia (25%)
  • Dementia with Lewy bodies (15%)
  • Frontotemporal dementia
  • AIDS dementia complex
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6
Q

List the Macroscopic pathological features of Alzheimer’s

A
  • Global cortical atrophy
  • Widening of Sulci
  • Enlarged ventricles (mainly Lateral and 3rd)
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7
Q

List the Microscopic pathological features of Alzheimer’s

A
  • Amyloid beta plaques
  • Neurofibrillary Tangles (Intracellular hyperphosphorylated tau filaments)

These 2 features kill neurones, mainly;

  • Cholinergic
  • Noradrenergic
  • Serotonergic
  • Those expressing Somatostatin
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8
Q

Is Alzheimer’s more common in Women or Men?

A

Women

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9
Q

Describe the pharmacological management of Alzheimer’s

A
  • Cholinesterase inhibitors (slow it down)
  • Antidepressants
  • Antipsychotics (controversial)

(Non-pharmacological: Occupational Therapy, Community services, ID bracelets)

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10
Q

In vascular dementia, cognitive impairment is caused by CVD (many small strokes)

List some risk factors (same as for Alzheimer’s and any vascular disease)

A
  • Smoking
  • Diabetes
  • Hypertension
  • Hypercholesterolaemia
  • Previous stroke/ MI
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11
Q

Describe the management of Vascular dementia

A

To reduce risk of further sclerotic/ embolitic effects

  • Antiplatelets/ anticoagulants
  • Lifestyle changes
  • Statins
  • BP control
  • Glycaemic control
  • Carotid endarterectomy if carotid stenosis> 70%
  • Cholinesterase inhibitors if Alzheimer’s also present
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12
Q

Describe the link between Dementia with Lewy Bodies and Parkinson’s

A
  • Essentially same disease
  • Parkinson’s: Movement disorder BEFORE dementia
  • DwLB: Dementia BEFORE movement disorder
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13
Q

Describe the pathology of Dementia with Lewy Bodies

Common to have co-existing Alzheimer’s

A
  • Accumulation of Lewy bodies (which are aggregates of the protein Alpha Synuclein)

Main deposits found in;

  • Substantia Nigra
  • Cingulate gyrus
  • Temporal lobe
  • Frontal lobe
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14
Q

The greatest risk factor for Dementia with Lewy Bodies is old age

How does it present?

A
  • Fluctuating cognition and alertness
  • Vivid visual hallucinations
  • Parkinsonian features (falls, motor symptoms)
  • Loss of Atonia during REM seep
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15
Q

Describe the management of Dementia with Lewy Bodies

A
  • Carbidopa + Levidopa if motor symptoms present and severe

Similar to Alzheimer’s;

  • Cholinesterase inhibitors
  • Antidepressants
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16
Q

Why can’t you give Antipsychotics to patients with Dementia with Lewy Bodies?

A

Antipsychotics are Dopamine Antagonists, can cause Neuroleptic Malignant Syndrome (a psychiatric emergency)

17
Q

How does Neuroleptic Malignant Syndrome present?

A
  • Fever
  • Encephalopathy (confusion)
  • Instable vital signs (Raised RR, HR, fluctuating BP)
  • Elevated CPK
  • Rigidity (due to dopamine antagonism)
18
Q

Frontotemporal dementia is the 2nd most common cause of early onset dementia.

Describe the pathology

A

Atrophy of Frontal and Temporal lobes

Cellular inclusions: FTD-Tau and FTD-U
(Possible element of family history)

19
Q

How does Frontotemporal dementia present?

A

Most symptoms related to Frontal lobe

  • Behavioural disinhibition
  • Inappropriate social behaviour
  • Loss of motivation without depression
  • Repetitive behaviours
  • Expressive dysphasia
20
Q

What are the 3 behavioural presentations of Frontotemporal dementia

A
  • Apathetic
  • Disinhibited
  • Stereotyping

(Can overlap)

21
Q

How is Frontotemporal dementia managed?

A
  • SSRIs (to treat compulsive behaviours e.g gambling)
  • Home assistance
  • Anxiolytics (e.g Benzodiazepines)
22
Q

As patients with HIV live longer, their chance of developing AIDS associated Dementia increases.

Describe the pathology

A
  • HIV-infected macrophages enter the brain and directly damage neurones
  • Insidious onset, but rapid progression
23
Q

Describe the clinical features of AIDS-Dementia Complex

Related to global damage, but also some Cerebellar involvement

A
  • Cognitive impairment
  • Psychomotor retardation (slow thoughts and movements)
  • Tremor
  • Ataxia
  • Dysarthria
  • Incontinence
24
Q

Describe the investigations for Dementia

Investigations to rule out other possible causes

A
  • Mini Mental State Exam
  • Dementia screen (FBC for Anaemia, TSH, B12, U&E for Na, Ca, Glucose)
  • Urine drug screen
  • CT head
  • MRI brain
  • ECG in Vascular Dementia
  • Syphilis testing if history is suggestive
25
Q

Generally, Dementia is managed pharmacologically using Cholinesterase inhibitors and NMDA Antagonists

List 3 Cholinesterase inhibitors

List 1 NMDA Antagonist

A
  • Donepezil
  • Rivastigmine
  • Galantamine
  • Memantine (Useful for treating agitation)
26
Q

Delirium is sometimes called ‘Acute Confusional State’ and is often Reversible.

Dementia can predispose to episodes of Delirum.

List some features of Delirium

A
  • Fluctuating
  • Hallucinations/ Delusions
  • Exaggerated emotional responses (etc aggression, fear, anxiety)
  • Rapid onset confusion
  • Clouded consciousness/ drowsiness
27
Q

What are the 3 types of Delirium

A
  • Hypoactive
  • Hyperactive
  • Mixed
28
Q

How may Hyperactive Delirium present?

A
  • Restless
  • Agitated
  • Aggressive
29
Q

How may Hypoactive Delirium present?

A
  • Quiet
  • Sleepy
  • Withdrawn
30
Q

The symptoms of Delirium are worse at the start and end of the day.

Why may this be?

A

Possible relation to changes in endogenous cortisol levels

31
Q

List ways Alcohol can cause Delirium

A
  • Intoxication

- Withdrawal (Delirium Tremens, caused by changes in GABA + NMDA receptors induced by long term intoxication)

32
Q

List 5 potential causes of Delirium

THINK DELIRIUM

A
  • Trauma
  • Hypoxia
  • Increasing age/ frailty
  • Neck of Femur fracture
  • smoKer or alcohol withdrawal
33
Q

List 8 potential causes of Delirium

THINK DELIRIUM

A
  • Drugs
  • Environment
  • Lack of sleep
  • Infection
  • Retention (urinary, constipation)
  • Imbalanced electrolytes
  • Uncontrolled pain
  • Medical conditions
34
Q

Describe the Prognosis of patients with Delirium

A
  • Increases risk of Dementia
  • Often have long hospital stays
  • High risk of re-admission

Clinical Neuroscience (19 decks)

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