Dementia vs Delirium Flashcards
What are characteristics of “Normal state of consciousness”
- Wakefulness, awareness, alertness when not asleep
- Can be readily awakened
- Requires arousal & cognition
What is arousal mediated by?
RAM
Cognition is a function of what?
Properly working hemispheres
Define: clouding of consciousness
- Very mild form of AMS
- Inattention & reduced wakefulness
Define: confusional state
- More profound deficit
- Disorientation, bewilderment & difficulty following commands
Define: lethargy
- Severe drowsiness
- Can be aroused by moderate stimuli, then drifts back to sleep
Define: obtundation
- Similar to lethargy
- Lessoned interest in the environment
- Slowed responses to stimulation
- Sleeps more than normal w/ drowsiness btwn sleep states
Define: stupor
- Only vigorous & repeated stimuli will arouse
- When left alone will immediately relapse
Define: coma. What is it a complication of?
State of unarousable unresponsiveness
- Major complication of serious nervous system d/o
What causes coma?
- seizure
- hypothermia
- metabolic disturbances
- structural lesions
How do you tx all comatose patients?
Hospitalization & referral to neurologist or neurosurgeon
What are the 3 phases used to evaluate an altered patient?
- Determine level of consciousness
- Search for cause of confusion/coma
- Look for presence or absence of focality of the d/o
What are the components of the GCS?
15 point scale
- Eye opening response
- Verbal response
- Motor response
What GCS is considered normal vs AMS vs coma?
- Normal = 15 pts
- AMS = greater than 3, but less than 15 pts
- Coma = 3 pts
What medical conditions can cause AMS?
- DM
- HTN
- Endocrine dz
- Renal failure
- CA
- Dementia
- Seizure
- Psychiatric
Describe dementia.
Progressive intellectual decline
What are RFs of dementia?
- Age*
- Family hx
- Vascular dz
- DM
- Hx of head injury
What population is most affected by dementia?
Females, after age 60
What should you be concerned about in a pt w/ dementia?
- Vit D deficiency
- Chronic sleep deprivation
- Need to educate
What is the MC form of dementia? How do you make the dx?
- Alzheimers
- Definitive dx = autopsy or brain biopsy
Describe dementia w/ lewy bodies. What other conditions have lewy bodies?
Type of dementia caused by deposits that damage cells over time.
- Lewy bodies are also found in Alzheimers & Parkinsons
What other microscopic findings are found in dementia?
- Plaques: deposits of protein “beta-amyloid”
- Tangles: twisted fibers of protein “tau”
Describe vascular dementia. What causes it? When does it occur?
Multifocal ischemic change
- Cause: impaired blood flow
- Occurs after CVA
What are RFs of vascular dementia?
- HTN
- Hyperlipidemia
- Smoking
