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Neurology > DEMENTIA/DELIRIUM > Flashcards

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
Q

How do you make the diagnosis of Alzheimer’s?

A

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
Q

What’s the only definitive way to diagnose Alzheimer’s?

A

autopsy – amyloid formation

27
Q

How do you treat Alzheimer’s?

A

Family educations, safety, adult care

28
Q

What form of dementia occurs classically in hypertensive patients?

A

Vascular dementia

29
Q

How does vascular dementia present?

A

Usually acute/more sudden onset; but symptoms progress in a stepwise fashion.

30
Q

How do you diagnose vascular dementia?

A

MRI – Lacunar infarcts with HTN

31
Q

How do you treat vascular dementia?

A

Treat risk factors – control HTN/metabolic disorder

32
Q

If an elderly male patient loses their personality, become more sexual or more violent, what disease is this? What type of dementia is this?

A

Pick’s Disease

Frontotemporal Dementia

33
Q

What treatment can you offer Pick’s disease?

A

None, palliative

34
Q

What other disease is categorized in the frontotemporal dementia?

A

Huntington’s Disease

35
Q

How do you diagnose and treat Huntington’s disease?

A

Genetic test (chromosome 4, kids have 50% chance of getting); treat the symptoms – dopamine blockers to help with the chorea

36
Q

What diagnosis involves a gaze paralysis, when they cannot look down?

A

Progressive Supranuclear Palsy

37
Q

What are the clinical features of Parkinson’s dementia?

A

Resting tremor, rigidity, masked face, bradykinesia, cogwheeling

38
Q

What other disease presents similar to Parkinson’s but the patient also has visual hallucinations & decreased alertness?

A

Lewy Bodies

39
Q

How does a patient present with Normal Pressure Hydrocephalus (NPH)?

A

The 3 W’s – Wet (incontinence), Wobbly (gate ataxia), and Weird (dementia)

40
Q

What would you see on MRI with NPH?

A

Big ventricles and small grey matter

41
Q

How do you diagnose & treat NPH?

A

Lumbar puncture (to diagnose and treat) can also do Shunting to treat

42
Q

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?

A

Korsakoff’s syndrome – can’t recall recent memory despite immediate memory retention

43
Q

What form of dementia is caused by a thiamin deficiency? How do they present?

A

Wernicke’s Encephalopathy – Diplopia (double vision), confusion, ataxia

44
Q

How do you recognize dementia?

A

Memory loss, duration, tremor, strokes, family history, and behaviors

45
Q

What does the workup look like for dementia?

A

History, MMSE, Neuro/psych testing, HTN

46
Q

What labs do we get when concerned about dementia?

A

B12 & thyroid levels

47
Q

What type of imaging can you get for dementia?

A

CT or MRI – but may not be helpful

48
Q

What are some of the syndromes you need to consider when treating a patient with dementia?

A

Safety (driving, shopping, eating), tremor, head trauma, nutrition deficiencies

49
Q

What are some meds that we can use to treat Dementia?

A

Anti-acetylcholinesterase drugs or NMDA receptor antagonists.

Neurology (11 decks)

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