Dementia & Delirium

Question 1

Delirium

Answer 1

• acute onset
• awareness/attention/sensory impairment
• also some kind of cognitive impairment (memory, confusion, language, perception..), multiple systems involved (so not focal lesion)

Question 2

Dementia

Answer 2

Now called Major Neurocognitive Impairment

• Progressive (delirium acute)
• Significant cognitive decline (memory, executive function, learning, language, social..)
• Impairs daily activities
• starts focal, slowly becomes global (delirium starts global)
• rarely reversible (delirium is)
• continuous (delirium waxes/wanes)
• No treatment for disease only symptoms (can treat underlying cause of deliriums)
• 100% mortality (better for delirium)

Question 3

Minor Neurocognitive Impairment

Answer 3

Abnormal decline in cognitive functions but no functional impairment
-% can progress to dementia

Question 4

Delirium mechanism

Answer 4

Failure in cerebral neuron metabolism (due to impaired AVAILABILITY or DISTRIBUTION of nutrients/O2, cellular INTEGRITY, toxic INTERFERENCE)

Question 5

Delirium- impaired availability of nutrients (5)

Answer 5

1) electrolyte disturbance (burns, dehydration, renal disease, etc)
2) hypoglycemia
3) hypoxia (pulm/cardiac failure, CO poisoning)
4) Deficiency states (B12, niacin, thiamine)
5) Endocrinopathies (PTH problems, adrenal insufficiency)

Question 6

Delirium- Impaired Delivery (of nutrients) (4)

Answer 6

• anemia
• hemoglobinemia
• hypotension (cardiac failure, medication)
• cerebrovascular disorder (stroke, hemorrhage, vasculitis)

Question 7

Delirium (toxic interference) (6)

Answer 7

• Infection
• Acid-base disturbance
• endocrinopathies
• toxins (pesticides, heavy metals)
• medications (sedatives, anticholinergics)
• illegal drugs/alcohol

Question 8

Impaired cell integrity

Answer 8

Trauma
hypertension
hydrocephalus
CVDs
Cerebral infarcts
drug withdrawal
seizures
neurodegenerative disorders (LBD)

Question 9

Lewy Body Dementia (diagnosis)

Answer 9

Diagnose via Dementia +
2/3 :
-impaired attention
-parkinsonism
-recurrent hallucinations
OR 1/3 + REM behavior sleep disorder, low dopamine uptake

and obviously lewy bodies if you did autopsy

Question 10

Lewy Body Dementia Pathology

Answer 10

Lewy Bodies in cortex
-amyloid plaques, neurofibrillary tangles
-loss of cholinergic neurons in nucleus basalis
-depletion of dopamine-containing neurons
Differentiated from parkinsons- parkinsons if >1yr between parkinsonism and cognitive decline, <1yr is LBD. Also LBD starts in cortex and parkinsons ascends over time

Question 11

Frontotemporal Dementia (FTD)

Answer 11

Dementia with behavioral abnormalities from frontal lobe degeneration (disinhibited, social issues,

• See Picks Bodies in variant (Picks Disease- behavorial variant)
• others are semantic dementia (temporal lobe invovled)
• can get non-fluent aphasia if Broca’s area involved

Question 12

Creutzfeld Jacob

Answer 12

rapid onset memory loss over a few months

• startle myoclonus
• disinhibition
• personality change