Dementia/Delirium Flashcards
Dementia def
progressive global decline in intellectual and memory
Reversible causes of dementia
normal pressure hydrocephalus alcohol abuse neurosyphillis hypothyroid Vit B12 deficiency pseudo-dementia of depression Neoplasms eg meningioma
Different types of memory
Sensory Short term (STM) Long term (LTM) : Semantic , episodic
Semantic memory
learned information
Episodic memory
persons experiences
Encoding
converson of STM to LTM
Dementia normally affects which type of memory
at early stages STM
later LTM
What is a sensory memory
visual auditory tactile taste
Irreversible causes of dementia
Alzheimers disease
Vascular dementia
Senile dementia of Lewy body type
Range of sx of AD
Early stages: impairment of - judgement - memory - abstract thinking Later stages: dintegeration of - intellect - personality - incoherence - incontinence
Which chromosomes ass with AD
1
14
21
Pathological findings in AD imaging
atrophy (esp hippocampus) + enlarged lateral ventricles/widened sulci
Pathological findings in AD post mortem
neurofibrillary tangles
senile plaques
Which neurotransmitter is depleted in AD
Ach
Diagnosis of AD
no single test
using CT findings + Hx
Meds to Rx AD
Cholinesterase inhibitors:
- Galantamine
- Donepezil
- Rivastigmine
Effectiveness of med mx of AD
works in half
effective only for 2-3 yrs
Vascular dementia rx
- modifying CVS risk factors may slow progression eg rx DM or HTN
- ACEi/aspirin may help
Vascular dementia def
mental impairment from cerbrovascular disease
Difference between AD and vascular dementia progression
vascular - abrupt onset, episodic deterioration - cognitive impairment tend to be selective and uneven depending on the part affected AD - slow progressive deterioration - everything affected
Senile dementia of the lewy body type (SDLT) def
histopathologically similar to AD and PD
but has Lewy Body in abundance
SDLT features
- progressive dementia
- varying mental state and functional ability on a daily basis
- could have features similar to PD (parkinson)
SLDT Rx
- Anti PD drugs help relieving sx
- poss Cholinergic agonists
Driving with dementia
- depends on the level, but advised against
- inform DVLA as last resort
Meds causing of delirium
O SAS opiates sedatives anticholinergics, anti PD meds, analgesics steroids
Non med causes of delirium
Infection
Pain
Retention (urine/faeces)
Withdrawal (alcohol, benzodiazepine)
Test to differentiate delirium from dementia
CAM score (confusion assessment method)
Main fx of delirium
- Acute (hrs-days) or fluctuating
- Inattention (diff maintaining conversation)
- and either
- altered consciousness (reduced awareness of surroundings)
- or disordered thinking ( speech disordered)
Cognitive function tests for delirium
AMT
MMSE
Criteria for Dementia
At least 6 months
Affects ADLs
Exclude reversible causes
Which gene protective of Alzheimer’s
ApoE-e2
Which gene increases risk of Alzheimer’s
ApoE-e4
TARDBP43 ass with which dementia
Fronto-temporal
Normal pressure hydrocephalus
ataxia
urinary incontinence
dementia
MMSE score interpretation
<10 severe dementia
10-20 modereate
<26 mild dementia
Pellagra
dementia
dermatitis
diarrhoea
Pellagra cause
Vit B3 deficiency