Dementia/delirium Flashcards
What is cognitive impairment?
Disturbance of higher cortical functions,
including memory, thinking, judgement, language, perception and awareness
Cognitive impairments may be single or multiple and may be static or progressive
It is not a specific illness but description of someones condition
What is dementia?
Cognitive impairement with decline in both memory and thinking which is sufficient enough to impair personal activities of daily living
Problems with the processing of incoming information (problems with maintaining and directing information)
CLEAR CONSCIOUSNESS
Above syndrome will be present for more than or equal to 6 months
What is delirium?
Impairement of cognition- disturbances of attention and conscious level; abnormal psychomotornbehaviour and affect, disturbed sleep- wake cycle
Onset is usually acute (hours/days)
All symptoms fluctuate during the daytime and are typically worse at night
2 SUBTYPES- hyperactive and hypoactive (easily overlooked 😟)
Hypoactive is the most common type
What does the inverse care law mean?
In someone with dementia, the more their disease progresses they become more dependent and vulnerable but also become less aware of their disabilities
What causes dementia?
Dementia is a syndrome, a range of diseases may cause it…
- alzheimers disease
- vascular dementia
- alcoholic
- dementia with lewy bodies
- frontotemporal dementia
- huntingtons disease
What are the early stage features of dementia?
Forgetfulness and other memory symptoms (most prominent cognitive abnormality, especially in Alzheimers disease)
There may be subtle changes in mood and behaviour- loss of motivation and interest
There may be minimal intrusion into day to day functions at the start ie: financial
What are the mid stage features of dementia?
Memory problems become more prominent and other cognitive difficulties may start to emerge
Behaviour becomes more marked
Disability becomes more obvious and they will need frequent support but not continous support and assistance
Often their awareness of disability starts to diverge from reality
What features are in the late stage of dementia?
Severe and pervasive memory problems accompany other major cognitive disabilities- severe disorientation, failure to recognise familiar people
Marked (+ve and -ve) changes in behaviour- agitation, restlessness, irritability, disinhibition, severe apathy
Disability is severe and even basic aspects of personal functioning snd failing, people require more or less continous supervision
What are the differentials for dementia?
hypothyroidism, Addison's B12/folate/thiamine deficiency syphilis brain tumour normal pressure hydrocephalus subdural haematoma depression chronic drug use e.g. Alcohol, barbiturates
What is vascular dementia?
Vascular dementia (VD) is the second most common form of dementia after Alzheimer disease. It is not a single disease but a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease. Vascular dementia has been increasingly recognised as the most severe form of the spectrum of deficits encompassed by the term vascular cognitive impairment (VCI). Early detection and an accurate diagnosis are important in the prevention of vascular dementia.
What are the risk factors of vascular dementia?
History of stroke or transient ischaemic attack (TIA) Atrial fibrillation Hypertension Diabetes mellitus Hyperlipidaemia Smoking Obesity Coronary heart disease A family history of stroke or cardiovascular
What do patients with vascular dementia present with?
Several months or several years of a history of a sudden or stepwise deterioration of cognitive function
Symptoms and speed of progression vary, but may include..
- focal neurological abnormalities (visual disturbance, sensory or motor symptoms)
- difficulty with attention and concentration
- seizures
- memory disturbance
- gait disturbance
- speech disturbance
- emotional disturbance
What may you see on an MRI of someone with vascular dementia?
May show infarcts and extensive white matter changes
What are the features of lewy body dementia?
In contrast to Alzheimers, early impairements in attention and executive function rather than just memory loss
Cognition may be fluctuating, in contrast to other forms of dementia
Usually develops before parkinsonism
Parkinsonism
Visual hallucinations (delusions and non visual hallucinations may also be seen)
How do you assess a patient with suspected dementia, in terms of history and examination…
Diagnostic assesment is a 2 stage process…
Firstly you diagnose the syndrome and then you diagnose the disease
History…
What is the course of the symptoms over time?
This is the most important bit of diagnostic information and the patient probably won’t be able to tell you
Is there any evidence of disability or impact on the day to day life?
Why have they come now? Has anything happened recently?
Any changes in the general health?
Examination
Cognitive screening assessment- GPCOG, AMT, 6-CIT, MMSE, MOCA etc….
Check for new physical findings if prompted by hx
(Neurological or cardiovascular)
What investigation do you do for suspected dementia?
‘Dementia screen’ bloods (these are not actually screening for dementia but screening for other things that may be contributing to the dementia)
FBC, LFTS
Structural brain imaging- CT/ MRI
Functional brain imaging- perfusion, glucose metabolism, dopamine transporter turnover (not routinely done)
Specialised tests for special situations with unusual disease like prion disease (EEG, lumbar puncture)
