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Geriatrics > Dementia vs Delirium > Flashcards

Dementia vs Delirium Flashcards

1
Q

Define dementia

A

Major neurocog disorder
- acquired disorder characterized by decline in cognition involving 1+ cognitive domains

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2
Q

Define mild cognitive impairment

A

Mild neurocog disorder
- state between normal cognition and dementia where functional abilities are preserved, but can be a precursor to dementia

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3
Q

Define delirium

A
  • problem with attention, awareness, develops over short period of time
  • triggered by wide variety of chonditions
  • days to months long
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4
Q

Define encephalopathy

A

medical diagnosis characterized by symptoms of delirium, confusion, AMS, secondary to many things like stroke, hypoglycemia, seizure, infection, substances, etc. (ie: septic encephalopathy from a UTI)

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5
Q

Describe the 5 key features of delirium in the DSM 5

A
  • disturbance in attention and awareness
  • short period of time
  • additional cognitive disturbances
  • not explained by established/evolving neurocog disorder
  • evidence that it is secondary to a physiologic consequence
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6
Q

Explain the consequences of delirium

A
  • increases risk of death within a month
  • length of hospital stay doubled
  • increased risk of complications
  • increased risk of dementia
  • 2x risk of RN home need
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7
Q

Describe the pathophys of delirium

A
  • systemic trigger (inflammation, hypoxemia)
  • vulnerabilities exacerbated (neuronal damage, vascular dysfunction, astrocyte/microglia degeneration)
  • cause cellular and functional changes leading to neuronal dysfunction, immune cell infiltration, metabolic insufficiency
  • lead to delirium
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8
Q

List some premorbid factors for delirium

A
  • age
  • dementia
  • low education
  • high comorbidity burden
  • frailty
  • tethers to bed
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9
Q

Describe hypoactive vs hyperactive delirium

A
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10
Q

How to diagnose symptoms of delirium

A

DSM 5 but more commonly the CAM (confusion assessment method)

CAM
- acute onset of mental status change or fluctuations and
- inattention and
- disorganized thinking or
- altered consciousness (anything other than alert)

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11
Q

How can delirium be prevented

A

through delirium prevention protocols that systemically address risk factors (ABCDEF ICU bundle)
- there are no pharm interventions that decrease risk indefinitely (pain, symptom management can help)

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12
Q

How to reduce risk of delirium

A

mitigate risk factors

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13
Q

How to manage delirium

A
  • identify and reverse potential reversible triggers
  • correct physiologic disturbances
  • engage family and other support
  • antipsychotics (olanzepine, haloperidol) off label as last resort - can exacerbate elderly with dementia or increase rate of death
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14
Q

How does the DSM define dementia

A
  • significant cognitive decline in 1+ cognitive domains
  • interference with ADLs
  • not exclusively during delirium
  • not better explained by another mh disorder
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15
Q

What are some of the types of dementia

A
  • Alzheimer’s (60-80%)
  • cerebrovascular disease
  • frontotemporal
  • dementia with lewy body
  • Parkinsons
  • Huntingtons
  • can have mixed types
  • etc.
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16
Q

Why is the rate of dementia increasing so much

A

because we are living longer

17
Q

How does dementia typically present initially

A
  • family/spouse brings problem to attention
  • memory difficulties
  • trouble retaining new info, complex tasks, reasoning, spatial orientation, language, behavior
  • change from baseline gradual and progressive over time
18
Q

Risk factors for dementia

A
  • age
  • lower education level
  • rare genetic factors (APOE Chr 19)
  • CV disease
  • psychiatric disease
  • head trauma
  • heavy alc use
19
Q

What are some protective factors against dementia

A
  • higher education level
  • bilingualism
  • cognitively stimulating activities
  • mediterranean diet
  • physical activity
20
Q

Describe alzheimer’s dementia

A
  • typically 65+ (25% 85-90, 33% 90)
  • memory impairment most common
  • brain changes thought to start 20 years before syx
21
Q

Describe the hallmark pathogenesis of alzheimer’s disease

A

accumulation of tau protein tangles inside neurons and beta-amyloid protein plaques outside neurons in the brain
- tau tangles block nutrients
- beta-amyloid plaques interfere with neuron communication
- results in neuronal death that is progressive and fatal

22
Q

Describe the inflammatory process involved in alzheimers

A

tangles and plaques activate microglia which try to clear the toxic proteins and debris from dying cells
- chronic inflammation sets in when microglia can’t keep up

23
Q

What are some diagnostic tests used in evaluation of alzheimer’s

A
  • clock drawing test: would be abnormal
  • PET biomarkers
24
Q

Describe treatment for Alzheimer’s

A
  • improve symptoms: Donepezil (Cholinesterase inhibitor) or Memantine (NMDA receptor agonist)
  • music, memory training, lighting
25
Q

What are the 5 As related to Alzheimers

A

Amnesia
Anomia
Apraxia
Agnosia
Aphasia

26
Q

Describe vascular dementia

A

associated with CV small vessel ischemic disease resulting in brain tissue lacking oxygen and nutrients
- changes in executive function and processing speed
- associated with strokes
- imaging will show evidence of vascular disease

27
Q

Describe Lewy body disease

A

Abnormal clumps of protein alpha-synuclein inside the neurons
- syx of sleep disturbance, AVH, visuospatial impairment
- often assoc. with Parkinsons

28
Q

Describe frontotemporal dementia

A

nerve cells in frontal and temporal lobes atrophy
- early syx of personality, behavior, language comprehension change

29
Q

What might be on the differential list for dementia evaluation

A
  • neurosurgical conditions (subdural hemorrhage, brain tumors, abscess, normopressure hydrocephalus)
  • inflammatory (meningitis, encephalitis, vasculitis, lyme)
  • metabolic (thyroid, calcium, cushing, hypoglycemia, folate, thamine deficiency, liver, resp, CKD, Wilson)
  • MH, epilepsy, substance use
30
Q

Describe some cognitive screening tools helpful in diagnosing dementia

A
  • clock drawing test
  • MMSE
  • Montreal Cognitive Assessment (MOCA)
  • neuropsych testing (including depression)
31
Q

What labs should be done in evaluating dementia

A

- B12, CBC, TSH
- sometimes syphilis, HIV

32
Q

What imaging should be used in evaluating dementia

A
  • always image for acute onset of cog impairment
  • noncontrast head CT or MIR in routine initial eval: can show atrophy of cerebrum, hippocampus, ventriculomegaly, old ischemia)
33
Q

Describe the non-pharm management of dementia

A
  • treat CV risk factors
  • review meds and avoid AEs
  • nutritional eval
  • exercise programs
  • limit alc
  • manage safety issues (driving, falls, behavior, wandering, cooking)
34
Q

Describe the key differences between delirium and dementia

A
35
Q

Describe the disease course of alzheimer’s

A
36
Q

what is the key triad for normal pressure hydrocephalus

A

urine incontinence, ataxic gait, cognitive impairment
(drain some CSF to see if it gets better)

37
Q

What is the new drug on the block for Alzheimer’s treatment

A

Aducanumab
- only in research studies
- monoclonal antibody directed against beta-amyloid plaques
- approved for mild alzheimers/mild cognitive impairment
- slows decline of alzheimers maybe, but how much plaque needs to be removed

Geriatrics (34 decks)

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