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Dementia & delirium Flashcards

1
Q

Definition of dementia

A

An acquired and irreversible CNS neurodegenerative process that affects Cognition:
memory, apraxia, agnosia, visual-spatial, aphasia, executive function

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2
Q

what can dementia cause?

A

Neuropsychiatric symptoms: depression, psychosis, wandering, physically assaultive, sleep disturbances

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3
Q

Epidemiology of dementia

A

5.4 million Americans with Dementia
13% >60 years of age
50% >85 years of age
every 68 seconds someone is diagnosed with dementia

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4
Q

What is the most common subtype of dementia?

A

Alzheimers
>50%prevalence among pts w/ dementia
Most common type of dementia

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5
Q

What are two other subtypes of dementia besides alzheimers?

A

Vascular: 10-20%
Multi-infarct
Lacunar infarct
Mixed Dementia

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6
Q

Lewy Body dementia is what percentage of dementia cases?

A

10-20% of dementia cases

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7
Q

Parkinson’s Dz has what percentage of dementia?

A

41% dementia prevalence

Needs to be distinguished from LBD but its very difficult

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8
Q

Frontal temporal dementia

A

May account for 25% of presenile dementia (<65 yo)
Range of onset 20-80 year old, average 58
Progresses more rapidly than AD
Loss of social boundaries/awareness

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9
Q

What is the hallmark of alzheimers?

A

Neurofibrillary tangles

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10
Q

3 neurotransmitter deficit found with alzheimers

A

Acetylcholine
Norepinephrine
Serotonin

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11
Q

Epidemiology of alzheimers

A

as early as in 4th decade
10% of 70 y/o have AD dementia
>50% of 80 y/o have AD dementia

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12
Q

Risk factors for alzheimers

A 
genetics
Age
Sex  
Prior head trauma 
Education
Vascular disease
DM
HTN
Down Syndrome
Smoking
Sedentary life style
Obesity
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13
Q

what are the 3 realm of symptoms associated with alzheimers

A

emotional
behavioral
perceptual

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14
Q

3 emotional symptoms of alzheimers

A

Depression
Apathy
Anger

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15
Q

2 perceptual symptoms of alzheimers

A

Delusions
Hallucinations
Sensory

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16
Q

5 behavioral symptoms of alzheimers

A 
Problems at work*
Irritability
Lack of sleep
Eating disruption
Euphoria
17
Q

Deceased function in memory, language, learning and ADLs, iADLS is considered what?

A

advanced neurocognitive disorder

18
Q

Vascular dementia risk factors

A

Hypertension
T2 DM
Presents with cognitive deficits (infarts= globally)

19
Q

Huntington’s disease

A

CHOREIFORM MOVEMENTS it’s dementia does not feature Agnosia, aphasia or apraxia
PD and Huntington’s are subcortical dementia: decreased Executive function, memory retrieval, visual-spatial, movement

20
Q

symptoms of frontal temporal dementia

A 
Sociopathic tendencies, Pt has little insight
Obsessions
Psychosis
Motor apraxis
Progressive aphasia
21
Q

Must Rule out Reversible Dementias like what?

A 
Normal Pressure Hydrocephalus (NPH)
Depression (pseudodementia)
Medication induced 
CNS neoplasm
Chronic Subdural hematomas
22
Q

symptoms of sundowning syndrome

A

Confusion, drowsiness, ataxia, accidental falls, agitation, restlessness

23
Q

etiology of sundowning syndrome

A

Dementia symptoms are exacerbated:
external stimuli, such as light and personal orienting are diminished
Other risk factors: VasDementia, Lewy Body Dementia
Overly sedated elderly (paradoxical effect of BZD
Dementia w/ delirium

24
Q

How do you prevent complications of dementia

A 
Exercise!!!!
Meditation/stress reduction
Improved cardiovascular health improves cognition
Nutrition—Mediterranean Diet
Low level wine consumption
New learning!
HTN/DM and lipid control
Smoking cessation
25
Q

Non-cognitive Behavioral Symptoms and reason for most psych consultations

A 
depression**
Apathy
Mood changes
Inappropriate sexual behaviors
Sleep disorders
Psychosis (delusions, hallucinations, paranoia)
Agitation
Aggression
Suicidal ideation
Homocidal ideation
Disruptive vocalization
 weight loss
Decision incapability
26
Q

anticholinesterase inhibitor treatment for dementia

A

Aricept
Good for mild to severe AD
Razadyne
Exelon

27
Q

Namenda treatment for dementia

A

moderate to severe AD

side effects: Headaches, Constipation, Confusion

28
Q

complications of dementia

A 
Urosepsis
Aspiration pneumonia
Decubitus Ulcers w/bacteria
Bacteremia
Sepsis
Osteomyelitis
29
Q

Prognosis for AD

A

~ 10 yrs after dx is made

Symptoms appear yrs before

30
Q

What is delirium

A

An acute change in consciousness, fluctuating between lucidity, confusion and mental obtundation, hallucinations

31
Q

Who is most often seen with delirium

A

high morbidity/mortality

Occurs in the older population most often

32
Q

risk factors for delirium

A 
CVA, Dementia, TBI, Neoplasm
Elderly
Polypharmacy
Withdrawing from addictive Rxs
Alcohol misuse
Medically compromised
33
Q

treatment of delirium

A

treat the cause

Geriatrics (7 decks)

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