Dementia, Delirium & Cognitive Decline

Question 1

What is dementia?

Answer 1

• Umbrella term (>100 different types)
• Progressive neurological disorder
• Group of symptoms caused by disorders affecting the brain

Question 2

What are the common symptoms of dementia?

Answer 2

• Hard to make new memories
• Hard to communicate
• Confusion

Question 3

What are some of the common types of dementia?

Answer 3

• 70% Alzheimer’s
• Lewy body
• Vascular
• Frontotemporal
• Mixed

Question 4

What are some of the less common types of dementia?

Answer 4

• Korsakoff’s syndrome
• HIV associated
• Huntington’s disease
• Mild cognitive impairment (MCI)

Question 5

What is a rare type of dementia?

Answer 5

Younger onset

Question 6

What conditions may have similar symptoms to dementia (but are reversible & not degenerative)?

Answer 6

• Vitamin & hormone deficiencies
• Depression
• Medication interaction
• Polypharmacy
• Infection
• Brain tumours
• Delirium
• MCI

Question 7

What is the pathology of Alzheimer’s?

Answer 7

• Abnormal plaques & tangles accumulate in the brain
• Plaques & tangles slowly destroy the hippocampus
• Slowly spreads to other parts of the brain (language, logic, emotion, sensory interpretation, long term memories)
• Finally compromises balance, coordination & autonomic function

Question 8

What are the characteristics of Alzheimer’s?

Answer 8

• Gradual onset & progressive decline
• Short then long-term memory
• Decline in cognition & executive functioning
• Difficulties with language, spatial skills
• Mood swings
• Visual & hearing disturbances
• Loss of enthusiasm/ability to initiate
• Decline in physical function

Question 9

When does the first lesion form in Alzheimer’s?

Answer 9

10-15 yrs before appearance of first symptoms

Question 10

What is the pathology of vascular dementia?

Answer 10

• Damage to blood vessels
• Single stroke or multiple infarct
• Progressive & sudden changes
• Symptoms dependent on area of brain affected
• Some overlap with Alzheimer’s (mild memory loss, behaviour changes, speech & swallowing)

Question 11

What are the characteristics of frontotemporal dementia?

Answer 11

• Atrophy/changes to frontal lobes
• Fixed mood & behaviour
• Loss of empathy
• Apathy or lack of motivation
• Loss of normal inhibitions
• Difficulty in reasoning, judgement, organisation & planning
• Distractibility & impulsiveness
• Changes in eating patterns
• Decline in self-care & personal hygiene

Question 12

What is the pathology of Lewy body disease?

Answer 12

• Degeneration & death of nerve cells (Lewy bodies within cell)
• May be hard to distinguish from PD

Question 13

What are the characteristics of Lewy body disease?

Answer 13

• Fluctuations in confusion & lucidity within short periods of time
• Parkinsonism (rigidity & balance difficulties)
• Visual hallucinations
• Visuospatial deficits (falls risk)
• Sleep disturbances

Question 14

What functions of the brain are affected by dementia?

Answer 14

• Memory
• Orientation
• Judgement/decision making
• Multi stage tasks
• Language
• Cognition
• Personality & behaviour
• Initiative
• Confusion

Question 15

What does dementia increase risk of?

Answer 15

• Falls
• Delirium
• Depression
• Difficult behaviour
• Poor nutritions & hydration
• Elder abuse

Question 16

What are the common characteristics of confusion?

Answer 16

• Altered sense (vision, hearing, smell, touch, proprioception)
• Not knowing about self (e.g. thinking they are 35 not 70)
• Memory loss

Question 17

What increases agitation & confusion?

Answer 17

• Confusing structures (noises & smells)
• Fatigue
• Change in routine
• Moving wards/beds
• Unmanaged pain
• Carer demands exceed capacity

Question 18

What are the key issues with dementia in hospitals?

Answer 18

• 30-50% of inpatients have some cognitive impairment
• 50% of those with dementia are not diagnosed
• Dementia = 2x risk of delirium & 2x more likely to die in hospital
• Average length of stay double non-dementia patient

Question 19

What are the strategies for reducing the impact of dementia in hospitals?

Answer 19

• Take time to find out what’s wrong
• Familiar objects
• Memory cues
• Good lighting
• Good signage
• Keeping noise level down
• Try to find out likes/dislikes & limit choices
• Planned admissions & discharges

Question 20

What are 5 things hospital staff should ask carers?

Answer 20

• What things may cause distress?
• What helps settle them down (words, actions)?
• Are there set routines that reassure?
• Are there any repetitive questions/recurring issues that need specific answers? What is the preferred answer?
• Is there somebody they may call out for?
• Are there any signs that indicate they need to go to the toilet?

Question 21

What is the treatment for dementia?

Answer 21

• Medication (slows progression for a short time only)
• Avoid psychotropic & anti-psychotic drugs (accelerate decline)
• Maintain a healthy heart
• Treat co-morbidities (diabetes, BP, cholesterol, limit alcohol)
• Exercise

Question 22

How can a carer be affected by dementia?

Answer 22

• Stress
• Grief
• Loss of occupation
• Role change
• Changes to relationships
• Isolation
• Risk of depression

Question 23

What are the risk factors for dementia?

Answer 23

• Getting older
• Family history
• High BP/cholesterol, diabetes, obesity, CVD
• Lifestyle factors (smoking, excessive drinking)
• Isolation

Question 24

How can the risk of dementia be reduced?

Answer 24

• Reduce CV risk
• Physical activity
• Mental challenge
• Healthy diet
• Social engagement
• Avoiding head injuries
• Managing depression