Dementia & Delirium (4-16-14) Flashcards
Second MC cause of dementia after 65yo?
dementia w/ lewy bodies (DLB) = 15-20%
MC cause dementia before 65?
frontotemporal dementia (FTD) = 5-9% pick's disease is a type of FTD (behavioral subtype)
MC cause of dementia after 65?
AD
AD starts in the…
entorhinal cortex (medial temporal lobe) then proceeds to the hippocampus
first sign of AD
memory loss
abnormal aggregation of the presynaptic protein alpha-synuclein
dementia w/ lewy bodies (DLB)
how do you distinguish between patient w/ DLB (dementia w/ lewy bodies) or PD (Parkinson’s disease)?
DLB = dementia w/i 1 yr of parkinsonium PD = no dementia in 1st year of parkinsonium
Parkinson’s presents w/
movement disorders
what presents w/ visual hallucinations?
DLB
fluctuating cognition = lucid for period of time then go back to being demented
DLB
DLB symptoms
sleep problems = act out dreams visual hallucinations (affects posterior brain) delusions fluctuating cognition = switch btwb dementia and lucid autonomic failure = syncope orthostatic hypotension
frontotemporal dementia onset
happens at an early age
temporal poles used for
naming things
semantic memory
subcortical scans are useful for
PD, DLB
low DA binding in striatum
Huntington’s age onset? dementia?
40s
dementia
what is delirium
confusional state
state of consciousness between normal alertness and coma
how many cases of delirium are misdiagnosed? what is is misdiagnosed as?
1/3 to 2/3 cases
misdiagnosed as depression
failure to recognize symptoms of delirium results in:
poorer outcomes including increased mortality
in one study, altered mental status noted in only ____% of elderly ED patients w/ delirium
16%
patient experiencing a sudden deterioration in cognitive function should be assessed for:
delirium
core symptoms of delirium
- attention deficits/memory impairment
- disorientation
- sleep/wake cycle disturbance
- thought process abnormalities
- language disturbances motor alterations
associated or non-core symptoms of delerium
affective changes = anxiety, fear, depression rapid shifts
hyperactive delirium frequently mistaken for depression
cause of deleirum
low ACh and/or excess DA
treatment of delerium
fix underlying cause
-since you have too much DA –> give anti-psychotics
Third MC cause of dementia after 65yo?
vascular dementia (5-10%)
