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Y4 OPIC > Dementia vs Delirium > Flashcards

Dementia vs Delirium Flashcards

1
Q

how would you define dementia?

A

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
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2
Q

what is the pathophysiology of Alzheimers?

A

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

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3
Q

what is the pathophysiology of vascular dementia?

A
  • second most common, M>F
  • cerebrovascular infarcts, affecting white matter, grey nuclei, striatum → HTN, vascular RF
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4
Q

what is the pathophysiology of lewy-body dementia?

A

spherical lewy body proteins, deposits in substantia niagra may present as parkinson’s

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5
Q

what is the pathophysiology of of fronton-temporal dementia?

A

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

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6
Q

what are some Alzheimers specific clinical features?

A

early impairment of memory
manifests as short term memory loss
difficulty learning new information

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7
Q

what are some vascular dementia specific clinical features?

A

stepwise decline in function
predominant gain
attention and personality changes
focal neuro signs - previous stroke

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8
Q

what are some Lewy body dementia specific clinical features?

A

parkinsonism
fall
syncope
hallucinations

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9
Q

what are some FTD specific clinical features?

A

onset before 65
personality change
behavioural disturbances
sexual disinhibition
memory and perception relatively preserved

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10
Q

what are some general dementia clinical features?

A
  • cognitive impairment: poor memory, language problems, problems with executive functioning, disorientation
  • BPSD
  • activities of daily living impaired: loss of independence
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11
Q

what are BPSD specific symptoms of dementia?

A
  • agitation and emotional liability
  • depression and anxiety
  • sleep cycle disturbance
  • disinhibition - social or sexually inappropriate
  • withdrawal and apathy
  • motor disturbance - wandering
  • psychosis
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12
Q

how is cognition assessed in suspected dementia patients?

A

*Assess domains attention & cognition, recent and remote memory, language, praxis, executive function, visuospatial

  • MMSE
  • ACE-III
  • abbreviated mental score
  • Mini-cog
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13
Q

What are some differentials for dementia?

A

hypothyroidism
prion disease
HIV related
normal pressure hydrocephalus
severe depression
drugs
delirium

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14
Q

what is the presentation of prion disease?

A
  • 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
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15
Q

what is HIV related cognitive impairment like?

A
  • 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
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16
Q

how does normal pressure hydrocephalus present?

A
  • 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
17
Q

how is normal pressure hydrocephalus managed?

A

ventriculoperitoneal shunt used drain excess CSF into abdomen to relieve pressure

18
Q

how would you differentiate between severe depression and dementia?

A

*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)
19
Q

How is dementia diagnosed?

A

*memory clinic
- functional ability: decline previous previous
- cognitive domains: 2<
- differentials excluded

20
Q

what is mild cognitive impairment?
*what is the significance?

A
  • 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

21
Q

what are some investigations carried out for dementia?

A
  • 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
22
Q

what is the management of dementia?

A
  • 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
23
Q

what is delirium?

A

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
24
Q

what are some causes of delirium?

A

Pain
Infection
Nutrition
Constipation
Hydration

Medication
Electrolytes

*not to forget change in env, hearing impairment, emotional stress and constipation

25
Q

what is the classification of delirium?

A

hyperactive: inappropriate behaviour, agitation or hallucinations, wandering, restlessness

hypoactive: reduced activity, quiet, lethargic, withdrawn, reduced concentration

mixed

26
Q

what are some risk factors of developing delirium?

A
  • age >65y
  • multiple co-morbidities
  • frailty
  • malnutrition
  • sensory impairment - vision, hearing
  • functional impairment
  • alcohol excess
  • major injury - hip #
  • cognitive impairment - dementia
27
Q

what are some clinical features of delirium?

A
  • abnormal consciousness
  • abnormal cognition
  • abnormal thinking
  • abnormal perception
  • other: labile changes mood, agitation, sleep disturbance
28
Q

how is delirium diagnosed?

A

DSM-5 criteria
- disturbance awareness
- acute onset
- disturbance in cognition
- not better explained by PMH
- evidence of an organic cause

29
Q

Differentiate between delirium vs dementia?

A

Causes - Dementia is a progressive neurological disorder, delirium is fluctuating state of acute confusion which has an underlying cause like infection

Onset - Dementia develops over months to years whereas delirium shows a more acute onset of hours to days

Symptoms - can be similar with behavioural changes, confusion, agitation etc but with delirium sx more likely to fluctuate

Attention - those with Dementia tend have relatively preserved attention and consciousness whereas those with delirium have impaired attention and consciousness

Course - Dementia may be stable and decline overtime whereas delirium quicker

Treatment - Dementia has no treatment for cognitive decline whereas in Delirium the cognition improves with the treatment of the underlying cause

30
Q

how is delirium assessed?

A
  • history
  • cognitive assessment
  • clinical examination
  • confusion screen: bloods including B12, folate, glucose, TFT, bone profile, infection markers // urinalysis // imaging
31
Q

How is delirium managed?

A

*identify cause + treat
- acute needs: deesclation and rapid tranquillisation with benzo, antipsychotics
- supportive: gentle reorientation, access to aids, enable independence
- environment adjustment: family involved, control noise
- medication: infection tx
- post-discharge: avoid precipitation

*Mental capacity act + Deprivation of Liberty Safeguarding (DoLS) involved when needed

32
Q

What is pseudomentia? and what are the key features to identify?

A

cognitive deficits in older patients battling depression
- short duration of dementia
- equal effects on both long and short-term memory, with patients often demonstrating amnesia for specific, emotionally charged events
- early loss of social skills and an overall lack of effort
- Highlighted failures in responses to memory-related questions

  • Common responses of “don’t know” to questions, rather than attempting to guess
33
Q

how do you manage pseudo-dementia?

A

treating the underlying depressive disorder, often with a combination of antidepressant medication and cognitive-behavioural therapy

*With appropriate treatment, cognitive symptoms usually improve or resolve

Y4 OPIC (10 decks)

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