Dementia/ Delerium Flashcards
S&S of an acute confusional state
Rapid change in mental state Looking/acting confused Altered/fluctuating consciousness Inattentiveness Agitation/lethargy Hallucinations (visual or tactile) Emotional changes (irritable, violent, euphoric, suspicious) Autonomic changes (dilated pupils sweating, tachycardia)
3 Causes of acute confusional state/delirium
Underlying medical conditions
- Medication
- Drug withdrawal
Population MC affected by delirium
White, female, young OR >60yo
______% of hospitalized patients experience delirium while ___% of post-hip fracture patients experience delirium
10-30%; 50%
Name 7 patient characteristics which increase risk of delirium
Hospitalization (esp in elderly) Multiple medical conditions Taking multiple medications Terminally ill Children Sensory deprivation (hearing/visual) Sleep deprivation
What medication conditions increase risk of delirium?
Dementia Post-surgical status Transplant Burn patient Trauma patient Drug/alcohol withdrawal Malnourishment Chronic hepatic disease Dialysis Parkinson's HIV Post-stroke
Which of the following variations of delirium is least common?
A) Hyperactive (i.e. aggressive behaviours)
B) Hypoactive (i.e. deer in headlights)
C) Mixed (i.e. quick to be hyperactive when overstimulated but sedate/reclused when not overstimulated)
A (only 20% of cases)
What are the 3 most sensitive tests for delirium?
. Orientation (time, date, place)
- Recall memory (ID 3 objects)
- Serial 7’s (count backwards from 100 by increments of 7)
What are 4 key differences between dementia and delirium?
- Timeline: dementia is chronic, delirium is acute cognitive changes
- Fluctuation: dementia does not fluctuate, delirium does
- Alterness/attention: intact with dementia, waxes/wanes in delirium
- Speech/thinking: improverished in dementia, confused/disorganized in delirium
True or false: normal nervous system aging involves small, sluggish pupils, impaired upward gaze, and impaired convergence
True! Important to keep in mind when conducting CN exam on elderly individuals
Which reflex usually diminishes first in elderly individuals:
A) L4
B) L5
C) S1
S1
There is usually (increased/decreased) muscle tone in normal nervous system aging, as well as a return of ____________ reflexes
Increased; primitive (eg. sucking, glabellar, grasp)
What is aphasia?
Loss of power of expression
What is agnosia?
loss of ability to recognize objects, people, or sounds
What is apraxia?
Loss of ability to carry out purposeful motions
What is abulia?
Loss or impairment of the ability to make decisions or act independently.
How does gait normally change in indivuals with dementia?
Reduced stride length and step gait
Slower pace, more cautious
(like the texting gait)
What would you expect to find with a neuro exam in an individual with dementia?
Normal (might have increased motor tone)
A focal lesion in which lobe of the brain is associated with incontinence?
Frontal
A focal lesion in which lobe of the brain is associated with agnosia?
Parietal
Impaired language is associated with which lobe of the brain?
Left temporal-frontal
What are the 3 MC types of dementia?
- Alzheimers (60%)
- Vascular (15-20%)
- Lewy-Body (10%)
It is expected that __________ dementia will be come the most common form of dementia throughout the world
Vascular
Why are hemorrhagic strokes more common after falls in individuals with Alzheimers?
Predisposed to having small ruptures in diploic arteries (the arteries that go from the brain to the skull)
What are 4 common features evidence on advanced imaging of an individual with Alzheimer’s?
- Brain atrophy
- Loss of function (hypoperfusion)
- Prominent sulci (i.e. central sulcus)
- Increased ventricular space
What are some key clinical characteristics of vascular dementia?
Focal cognitive deficits
Stepwise progression with prolonged plateaus
Impaired exercutive function
Memory loss often not the first symptom
What is another name for small-vessel vascular dementia?
Lacunar dementia
What is strategic stroke?
Type of large-vessel vascular dementia developing after occlusion of a single large sized vessel in a functionally critical area
6 Risk factors for post-stroke VD
Older age Lower education Recurrent stroke Left hemisphere stroke Trouble swallowing Gait changes/urinary incontinence Acute complciations of stroke (seizures, cardiac arrhythmias, aspiration pneumonia)
What are the 4 categories of vascular dementia?
Large vessel
Small vessel
Ischemic-hypoxic
Hemorrhagic
What strategies can be used to treat dementia?
Management of symptoms:
- diversion therapy (eg. old movies, memorabilia)
- fidget toys for restlessness
- emphasize wellness to life, exercise, scheduled ADLs
- depression treatments may be needed
What kind of music was found to be helpful in the management of dementia symptoms?
Baroque - 60bpm
Caused 40% reduction in adverse behaviour
