Dementia vs Delirium Flashcards
how would you define dementia?
irreversible, progressive decline and impairment of more than one aspect of higher brain function without impairment of consciousness
- concentration, memory, language, personality, emotion
- measured through impaired ADL
what is the pathophysiology of Alzheimers?
amyloid plaques and neurofibrillary tangles of TAU protein → accumulation leads to reduced information transmission and death of brain cells
deficit of ACh from damage to ascending forebrain projections
atrophy of cortex and hippocampus
*M>F
what is the pathophysiology of vascular dementia?
- second most common, M>F
- cerebrovascular infarcts, affecting white matter, grey nuclei, striatum → HTN, vascular RF
what is the pathophysiology of lewy-body dementia?
spherical lewy body proteins, deposits in substantia niagra may present as parkinson’s
what is the pathophysiology of of fronton-temporal dementia?
neuron damage and death in frontal and temporal lobes, atrophy due to deposition of abnormal proteins (TAU) → genetics
Pick bodies - spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques
*mostly under 65
what are some Alzheimers specific clinical features?
early impairment of memory
manifests as short term memory loss
difficulty learning new information
what are some vascular dementia specific clinical features?
stepwise decline in function
predominant gain
attention and personality changes
focal neuro signs - previous stroke
what are some Lewy body dementia specific clinical features?
parkinsonism
fall
syncope
hallucinations
what are some FTD specific clinical features?
onset before 65
personality change
behavioural disturbances
sexual disinhibition
memory and perception relatively preserved
what are some general dementia clinical features?
- cognitive impairment: poor memory, language problems, problems with executive functioning, disorientation
- BPSD
- activities of daily living impaired: loss of independence
what are BPSD specific symptoms of dementia?
- agitation and emotional liability
- depression and anxiety
- sleep cycle disturbance
- disinhibition - social or sexually inappropriate
- withdrawal and apathy
- motor disturbance - wandering
- psychosis
how is cognition assessed in suspected dementia patients?
*Assess domains attention & cognition, recent and remote memory, language, praxis, executive function, visuospatial
- MMSE
- ACE-III
- abbreviated mental score
- Mini-cog
What are some differentials for dementia?
hypothyroidism
prion disease
HIV related
normal pressure hydrocephalus
severe depression
drugs
delirium
what is the presentation of prion disease?
- disease indolent for many years, PC minor memory lapses, loss of interest, mood disturbances
- progresses quickly - unsteadiness, physical clumsiness, stiffness, jerking movements, incontinence, aphasia
- death within 6m
what is HIV related cognitive impairment like?
- almost half of those with HIV experience cognitive sx - mild cognitive impairment and dementias
- milder cognitive impairment - indirectly by weak immune system or directly by virus
- STM problems, concentration issues, thinking and language skills
- mood disturbance - common, misdiagnosed as depression
- milder cognitive impairment - indirectly by weak immune system or directly by virus
how does normal pressure hydrocephalus present?
- common in elderly, RF head trauma, infection, inflammation in brain, tumour, subarachnoid haemorrhage leading to reduced CSF absorption at the arachnoid villi
- sx: triad of urinary incontinence, dementia+bradyphrenia, gait abnormality
how is normal pressure hydrocephalus managed?
ventriculoperitoneal shunt used drain excess CSF into abdomen to relieve pressure
how would you differentiate between severe depression and dementia?
*depression favoured if
- short history, rapid onset
- biological symptoms e.g. weight loss, sleep disturbance
- patient worried about poor memory
- reluctant to take tests, disappointed with results
mini-mental test score: variable - global memory loss (dementia characteristically causes recent memory loss)
How is dementia diagnosed?
*memory clinic
- functional ability: decline previous previous
- cognitive domains: 2<
- differentials excluded
what is mild cognitive impairment?
*what is the significance?
- deficits in one or more major cognitive domains - insufficient to interfere with ADL
*helps identify patients who may progress to dementia → undertake healthy brain activities
what are some investigations carried out for dementia?
- FBC, ESR, U&E, HbA1c, LFT, TFT, B12, folate, bone profile
- ECG
- virology - HIV
- syphilis testing
- CXR
- neuroimaging - MRI
- but CT exclude tumours etc
- biomarkers - functional MRI
- mental health
what is the management of dementia?
- assess capacity, advanced care planning, LPA
- mental health
- driving: DVLA
- pharmacological: Donepezil or mimantine if severe
- exercise, art therapy, music therapy
- BPSD mx
- care plans: referral
- end of life care planning when needed
what is delirium?
state of acute confusion typified by abnormal consciousness, attention, perception and cognition
- hours to days
- fluctuating sx - altering through day
- disturbance in awareness and attention
- disturbance cognition
- evidence of organic cause
what are some causes of delirium?
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Electrolytes
*not to forget change in env, hearing impairment, emotional stress and constipation
