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DEMENTIA/DELIRIUM Flashcards

1
Q

If a patient had a fall and hit their head and they now appear confused but their exam is otherwise unremarkable, what diagnosis?

A

Delirium

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2
Q

For how long can delirium last?

A

Usually acute - hours to days or months to year

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3
Q

What patients are at risk of delirium?

A

declining health, nursing home patients, patients with catheters, multiple pain meds, almost always infection

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4
Q

What is the pathology of delirium?

A

Diffuse cerebral dysfunction, low acetylcholine levels, possibly high dopamine levels

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5
Q

What would you be looking for on PE with delirium?

A

Decreased attention, hallucinations, delusions, Hypo or hyperactive state, change in sleep wake cycles.

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6
Q

How would you make the diagnosis of delirium?

A

Clinical (compare with normal from family), check medications, perform a complete PE

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7
Q

What types of medications can cause delirium?

A

Anti-cholinergic, sedatives, narcotics, and benzo’s

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8
Q

If a patient has delirium due to illness (sepsis, fever, dehydration, etc), what is this known as, what do we have to R/O?

A

ICU psychosis R/O stroke

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9
Q

What is it known as when a patient’s delirium symptoms get worse in the evening/nighttime.

A

Sundowning

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10
Q

How do you treat sundowning delirium?

A

Normal environment, involve the family, and normal sleep/wake cycle.

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11
Q

If a patient has delirium along with agitation, tremor, hallucinations, and seizures, what is this known as? What causes it?

A

Delirium Tremens

Usually caused by acute alcohol withdrawal syndrome

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12
Q

How do you prevent delirium tremens?

A

Don’t drink, slowly taper off alcohol, hydrate, B vitamins.

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13
Q

How do you treat delirium tremens?

A

Benzos (diazepam – which can be given IV) if it’s really bad give a higher dose, phenobarbital, antipsychotics

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14
Q

What does the delirium workup involve?

A

Toxins, metabolic (liver, kidney, electrolytes, glucose), infection, endocrine, CV, EEG to r/o seizures

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15
Q

Does imaging help with delirium diagnosis?

A

Nope

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16
Q

How do you treat delirium?

A

Identify and treat unnecessary meds, infection, dehydration. Supportive & day-night normalcy.

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17
Q

What are some of the key features of dementia?

A

Memory loss, speech/language difficulties, problems solving difficulties, impaired judgment, mood issues (subtle depression).

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18
Q

What is occurring neurologically in dementia?

A

Change in cerebral circuits, nerve loss, changes in neurotransmitters.

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19
Q

What are the risk factors of dementia?

A

Age (dementia = not a normal part of dementia), viral (prion disease), genetics

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20
Q

There are 7 types of dementia, what are they?

A

Alzheimer’s, vascular, multi-infarct, frontotemporal, Parkinson’s, Lewy bodies, Alcohol/Drugs, and viral/prion disease

21
Q

How does Alzheimer’s develop?

A

Very slowly, progressive over years, memory loss that is often subtle

22
Q

Who are the most common people to get dementia?

A

Women (due to longevity), Down’s Syndrome, but can occur with anyone

23
Q

What types of problems do people initially present with Alzheimer’s?

A

Difficulty with ADL’s, behavior changes (may get lost), word finding issues/other speech difficulties, and can’t do puzzles

24
Q

What are some of the late findings of Alzheimer’s?

A

Wandering, poor judgment, delusions, aggression, sleep disturbance, incontinence

25
How do you make the diagnosis of Alzheimer’s?
Intellectual decline in 2 or more areas of cognition, documented by mental status exam. Labs: CBC, heavy metal, electrolytes, glucose, TSH, B12, renal & liver function tests
26
What’s the only definitive way to diagnose Alzheimer’s?
autopsy – amyloid formation
27
How do you treat Alzheimer’s?
Family educations, safety, adult care
28
What form of dementia occurs classically in hypertensive patients?
Vascular dementia
29
How does vascular dementia present?
Usually acute/more sudden onset; but symptoms progress in a stepwise fashion.
30
How do you diagnose vascular dementia?
MRI – Lacunar infarcts with HTN
31
How do you treat vascular dementia?
Treat risk factors – control HTN/metabolic disorder
32
If an elderly male patient loses their personality, become more sexual or more violent, what disease is this? What type of dementia is this?
Pick’s Disease Frontotemporal Dementia
33
What treatment can you offer Pick’s disease?
None, palliative
34
What other disease is categorized in the frontotemporal dementia?
Huntington’s Disease
35
How do you diagnose and treat Huntington’s disease?
Genetic test (chromosome 4, kids have 50% chance of getting); treat the symptoms – dopamine blockers to help with the chorea
36
What diagnosis involves a gaze paralysis, when they cannot look down?
Progressive Supranuclear Palsy
37
What are the clinical features of Parkinson’s dementia?
Resting tremor, rigidity, masked face, bradykinesia, cogwheeling
38
What other disease presents similar to Parkinson’s but the patient also has visual hallucinations & decreased alertness?
Lewy Bodies
39
How does a patient present with Normal Pressure Hydrocephalus (NPH)?
The 3 W’s – Wet (incontinence), Wobbly (gate ataxia), and Weird (dementia)
40
What would you see on MRI with NPH?
Big ventricles and small grey matter
41
How do you diagnose & treat NPH?
Lumbar puncture (to diagnose and treat) can also do Shunting to treat
42
If a patient is a long time alcoholic, you ask them to name 3 animals, and then repeat them, and they can’t, what is this known as?
Korsakoff’s syndrome – can’t recall recent memory despite immediate memory retention
43
What form of dementia is caused by a thiamin deficiency? How do they present?
Wernicke’s Encephalopathy – Diplopia (double vision), confusion, ataxia
44
How do you recognize dementia?
Memory loss, duration, tremor, strokes, family history, and behaviors
45
What does the workup look like for dementia?
History, MMSE, Neuro/psych testing, HTN
46
What labs do we get when concerned about dementia?
B12 & thyroid levels
47
What type of imaging can you get for dementia?
CT or MRI – but may not be helpful
48
What are some of the syndromes you need to consider when treating a patient with dementia?
Safety (driving, shopping, eating), tremor, head trauma, nutrition deficiencies
49
What are some meds that we can use to treat Dementia?
Anti-acetylcholinesterase drugs or NMDA receptor antagonists.

Neurology (11 decks)

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