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Psychiatry > Dementia + Delirium > Flashcards

Dementia + Delirium Flashcards

1
Q

What are the different types of dementia

A

Alzheimer’s
Vascular dementia
Lewy Body
Fronto-temporal

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2
Q

Which is the most common type of dementia

A

Alzheimer’s

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3
Q

Describe Alzheimer’s

A

Chronic neurodegenerative disease with insidious and progressive but slow decline

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4
Q

What is the MAJOR risk factor for Alzheimer’s

A

Age

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5
Q

Is Alzheimer’s reversible

A

No

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6
Q

Is Alzheimer’s progressive

A

Yes

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7
Q

Clinical features of Alzheimer’s

A 
Memory loss 
Disorientation 
Nominal dysphasia 
Misplacing items 
Getting lost 
Apathy 
Decline in activities 
Personality change
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8
Q

O/E findings in Alzheimer’s

A

Unremarkable

None to note

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9
Q

Ix for Alzheimer’s

A

MOCA
MSSE

Collateral history

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10
Q

Reversible causes of alzheimer’s

A 
Hypothyroidism 
Intracerebral bleed/tumour B12 deficiency 
Hypercalcaemia 
NPH (wet wobbly wacky)
Depression
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11
Q

What type of specificity does capacity have

A

Capacity is decision specific

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12
Q

What is a power of attorney

A

Someone whom the patient/person has appointment to make decisions should they lack capacity

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13
Q

Pharmacological Rx for Alzheimer’s

A

Cholinisterase inhibitors
NDMA Antagonist
Antidepressants
Anti-psychotics

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14
Q

Which Cholinisterase inhibitor is used to treat AD

A

Donepezil

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15
Q

Which NDMA antagonist is used to treat AD

A

Memantine

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16
Q

Risk factors for AD

A

Age
FH
Vascular risk factors

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17
Q

Which anti-psychotic can sometimes be prescribed in AD

A

Risperidone

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18
Q

non-pharmacological management of Alzheimer’s

A 
Support for person and carers 
Cognitive stimulation 
Exercise 
Environmental design 
Music/light therapy 
Reality orientation therapy 
Validation therapy §
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19
Q

What type of history is crucial for any form of dementia

A

Collateral

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20
Q

What progression does Vascular dementia typically show

A

Step wise

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21
Q

Risk factors for vascular dementia

A 
Hypertension 
Age
DM 
Smoking 
Hyperlipidaemia 
Obesity 
Alcohol 
AF 
IHD
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22
Q

Symptoms of vascular dementia

A 
Memory loss 
Difficulty concentrating 
difficulty finding words
Change in personality 
Confusion 
Disorientation
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23
Q

Can the same pharmacological methods used to treat Alzheimers be used in vascular dementia

A

No

24
Q

Management of vascular dementia

A 
OT 
Physio
Support for person and carers 
Cognitive stimulation 
Exercise 
Environmental design 
Music/light therapy 
Reality orientation therapy 
Validation therapy
25
Q

What is the mean survival of AD

A

7 yrs

26
Q

Which disease does lewy body dementia have a strong link with

A

Parkinson’s

27
Q

Clinical features of Lewy body

A 
Hallucinations common 
Falls
Fluctuating confusion and alertness
Parkinsonism 
REM sleep
28
Q

Which type of sleep will Lewy body affect

A

REM

29
Q

Features of Parkinsonism

A

Bradykinesia
Tremor
Postural instability y
Rigidity

30
Q

Ix for Lewy Body dementia

A

MOCa
MMSE
Collateral history

Sometimes MRI brain

31
Q

Pharmacological Rx Lewy Body Dementia

A

Acetylcholinisterase inhibitor e.g Dozezepril

Memantine

Antidepressant
Anti-psychotic

32
Q

What is the typical pictures of frontotemporal dementia

A

Early symptoms different from other dementias:
Behavioural change
Language difficulties
Memory early on not often affected

33
Q

Compare the onset of frontotemporal dementia

A

Often an early onset

34
Q

Where does frontotemporal dementia affect

A

Fronto-temporal lobes

35
Q

What is the first thing normally to change in front-temporal dementia

A

Behaviour

36
Q

What is the pharmacological Rx of fronton-temporal dementia

A

No pharmacological Rx

37
Q

Non-pharmacological Rx for frontotemporal dementia

A 
Support for person and carers 
Physio.
OT 
Cognitive stimulation 
Exercise 
Environmental design 
Music/light therapy 
Reality orientation therapy 
Validation therapy
38
Q

Clinical features of fronts-temporal dementia

A 
Early behavioural change 
Drastic personality change 
Early dysphagia 
Emotional unconcern 
Changes in eating habits 
Loss of personal hygiene

Memory often affected later on

39
Q

Is delirium common or uncommon

A

Very common

40
Q

What are the 3 types of delirium

A

Hyperactive
Hypoactive
Mixed

41
Q

Potential causes of delirium

A 
Infection (e.g UTI)
Dehydration 
Pain 
Constipation 
Drugs 
Urinary retention
Hypoxia 
Alcohol/drug withdrawal 
Brain injury 
SLE 
Endocrinopathies
42
Q

Key clinical features of delirium

A 
Disturbed consciousness 
Acute onset 
Fluctuant course
Change in cognition:
Memory
Perceptual Language 
Illusions 
Hallucination (auditory/visual)
43
Q

Which scores can be used to assess for delirium

A

4AT

AMT

44
Q

Non-Pharmacological Rx for delirium

A 
Reorientate and Reassure:
Use families/carers
Normalise sleep wake cycle 
Continuity f care
Avoid urinary catheterisation
45
Q

Rx for delirium

A 
Non-pharmacological measures 
Remove any bad/precipitating drugs 
Enema/laxatives 
Abx. 
analgesia
46
Q

Should you sedate patients who have delirium

A

Try to avoid

47
Q

What is the commonest complication of hospitalisation

A

Delirium

48
Q

Complications of delirium

A

Increased risk of dementia

Increased risk of further delirium

49
Q

Ddx for delirium

A

Drug/alcohol withdrawal
Mania
Dementia

50
Q

Ix for delirium

A

4AT
AMT

U&E's
FBC 
Blood gas 
Urine dipstick 
PR 
Glucose 
Cultures 
LFT 
ECG 
CT 
CXR 
LP
51
Q

Is a higher or lower score worse in 4AT

A

Higher

52
Q

Is a higher or lower score worse in the AMT

A

Lower

53
Q

What morbidity and mortality complications is delirium associated with

A

Increased risk of death
Longer length of stay
Increased rates of institutionalisation
Persistent functional decline

54
Q

Describe features of hyperactive delirium

A

Agitated and upset
Tend to cause more disturbance eon the ward
Are far more obvious therefore far easier to identify

55
Q

Describe features of hypoactive delirium

A

Drowsy and withdrawn
Tend to sleep a lot
A lot less obvious and therefore far more commonly missed

56
Q

Other less key features of delirium

A 
Disturbance of sleep wake cycle 
Disturbed psychomotor behaviour 
Emotional disturbance 
(agitation)
Delusions 
Change in appetite

Psychiatry (15 decks)

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