Dementia & Delirium Flashcards
1
Q
What is dementia?
A
- Loss of intellectual ability –> impairment of functioning
- Must involve memory impairment + at least 1 other domain (memory, attention, language, mood)
- Can be static, progressive or remitting BUT it’s acquired and irreversible
2
Q
Dx of Dementia - Strategy and Tools
A
- Goal = r/o other possible causes of cognitive effects
- Patient and informant interview
- MRI - r/o stroke or subdural hemorrhage & look for hippocampus or medial parietal atrophy
- PET - can see hypoperfusion or hypometabolism
- CSF - may show AlphaBeta or tau
- Bloodwork to look for treatable causes of dementia - TSH, B12, inflammatory markers, etc
3
Q
AD Risk Factors (5)
A
- AGE
- ApoE
- Cardiovascular - hypertension, DM, stroke
- High educ is protective
- Head trauma
4
Q
AD Symptoms In Order
A
**follow time course as pathology progresses to additional brain networks
- 1- episodic memory deficits; forgetfulness; problems w/ consolidation of new declarative memory (entorhinal cortex/hippocampus)
- 2- aphasia, visual-spatial, executive function deficits + anxiety/depression if amygdala involved (heteromodal or different unimodal areas)
- 3- Motor/sensory changes (primary motor, auditory and visual cortex) + retrograde amnesia
5
Q
3 Types of AD Pathology
A
- Amyloid = extracellular
- APP (amyloid precursor protein) is transmembrane; can be cut by multiple proteases; if cleaved in certain way –> amyloid Beta produced which is insoluble
- Mainly in limbic system
- Tau = intracellular
- Hyper-phosphorylated tau protein forms tangles
- Mainly in temporal lobes
- More linked to symptoms
- Acetylcholine
- Loss of cholinergic cells in basal forebrain (moderately improved w/ acetylcholinesterase inhibitors)
6
Q
DLB v. PDD
A
- DLB if… dementia w/in 1 yr of Parkinsons onset + early visual hallucinations
- PDD (Park Disease w/ Dementia) if… dementia only after»_space;1 yr and visual hallucinations later
7
Q
DLB Features
A
- Core Features - dementia, parkinsonism, fluctuating cognition (min to hrs rather than days like AD), visual hallucination are form and threatening
- Suggestive Features - REM sleep behavior (act out dreams), neuroleptic snesitivity
- Others - repeated falls, autonomics (constipation, orthostatic hypertension), delusions, depression, etc
8
Q
DLB Time Course
A
**represents spread of pathology
- 1- early autonomic problems w/ orthostatic hypertension, constipation, incontinence (brainstem)
- 2- Motor/Parkinsonian symptoms (midbrain - substantia nigra pars compacta)
- 3- Visual hallucinations and attention lapses (Ach –> cortex)
- 4- Executive function and memory (limbic system)
9
Q
DLB Pathology
A
- Lewy Bodies = intracellular or intra-axonal deposits of alpha - synuclein
- Can identify them immuno-histochemically
10
Q
What drugs should you avoid in those w/ DLB?
A
- Typical anti-psychotics to treat hallucinations; they have neuroleptic inc sensitivity to them b/c already have depleted Ach and these drugs inc dopamine at expense of Ach; makes symptoms worse
- Can lead to deterioration - Neuroleptic Malignant Syndrome
11
Q
Delirium v. Dementia
A
- Both acquired and present w/ cognitive impairment in mult domains
- Differ in time course - delirium is acute, time-limited, reversible and fluctuates in type and severity
- Delirium includes impairment in attention, hallucinations, drowsiness and agitation (but these can all also be seen in dementia); attention/arousal problems usually not seen until later in dementia course
- **Dementia is a risk factor for delirium
12
Q
Delirium DSM V Criteria
A
- Disturbance in attention and awareness that develops over short period of time and fluctuates in severity over course of day (v. dementia which is gradual progression)
- Reduced ability to adjust, shift, focus attention
- Must have 1 additional disturbance - includes memory deficit, disorientation, perception disturbances, etc
- Cannot be better explained by evolving neurodegenerative disorder OR coma
- Not direct results of med, intoxication, withdrawal, etc
13
Q
Epidemiology of Delirium
A
- 80% ICU patients
- Common in hospitalized pts (esp elderly post-op)
- Inc hospital time, inc mortality, inc D/C to facilities
14
Q
Risk Factors for Delirium (7)
A
- Age
- Cognitive impairment (Dementia)
- Severity of illness
- Vision, hearing impairment
- Dehydration (High BUN/Cr)
- Chronic medical illness
- Orthopedic and cardiac surgery
15
Q
Clinical Features of Delirium + 3 Types
A
- Arousal (can be inc or dec), awareness, attention (easy to distract and cannot keep up w/ sequences), perceptual disturbances (hallucinations) and sleep-wake disturbances (sleepy in day then sundowning- agitated at night)
- 3 Types - hyperactive, hypoactive, mixed
