Dementia & Delirium Flashcards
Frontotemporal dementia is associated with what other condition?
Motor neurone disease.
Developing a sweet tooth is associated with which type of dementia?
Frontotemporal.
What is the general cut off for the Addenbrooke’s cognitive examination?
<83
Andrew is 59 years old. He presents with gradual change in personality over the last 6 months, becoming more irritable and aggressive. He is over familiar and disinhibited towards unknown female teenagers in the local park, approaching them and putting his hand on their bare arms. He has been sacked from his job as manager at a local store after complaints from customers that he was using offensive and sexualised language to them. His mood is very up and down, he is often crying for no reason. His speech has become less fluent and he often gets stuck on words when speaking (being unable to find the right word). His family report that his diet has become poor and he will only eat puddings and unhealthy food. His memory is reported as being good. He can relay current affairs accurately. He scores 84/100 on the Addenbrooke’s cognitive examination.
Frontotemporal dementia.
Brenda is 78 years old. She is a retired nurse. Her daughter has raised concerns that Brenda’s memory is not as good as it used to be. She has become forgetful over the last 2 years and it is now to a level where she drove to the shops and then walked home. On her return she phoned her daughter because she thought her car had been stolen. Her daughter has been throwing out food from the fridge because it is out of date. She has also found unpaid bills, which is very out of character for her. Brenda’s mother had dementia and her daughter is concerned that Brenda may be suffering from Alzheimer’s. She reports that Brenda’s memory problems started after a TIA and have recently suddenly got worse. Brenda’s past medical history includes hypertension, TIAs and type 2 diabetes. She is on aspirin, simvastatin, atenolol and co-codamol.
Vascular dementia.
Mixed vascular and Alzheimer’s.
Colin is an 81 year old retired engineer. He has been referred by his GP with a 5 month history of confusion and memory problems which varies day to day. He sometimes falls and his wife reports she has noticed he doesn’t always lift his feet when walking. He reports a tremor in his hands, worse on his right side and worse when he is upset. His wife reports he has seen things she cannot see. This includes seeing people stood outside his front room, in the garden and sometimes a cat in his living room. He has no PMHx and is on no medication. He scores 78/100 on the Addenbrooke’s cognitive examination.
Dementia with Lewy bodies.
Parkinson’s disease dementia.
Space occupying lesion (e.g. subdural haemorrhage, normal pressure hydrocephalus).
Vascular dementia.
Dorothy is a 69 year old retired dinner lady. She is referred by her GP after her son noticed she was becoming more forgetful. He believes this has been happening for 3 years, although he can’t remember exactly when it started and feels it has got worse gradually. She has started to get distracted when cooking and has left food on the hob, which has burnt. She doesn’t appear to be looking after herself the same, looking a bit dishevelled and her food shopping has be come very rigid, buying lots of the same things, with excessive amounts of food in the cupboards. Her father had Alzheimer’s disease and her son is worried she may also have Alzheimer’s as he has heard it can run in the family. Dorothy is not worried about her memory at all; she thinks there is nothing wrong and her son is ‘being over the top, as usual’. She has arthritis and recurrent UTIs. She takes OTC pain relief only. She refuses to do a memory test but in general conversation you note that she is confused and when talking about the upcoming election she talks about wanting to get Tony Blair out of power. She also struggles to name her children and grandchildren in the assessment.
Alzheimer’s disease.
Delirium (recurrent UTIs).
What does the frontal assessment battery test screen for?
Frontotemporal dementia.
How does dementia differ from normal ageing?
Forgetfulness is a normal part of ageing, but the symptoms must significantly affect an individuals daily life for a diagnosis of dementia.
Is a mild cognitive impairment classified as dementia?
No
What is a mild cognitive impairment?
Memory impairment that is not severe enough to impair ADLs. Intermediate stage between normal ageing and dementia.
What is the age cut off for young onset dementia?
<65
What is the biggest risk factor for developing dementia?
Increasing age.
What factors would suggest a diagnosis of depression over dementia?
Short Hx/rapid onset.
PMHx of depression.
Biological symptoms e.g. weight loss, sleep disturbance.
Patient worried about poor memory.
Worse in morning.
Reluctant to take tests, disappointed with results.
Variable mini-mental test score.
Global memory loss (dementia characteristically causes recent memory loss).
What are the differential diagnoses of dementia?
Ageing, mild cognitive impairment, delirium, depression, amnesia, space occupying lesions, alcohol abuse, medication effects, thyroid problems, normal pressure hydrocephalus, vitamin deficiencies, prion protein diseases, HIV.
What factors would suggest a diagnosis of delirium over dementia?
Rapid onset/short Hx.
Fluctuating course of cognitive impairment and level of consciousness.
More prominent and complex, fleeting psychotic symptoms e.g. visual hallucinations.
Abnormal motor activity.
Emotional changes more prominent and variable.
Define dementia
Syndrome due to disease or the brain, usually of a chronic/progressive nature, where there’s disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, learning, language and judgment. Consciousness isn’t clouded. Impairments of cognitive function are commonly accompanied by deterioration in emotional control, social behaviour or motivation.
What are the general symptoms of dementia?
Memory problems, impairment of cognition, impairment in communication, change in personality and behaviour.
