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Integrated Care > Dementia & Delirium > Flashcards

Dementia & Delirium Flashcards

1
Q

What is dementia?

A 
Several diseases
A Syndrome
Cognitive impairment
Decline in both memory and thinking
Affects ability to perform personal ADLs
Present for at least 6 months
Nearly always progressive
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2
Q

Name 5 different types of dementia

A 
Alzheimer's disease
Vascular Dementia
Frontotemporal Dementia
Lewy body Dementia
Alcoholic Dementia
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3
Q

What is the course/onset for the following types of dementia:
Alzheimer’s
Vascular
Frontotemporal

A

Alzheimer’s - Gradual, insidious onset. Slow progression

Vascular - Gradual or abrupt onset, erratic course

FTD - Gradual onset, may progress quickly

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4
Q

When might Frontotemporal dementia progress more quickly than usual?

A

In younger patients

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5
Q

Describe the course/onset for the following types of dementia:
Lewy body Dementia
Alcoholic Dementia

A

LBD - Fluctuating, episodic course, may initially look like delirium

Alcoholic - Gradual, but cognitive status fluctuates with drinking and withdrawal episodes

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6
Q

How do the 5 different types of dementias usually present (early on)?

A

Alzheimer’s - Usually memory impairment
Vascular - Variable, may have prominent dysexecutive features
FTD - Loss of executive ability and impaired social behaviours
LBD - Perceptual disturbance (hallucinosis) and Parkinsonism
Alcoholic - Memory problems, dysexecutive (frontal) features

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7
Q

What neurological features is often associated with Lewy body Dementia?

A

Parkinsonism

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8
Q

What are the mood and behavioural changes observed in the following dementias?
Alzheimers
Vascular
FTD

A

Alzheimer’s - Minimal initially, pre-existing anxiety may worsen
Vascular - Depression common after stroke, emotional lability
FTD - Apathy, loss of volition, disinhibition may be early features

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9
Q

What are the mood and behavioural changes observed in the following dementias?
LBD
Alcoholic

A

LBD - May be paranoia, suspiciousness (psychotic Sx)

Alcoholic - Depression commonly associated with alcohol misuse problems

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10
Q

What are the structural brain abnormalities seen in the 5 dementias?

A

Alzheimer’s - Volume loss in medial temporal lobe, posterior cingulate, precuneus
Vascular - Evidence of infarcts, bleeds, white matter ischaemia
FTD - Frontotemporal atrophy
LBD - No specific abnormalities
Alcoholic dementia - Age disproportionate cortical and WM atrophy

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11
Q

What might you see in the early stages of dementia?

A

Forgetfulness and other memory Sx

Subtle changes in mood and behaviour

Minimal intrusion into ADLs

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12
Q

What might you see in the mid-stages of dementia?

A

Memory problems more apparent

Cognitive difficulties may emerge e.g. language and executive function

Marked behaviour changes

Complex ADLs are difficult e.g. finances, planning

Some people are aware, some are not

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13
Q

What might you see in the late stages of dementia?

A

Severe and pervasive memory problems

Major cognitive disability e.g. failure to recognise people

Severe behaviour changes e.g. inhibition, irritability, severe apathy

Severe disability e.g. incontinence

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14
Q

What are the important questions to ask in a history involving a patient with suspected dementia?

A

What is the course of Sx over time

Evidence of disability on daily life (ADLs)

Anything specific that has made then come now?

Any changes to general health?

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15
Q

What kind of examinations can you do for a patient with suspected dementia?

A

Cognitive screening assessments

Neurological exam

CVS Exam

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16
Q

What kind of cognitive assessment can you do in suspected dementia?

A

GPCOG
AMT
MMSE
MOCA

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17
Q

What investigations can you do for suspected dementia?

A

Bloods - Dementia screen
Imaging - CT, preferably MRI
Functional brain imaging

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18
Q

Justify the investigations used in dementia?

A

Bloods -

Imaging - Check for demyelination and dilatation of ventricles
To subtype the dementia

Functional brain imaging - check perfusion with glucose metabolism

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19
Q

Name some additional special tests you might do for dementia and why

A

EEG - To investigate unusual, atypical presentations

Lumbar puncture

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20
Q

What does conservative treatment in dementia usually involve?

A

Informing and explain to patient and family

Psychological support - help remain engaged in life

Practical advice +/- assistive tehnologies

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21
Q

What are the types of medications that we can give in Alzheimers dementia?

A

Cholinesterase inhibitors

NMDA Receptor Antagonists

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22
Q

Name some cholinesterase inhibitors used in the treatment of dementia

A

Donepezil

Rivastigmine

Galantamine

23
Q

Name the NMDA receptor antagonist used in Alzheimer’s dementia

A

Memantine

24
Q

What is the drug used in the treatment of Lewy body Dementia?

A

Rivastigmine

25
Q

Name some of the drugs used in the treatment of dementia

A

Donepezil

Rivastigmine

Galantamine

Memantine

26
Q

What types of medications should you avoid the use of in dementia and why?

A

Anti-cholinergics - Congtive deterioration, hallucinosis

Benzodiazepines - Risk of falls, cognitive decline

Anti-psychotic tranquillisers - Risk of stroke, falls, movement disorders, cognitive decline

27
Q

What is delirium

A

Impairment of cognition, attention and conscious level

Abnormal psychomotor behaviour and effect

Disturbed sleep wake cycle

Usually acute onset

Sx fluctuate during daytime, worse at night

28
Q

What are the two types of delirium?

A

Hypoactive

Hyperactive

29
Q

What is hyperactive delirium characterised by?

A 
Heightened arousal
Restlessness
Irritability
Wandering
Carphologia (picking at clothing)
30
Q

What is hyperactive delirium sometimes mistaken for?

A

Acute psychosis

31
Q

What is hyoactive delirium characterised by?

A

Quite
Sleepy
Inactive
Unmotivated

32
Q

What is hypoactive delirium sometimes mistaken for?

A

Depression

33
Q

Name some risk factors for delirium

A 
Over 65
Hip Fracture
Existing Cognitive Impairment
Sensory Impairment
Co-morbidities
Acute illness/infection
Surgery
Pain
Medication
Drug/alcohol withdrawal
34
Q

How is delirium linked to dementia?

A

Delirium can take a long time to resolve fully (>3 months)

Can therefore be mistaken for dementia

Some evidence that it may in fact precipitate or permanently worsen dementia

35
Q

What kind of drugs can induce delirium?

A

Psychotropic drugs:

  • Antidepressants
  • Antipsychotics
  • Benzodiazepines
Antiparkinsonian
Anticholinergic
Opiates
Diuretics
Recreational (intoxication and withdrawal)
36
Q

What is the most important aspect of history taking in someone with suspected delirium?

A

Establishing a patient’s baseline using either a patient history or a collateral history

37
Q

What screening tools can be used in screening for delirium?

A

Single question in Delirium (SQiD)

Confusion Assessment Method (CAM)

4AT

6CIT

38
Q

What bloods would you do in someone with suspected delirium?

A

Complet bloods (U&Es, FBC, LFT, Calcium, Glucose, CRP)

Guided bloods (TFT, Vit B12, Folate, ABG)

39
Q

What two investigations, done by the bedside, could you do in suspected delirium?

A

MSU

Check bowels

40
Q

What imaging could you do in delirium?

A

CT head - check for intracranial changes

Guided Investigations: CXR and MRI

41
Q

What kind of special tests could you do in delirium, if indicated?

A

Lumbar Puncture

EEG

42
Q

What is it important to do for a patient once they leave hospital following an episode of delirium?

A

Organise a GP appointment to detect any residual issues

If there are any lasting issues, the GP should refer to memory clinic

43
Q

What kind of things can be done for a patient, in hospital, should they be suffering from delirium?

A

Avoid moving patient around hospital
Know me Better profile
Ensuring glasses and hearing aids are available
Ensure good sleep - activities in the day, minimal noise at night
Orientation - Clocks, calendars, family photos
Nutrition - Offer regular drinks, snacks, finger foods
Mobilise
DOLS, 1-1, behaviour charts

44
Q

What kind of routine medical interventions can be done to delirious patients?

A

Constipation - PR to exclude impaction, hydrate, laxatives, enemas

Retention - Treat underlying cause, ONLY CATHETERISE IF ABSOLUTELY NECESSARY

Pain - Non-verbal pain scores, pain patches

Review medication - check for recent changes

45
Q

What medical intervention can be used, as a last resort, in delirium?

A

Haloperidol 0.5-1mg

Lorazepam 0.5-1mg

46
Q

What is the maximum dose of haloperidol or lorazepam that can be given in 24hrs?

A

2mg max

47
Q

When should you NOT give haloperidol in delirium?

A

Patients with background of Parkinsons or LBD

Do not give with other anti-psychotics

48
Q

What does a delirious episode increase the risk of in the future?

A

Further delirious episodes

49
Q

Is Dementia a normal part of the ageing process?

A

No

50
Q

How is dementia different to memory problems associated with normal ageing?

A

Dementia is sufficient enough to impair ADLs

Family are not usually concerned with memory problems

51
Q

What is the transitional condition between normal ageing and dementia known as?

A

Mild Cognitive Impairment

52
Q

Define Mild Cognitive Impairment (MCI)

A

May affect memory, problem solving, planning, language, visuospatial awareness

Does NOT interfere significantly with daily life

53
Q

Where is a patient referred to if they are suspected to have dementia?

A

Memory Clinic

54
Q

Where are patients referred to if they are seen to have rapidly progressive dementia?

A

Neurology

Integrated Care (2 decks)

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