Dementia & Delirium Flashcards
Name the 5 types of dementia.
Alzheimer's disease Vascular dementia Dementia with Lewy Bodies Frontotemporal dementia AIDS dementia complex
What is the main difference between dementia and delirium?
Someone with dementia has clear consciousness - they are not confused and are alert, whereas someone with delirium is confused.
What is dementia?
A syndrome with cognitive and behavioural decline, usually caused by brain death/damage.
What are the 2 types of dementia symptoms?
Cognitive
Non-cognitive
State some cognitive symptoms for dementia.
Depends on which area of the brain is affected:
- temporal - memory impairment
- parietal - visual impairment
- frontal - impaired learning and judgement
State some non-cognitive symptoms for dementia.
- behavioural - agitation, aggression, sexual disinhibition
- mood - depression, anxiety
- psychosis - visual and auditory hallucinations, persecutory delusions
- sleep - insomnia, daytime drowsiness
Name the 3 things that means a diagnosis of dementia is likely.
- cognitive decline
- impairment to do daily activities
- clear consciousness
Name some symptoms of hypercalcaemia.
Moans - depression
Groans - GI pain
Stones - renal
What is sexual disinhibition?
Loss of ability to know what is appropriate, it is a common non-cognitive symptom of dementia.
State 3 macroscopic changes with Alzheimer’s disease.
- Sulcal widening
- global brain atrophy
- enlargement of 3rd and 4th ventricles
What is Alzheimer’s disease?
A type of dementia where neuronal death leads to a decrease in neurotransmitter at synapses.
Name 2 microscopic changes of Alzheimer’s disease.
- senile plaque - aggregates of amyloid formed by abnormal breakdown of amyloid precursor protein
- neurofibrillary tangles - hyperphosphorylated tau proteins
What is vascular dementia?
Cognitive impairment caused by ischaemia or haemorrhage secondary to cerebrovascular disease.
State some risk factors for vascular dementia.
- hypertension
- diabetes
- smoking
- hypercholesterolaemia
Which type of dementia is associated with Parkinson’s disease?
Dementia with Lewy bodies
What is a Lewy body?
Abnormal aggregation of alpha-synuclein protein in the cytoplasm of a cell.
What is Lewy Body dementia?
When Lewy bodies are deposited in the frontal and temporal lobes, substantia nigra and cingulate gyrus, leading to cognitive symptoms and Parkinsonian features.
State some symptoms of dementia with Lewy bodies.
- vivid visual hallucinations
- features of Parkinsonism
- sensitive to neuroleptic malignant syndrome
What is neuroleptic malignant syndrome?
When there is a sudden drop in dopamine as a side effect of antipsychotics. Symptoms remembered as FEVER.
What are the symptoms of neuroleptic malignant syndrome?
F - fever
E - encephalopathy
V - vital signs instability - tachycardia, tachypnoea
E - elevated creatine phosphokinase enzyme level
R - rigidity
What is frontotemporal dementia?
When atrophy of the frontal and temporal lobes occurs, leading to dementia (common cause of early onset dementia).
Name some symptoms specific to frontotemporal dementia.
- inappropriate social behaviour
- non-fluent aphasia (difficulty articulating speech)
What is AIDS dementia complex?
When an HIV infected macrophage enters the brain and damages neurones, leading to cognitive impairment, tremor, ataxia, dysarthria etc.
How can the AIDS dementia complex be managed?
- Acetylcholinesterase inhibitors - reduces ACh breakdown in synaptic cleft, increasing neurotransmission
- NMDA antagonists - reduces overstimulation of glutamate, which can cause aggression.
What is delirium?
When insult to the brain caused by hypoxia or inflammation leads to acute neuronal cell death.
What are the 2 types of delirium?
Hypoactive - withdrawn, quiet, sleepy
Hyperactive - restless, agitated, aggressive
Name some causes of delirium.
- extracranial infections e.g. UTI, pneumonia, sepsis
- intracranial trauma or infection
- alcohol withdrawal
- vitamin B12 or folate deficiency
- renal or hepatic failure
What is the management of delirium?
Treat the underlying cause.
If left untreated, what is the prognosis of delirium?
Increased risk of dementia.
