Dementia + Delirium Flashcards
What are the different types of dementia
Alzheimer’s
Vascular dementia
Lewy Body
Fronto-temporal
Which is the most common type of dementia
Alzheimer’s
Describe Alzheimer’s
Chronic neurodegenerative disease with insidious and progressive but slow decline
What is the MAJOR risk factor for Alzheimer’s
Age
Is Alzheimer’s reversible
No
Is Alzheimer’s progressive
Yes
Clinical features of Alzheimer’s
Memory loss Disorientation Nominal dysphasia Misplacing items Getting lost Apathy Decline in activities Personality change
O/E findings in Alzheimer’s
Unremarkable
None to note
Ix for Alzheimer’s
MOCA
MSSE
Collateral history
Reversible causes of alzheimer’s
Hypothyroidism Intracerebral bleed/tumour B12 deficiency Hypercalcaemia NPH (wet wobbly wacky) Depression
What type of specificity does capacity have
Capacity is decision specific
What is a power of attorney
Someone whom the patient/person has appointment to make decisions should they lack capacity
Pharmacological Rx for Alzheimer’s
Cholinisterase inhibitors
NDMA Antagonist
Antidepressants
Anti-psychotics
Which Cholinisterase inhibitor is used to treat AD
Donepezil
Which NDMA antagonist is used to treat AD
Memantine
Risk factors for AD
Age
FH
Vascular risk factors
Which anti-psychotic can sometimes be prescribed in AD
Risperidone
non-pharmacological management of Alzheimer’s
Support for person and carers Cognitive stimulation Exercise Environmental design Music/light therapy Reality orientation therapy Validation therapy §
What type of history is crucial for any form of dementia
Collateral
What progression does Vascular dementia typically show
Step wise
Risk factors for vascular dementia
Hypertension Age DM Smoking Hyperlipidaemia Obesity Alcohol AF IHD
Symptoms of vascular dementia
Memory loss Difficulty concentrating difficulty finding words Change in personality Confusion Disorientation
Can the same pharmacological methods used to treat Alzheimers be used in vascular dementia
No
Management of vascular dementia
OT Physio Support for person and carers Cognitive stimulation Exercise Environmental design Music/light therapy Reality orientation therapy Validation therapy
What is the mean survival of AD
7 yrs
Which disease does lewy body dementia have a strong link with
Parkinson’s
Clinical features of Lewy body
Hallucinations common Falls Fluctuating confusion and alertness Parkinsonism REM sleep
Which type of sleep will Lewy body affect
REM
Features of Parkinsonism
Bradykinesia
Tremor
Postural instability y
Rigidity
Ix for Lewy Body dementia
MOCa
MMSE
Collateral history
Sometimes MRI brain
Pharmacological Rx Lewy Body Dementia
Acetylcholinisterase inhibitor e.g Dozezepril
Memantine
Antidepressant
Anti-psychotic
What is the typical pictures of frontotemporal dementia
Early symptoms different from other dementias:
Behavioural change
Language difficulties
Memory early on not often affected
Compare the onset of frontotemporal dementia
Often an early onset
Where does frontotemporal dementia affect
Fronto-temporal lobes
What is the first thing normally to change in front-temporal dementia
Behaviour
What is the pharmacological Rx of fronton-temporal dementia
No pharmacological Rx
Non-pharmacological Rx for frontotemporal dementia
Support for person and carers Physio. OT Cognitive stimulation Exercise Environmental design Music/light therapy Reality orientation therapy Validation therapy
Clinical features of fronts-temporal dementia
Early behavioural change Drastic personality change Early dysphagia Emotional unconcern Changes in eating habits Loss of personal hygiene
Memory often affected later on
Is delirium common or uncommon
Very common
What are the 3 types of delirium
Hyperactive
Hypoactive
Mixed
Potential causes of delirium
Infection (e.g UTI) Dehydration Pain Constipation Drugs Urinary retention Hypoxia Alcohol/drug withdrawal Brain injury SLE Endocrinopathies
Key clinical features of delirium
Disturbed consciousness Acute onset Fluctuant course Change in cognition: Memory Perceptual Language Illusions Hallucination (auditory/visual)
Which scores can be used to assess for delirium
4AT
AMT
Non-Pharmacological Rx for delirium
Reorientate and Reassure: Use families/carers Normalise sleep wake cycle Continuity f care Avoid urinary catheterisation
Rx for delirium
Non-pharmacological measures Remove any bad/precipitating drugs Enema/laxatives Abx. analgesia
Should you sedate patients who have delirium
Try to avoid
What is the commonest complication of hospitalisation
Delirium
Complications of delirium
Increased risk of dementia
Increased risk of further delirium
Ddx for delirium
Drug/alcohol withdrawal
Mania
Dementia
Ix for delirium
4AT
AMT
U&E's FBC Blood gas Urine dipstick PR Glucose Cultures LFT ECG CT CXR LP
Is a higher or lower score worse in 4AT
Higher
Is a higher or lower score worse in the AMT
Lower
What morbidity and mortality complications is delirium associated with
Increased risk of death
Longer length of stay
Increased rates of institutionalisation
Persistent functional decline
Describe features of hyperactive delirium
Agitated and upset
Tend to cause more disturbance eon the ward
Are far more obvious therefore far easier to identify
Describe features of hypoactive delirium
Drowsy and withdrawn
Tend to sleep a lot
A lot less obvious and therefore far more commonly missed
Other less key features of delirium
Disturbance of sleep wake cycle Disturbed psychomotor behaviour Emotional disturbance (agitation) Delusions Change in appetite
