Dementia and Delirium symposium Flashcards
What investigations would you ask for?
urine dipstick, fbc, u/e, LFT, thiamine, folate, thyroid, blood glucose, ecg (arrhythmia/ ischaemia), calcium, vit d, cultures.
imaging CXR,CT head
collateral history question?
memory, personality change, attention, language (repeats questions), executive function driving/dressing, visuospatial perception (recognising objects)
MAPLEV
what is delirium?
confusion/change in behaviour with acute onset and fluctuating course
altered cognition, decreased concentration
altered physical function, less mobility, restless
types of delirium?
hyper- heightened arousal, restless distressed
hypo- sleepy withdrawn quiet
or mixed
confusion assessment method
acute onset and fluctuating course, inattention and distractibility plus 3 or 4
sqid?
are they more confused than normal
delirium causes?
drugs withdrawal, toxicity/ dehydration
environment/ energy
level of pain
infection/inflammation
respiratory failure (hypoxia, hypercapnia)
impaction of faeces
urinary retention
metabolic disorders: thyroid hypoglycaemia
pharmacological treatment with delirium?
1st line- lorazepam
2nd- haloperidol
avoid haloperidol in?
LBD, parkinsons
why dont you give lorazepam iv?
makes available much quicker, can cause death
how do you find out someone is in urinary retention?
palpation, or bladder scan
how long does it take for delirium resolve?
can take up to months
what is dementia?
syndrome due to disease of the brain, chronic or progressive nature in which there is impairment in more than one cognitive domain accompanied by IMPAIRMENT OF FUNCTION
most common type of dementia?
alzheimers then vascular
alzheimers macroscopic?
cortical atrophy, neurofibrillary tangles and amyloid plaques and reduction in acetylcholine
vascular dementia details?
1 large stroke or small tia
step wise
FTLD features?
personality changes difficulties in language and behaviours, usually 60s
LBD triad?
visual hallucination
cognitive fluctuations,
parkinsonism
other cause of dementia
korsakoffs, thamine
cjd prion
huntingtons
hypothyroidism
folate
VANISHED?
V: vascular, vitamin deficiency: B1, B6, B12, folate
A: Alzheimer disease, autoimmune: cerebral vasculitis, systemic lupus erythematosus
N: normal pressure hydrocephalus, neoplasia
I: infection, e.g. Creutzfeldt-Jakob disease, herpes simplex encephalitis, prion diseases, tertiary syphilis, HIV/AIDS, PML
S: substance abuse, serum abnormalities e.g. hyperammonaemia, uraemia, Wilson disease
H: hormones: hypothyroidism, hyperparathyroidism
E: electrolyte disturbances: e.g. hyponatraemia, hypokalaemia, hypocalcaemia, hypercalcaemia etc.
D: depression (pseudodementia)
pseudodementia?
people with depression seem to have dementia but dont
which medication can cause decrease in acetylcholine?
bladder, psychiatry
what percent of risk factors of dementia are modifiable?
35
what is cognition?
correctly interpret input from sensory organs, make an appropriate judgement, initiate a verbal or motor response, keep a record of above
