Dementia and Delirium (Exam 2) Flashcards
Delirium
-Acute confusional states
-Transient disorder of cognitive function, consciousness, or perception
Onset of Delirium
Can be sudden or gradual
When can delirium be seen
-Other medical conditions
-Drug and Alc intox
-Hypoglycemia
-Build of metabolites
2 main types of Delirium
-Hyperactive confusional state
-Hypoactive confusional state
Hyperactive Delirium
-Acute disturbance in attention or awareness
-Typically develops over 2-3 days
-Autonomic NS of activated
Where is Hyperactive delirium seen?
ICU, post-opp, withdrawl, and hospitalized elderly
Hyperactive Delirium: Risk Factors
-Medication
-Acute infection
-Surgery
-Hypoxia
-Insomnia
Hyperactive Delirium: Manifestations
-Restlessness, Irritability, difficulty concentrating, insomnia, tremulousness.
Fully developed delirium
-Hallucinations, person completely inattentive, grossly-altered perception
-Patient often distressed and very confused, difficult calming down
If hyperactive delirium is not resolved it can lead to what?
Excited delirium syndrome
Which can cause death
Hyperactive Delirium: Treatment
-Remove risk factors
-Usually self-resolves in 2-3 days but can stay for weeks
Hypoactive Delirium
-Associated with right-sided frontal basal-ganglion disruption
-More common in those with metabolic disorders (liver or kidney failure)
What failures can lead to hypoactive delirum
-Kidney or Liver failure
Hypoactive Delirium: Manifestations
-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
Treatment and Evaluation of Delirium
-Identify cause and remove causative agents, modify risk factors when possible
Can Delirium be prevented?
Yes
Who is at greater risk of delirium?
People who have dementia
What medications can we use for acute delirium
-Anti-psychotics
-When there is a danger to the patient or the provider
-Only short term solution
If symptoms of delirium do not resolve with time
The patient needs to be evaluated with other conditions. It is not longer delirium that is causing symptoms
Dementia
-Acquired deterioration and progressive failure of cerebral functioning
-Impaired intellectual processes. Memory, language, judgment, decision making, orientation
How might a person with dementia present?
-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
Dementia: Pathophysiology
Neuron degeneration, compression of brain, atherosclerosis of vessels, brain trauma, infection, and inflammation
What predisposition is associated with many dementia-related disorders?
Genetic-predispostion
Dementia: Onsent
-Generally slow, and symptoms are IRREVERSIBLE
Dementia: Manifestations
-Depend on the cause
-Memory loss, decreased concentation and memory, overall cognitive slowing
Dementia: Causes
Complicated process, not completely understood
Cure for dementia
-NO CURE
-Treatment directed at restoring and optimizing functional capacity and accommodating with lost abilities
Types of Dementia
-Alzheimer’s (50-75%)
-Vascular (20-30%)
-Lewy Body (10-25%)
-Frontotemperal (10-15%)
Types of Dementia con
-Usually multiple types combined
Alzheminier’s Disease
-Leading cause of severe cognitive dysfuntion in the elderly
-Almost 6 million americans have the disease
-2/3 females
Alzheimers Disease: Cause
-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
AD: Diagnosis
-Made by ruling out other conditions
-Is not one test or scan
AD: Risk Factors
-Older 65
-Family History
-Existing cognitive impairment
-Head trauma
-Social Isolation
Pathophysiology of AD
-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
Key factor in nerve cell degenration
Tau Protein (Neurofibrillary tangles)
-Accelerated nerve cell degeneration
When do changes occur in AD disease
-Changes occur DECADES prior to symptoms occurring
-Starts as short term little lapses in memory. Leads to total loss of cognitive function
Vascular Dementia
-2nd most common
-Related to cerebrovascular disease
-Large artery disease, cardioembolsim, small vessel disease, and stroke. (HYPOERFUSION to the brain)
Vascular Dementia: Risk factors
-Things that hypofuse the brain
-DM, HLD, HTN, and smoking
Vascular Dementia: Treatment
-Prevent risk factors
-DM, HLD, HTN, smoking
Frontotemporal Dementia
-Pick disease (RARE)
-Familial association with age of onset less than 60
How does frontotemporal dementia occur?
-Occurs as result of mutations in genes that encode for the tau protein
FTD: 3 distinct syndromes
- Behavioral variant
- Progressive non-fluent behavior (Langauge Writting)
- Semantic dementia (Speech)
Delirium vs Dementia
Talk through the comparison screen shot
