Dementia, Delerium, Depression

Question 1

4 major causes of delirium:

Answer 1

Underlying medical condition
Substance intoxication
Substance withdrawal
Combination of any of these

Question 2

Causes of delirium: “I WATCH DEATH”

Answer 2

Infections
Withdrawal
Acute metabolic
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrinopathies
Acute vascular
Toxins or drugs
Heavy metals

Question 3

Patients with dementia may have difficulty with one or more of the following:

Answer 3

Retaining new information (trouble remembering events)
Handling complex tasks (balancing a checkbook)
Reasoning (unable to cope with unexpected events)
Spatial ability and orientation (getting lost in familiar places)
Language (word finding)
Behavior

Question 4

Delirium

Answer 4

Abrupt, precise onset
Acute illness, days-weeks
Usually reversible
Disorientation early
Variability, fluctuates
Prominent physiologic changes
Clouded, altered and changing consciousness
Hallucinations early

Question 5

Dementia

Answer 5

Gradual Onset
Chronic illness, years
Irreversible, progressive
Disorientation later
Stable
Less prominent physiologic change
Consciousness not clouded until terminal
Hallucinations late (end stages)

Question 6

Laboratory Testing for dementia patients

Answer 6

CBC, TSH, B12, Comprehensive Metabolic Panel (CMP)
Urinalysis and culture
Serologic tests for syphilis if high index of suspicion

If ETOH – check folate
If multiple myeloma, prostate ca or breast ca – check an ionized calcium level

Question 7

Dementia Pharm

Answer 7

Cholinesterase inhibitors:
Donepezil (Aricept)- GI SE
Rivastigme (Excelon)
Galantamine (Razadyne)

Memantine (Namenda)- dizziness

Question 8

Dementia Pharm Specific symptom

Answer 8

Depression:
Citalopram (Celexa) or Sertraline (Zoloft)
Agitation, aggression:
Citalopram (Celexa) or an antipsychotic as listed below
Psychosis with agitation:
Olanzipine (Zyprexa) or Risperdon (Risperdal)

Question 9

Depression- Treatment Meds

Answer 9

SSRI’s: Citalopram (Celexa) and Sertraline (Zoloft) first line in elderly
Venlafaxine (Effexor) or duloxetine (Cymbalta) for depression + neuropathic pain
Mirtazepine (Remeron): good for treatment of symptoms of agitation, insomnia, restlessness, anorexia, wt loss