Dementia and Delirium (Exam 2)

Question 1

Delirium

Answer 1

-Acute confusional states

-Transient disorder of cognitive function, consciousness, or perception

Question 2

Onset of Delirium

Answer 2

Can be sudden or gradual

Question 3

When can delirium be seen

Answer 3

-Other medical conditions

-Drug and Alc intox

-Hypoglycemia

-Build of metabolites

Question 4

2 main types of Delirium

Answer 4

-Hyperactive confusional state

-Hypoactive confusional state

Question 5

Hyperactive Delirium

Answer 5

-Acute disturbance in attention or awareness

-Typically develops over 2-3 days

-Autonomic NS of activated

Question 6

Where is Hyperactive delirium seen?

Answer 6

ICU, post-opp, withdrawl, and hospitalized elderly

Question 7

Hyperactive Delirium: Risk Factors

Answer 7

-Medication
-Acute infection
-Surgery
-Hypoxia
-Insomnia

Question 8

Hyperactive Delirium: Manifestations

Answer 8

-Restlessness, Irritability, difficulty concentrating, insomnia, tremulousness.

Question 9

Fully developed delirium

Answer 9

-Hallucinations, person completely inattentive, grossly-altered perception

-Patient often distressed and very confused, difficult calming down

Question 10

If hyperactive delirium is not resolved it can lead to what?

Answer 10

Excited delirium syndrome

Which can cause death

Question 11

Hyperactive Delirium: Treatment

Answer 11

-Remove risk factors

-Usually self-resolves in 2-3 days but can stay for weeks

Question 12

Hypoactive Delirium

Answer 12

-Associated with right-sided frontal basal-ganglion disruption

-More common in those with metabolic disorders (liver or kidney failure)

Question 13

What failures can lead to hypoactive delirum

Answer 13

-Kidney or Liver failure

Question 14

Hypoactive Delirium: Manifestations

Answer 14

-Decreased alertness and attention span, decreased ability to perception, and interpretation of the environment, forgetful, apathetic, slow speech, frequently falling asleep

-Everything slows down

-catatonic

Question 15

Treatment and Evaluation of Delirium

Answer 15

-Identify cause and remove causative agents, modify risk factors when possible

Question 16

Can Delirium be prevented?

Answer 16

Yes

Question 17

Who is at greater risk of delirium?

Answer 17

People who have dementia

Question 18

What medications can we use for acute delirium

Answer 18

-Anti-psychotics

-When there is a danger to the patient or the provider

-Only short term solution

Question 19

If symptoms of delirium do not resolve with time

Answer 19

The patient needs to be evaluated with other conditions. It is not longer delirium that is causing symptoms

Question 20

Dementia

Answer 20

-Acquired deterioration and progressive failure of cerebral functioning

-Impaired intellectual processes. Memory, language, judgment, decision making, orientation

Question 21

How might a person with dementia present?

Answer 21

-As being agitated, wandering, and aggression

-Not remembering or doing things like they use to

-You see this with people who observe the patient. Not the patient because they do not know what is happening

Question 22

Dementia: Pathophysiology

Answer 22

Neuron degeneration, compression of brain, atherosclerosis of vessels, brain trauma, infection, and inflammation

Question 23

What predisposition is associated with many dementia-related disorders?

Answer 23

Genetic-predispostion

Question 24

Dementia: Onsent

Answer 24

-Generally slow, and symptoms are IRREVERSIBLE

Question 25

Dementia: Manifestations

Answer 25

-Depend on the cause -Memory loss, decreased concentation and memory, overall cognitive slowing

Question 26

Dementia: Causes

Answer 26

Complicated process, not completely understood

Question 27

Cure for dementia

Answer 27

-NO CURE -Treatment directed at restoring and optimizing functional capacity and accommodating with lost abilities

Question 28

Types of Dementia

Answer 28

-Alzheimer's (50-75%) -Vascular (20-30%) -Lewy Body (10-25%) -Frontotemperal (10-15%)

Question 29

Types of Dementia con

Answer 29

-Usually multiple types combined

Question 30

Alzheminier's Disease

Answer 30

-Leading cause of severe cognitive dysfuntion in the elderly -Almost 6 million americans have the disease -2/3 females

Question 31

Alzheimers Disease: Cause

Answer 31

-Exact cause unknown -Genetic associations--More common in early onset AD -Sporadic late-onset AD is most common and does not have a specific genetic association

Question 32

AD: Diagnosis

Answer 32

-Made by ruling out other conditions -Is not one test or scan

Question 33

AD: Risk Factors

Answer 33

-Older 65 -Family History -Existing cognitive impairment -Head trauma -Social Isolation

Question 34

Pathophysiology of AD

Answer 34

-Accumulation of neuritic plaques and intraneronal neurofibrillary tangles of tau protein -Plaques dirupt nerve impulse transmission and kill neurons -More centralized in cerebral cortx and hippocampus -Loss of synapses, acetylcholine, and other neurotransmitters contributes to memory and cognitive decline -Loss of neurons lead to brain atrophy -Decreases levels of acetylcholine

Question 35

Key factor in nerve cell degenration

Answer 35

Tau Protein (Neurofibrillary tangles) -Accelerated nerve cell degeneration

Question 36

When do changes occur in AD disease

Answer 36

-Changes occur DECADES prior to symptoms occurring -Starts as short term little lapses in memory. Leads to total loss of cognitive function

Question 37

Vascular Dementia

Answer 37

-2nd most common -Related to cerebrovascular disease -Large artery disease, cardioembolsim, small vessel disease, and stroke. (HYPOERFUSION to the brain)

Question 38

Vascular Dementia: Risk factors

Answer 38

-Things that hypofuse the brain -DM, HLD, HTN, and smoking

Question 39

Vascular Dementia: Treatment

Answer 39

-Prevent risk factors -DM, HLD, HTN, smoking

Question 40

Frontotemporal Dementia

Answer 40

-Pick disease (RARE) -Familial association with age of onset less than 60

Question 41

How does frontotemporal dementia occur?

Answer 41

-Occurs as result of mutations in genes that encode for the tau protein

Question 42

FTD: 3 distinct syndromes

Answer 42

1. Behavioral variant 2. Progressive non-fluent behavior (Langauge Writting) 3. Semantic dementia (Speech)

Question 43

Delirium vs Dementia

Answer 43

Talk through the comparison screen shot