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Foundations II (Cholley) > Dementia vs Delirium > Flashcards

Dementia vs Delirium Flashcards

1
Q

What are characteristics of “Normal state of consciousness”

A
  • Wakefulness, awareness, alertness when not asleep
  • Can be readily awakened
  • Requires arousal & cognition
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2
Q

What is arousal mediated by?

A

RAM

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3
Q

Cognition is a function of what?

A

Properly working hemispheres

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4
Q

Define: clouding of consciousness

A
  • Very mild form of AMS

- Inattention & reduced wakefulness

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5
Q

Define: confusional state

A
  • More profound deficit

- Disorientation, bewilderment & difficulty following commands

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6
Q

Define: lethargy

A
  • Severe drowsiness

- Can be aroused by moderate stimuli, then drifts back to sleep

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7
Q

Define: obtundation

A
  • Similar to lethargy
  • Lessoned interest in the environment
  • Slowed responses to stimulation
  • Sleeps more than normal w/ drowsiness btwn sleep states
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8
Q

Define: stupor

A
  • Only vigorous & repeated stimuli will arouse

- When left alone will immediately relapse

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9
Q

Define: coma. What is it a complication of?

A

State of unarousable unresponsiveness

- Major complication of serious nervous system d/o

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10
Q

What causes coma?

A
  • seizure
  • hypothermia
  • metabolic disturbances
  • structural lesions
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11
Q

How do you tx all comatose patients?

A

Hospitalization & referral to neurologist or neurosurgeon

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12
Q

What are the 3 phases used to evaluate an altered patient?

A
  • Determine level of consciousness
  • Search for cause of confusion/coma
  • Look for presence or absence of focality of the d/o
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13
Q

What are the components of the GCS?

A

15 point scale

  • Eye opening response
  • Verbal response
  • Motor response
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14
Q

What GCS is considered normal vs AMS vs coma?

A
  • Normal = 15 pts
  • AMS = greater than 3, but less than 15 pts
  • Coma = 3 pts
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15
Q

What medical conditions can cause AMS?

A
  • DM
  • HTN
  • Endocrine dz
  • Renal failure
  • CA
  • Dementia
  • Seizure
  • Psychiatric
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16
Q

Describe dementia.

A

Progressive intellectual decline

17
Q

What are RFs of dementia?

A
  • Age*
  • Family hx
  • Vascular dz
  • DM
  • Hx of head injury
18
Q

What population is most affected by dementia?

A

Females, after age 60

19
Q

What should you be concerned about in a pt w/ dementia?

A
  • Vit D deficiency
  • Chronic sleep deprivation
  • Need to educate
20
Q

What is the MC form of dementia? How do you make the dx?

A
  • Alzheimers

- Definitive dx = autopsy or brain biopsy

21
Q

Describe dementia w/ lewy bodies. What other conditions have lewy bodies?

A

Type of dementia caused by deposits that damage cells over time.
- Lewy bodies are also found in Alzheimers & Parkinsons

22
Q

What other microscopic findings are found in dementia?

A
  • Plaques: deposits of protein “beta-amyloid”

- Tangles: twisted fibers of protein “tau”

23
Q

Describe vascular dementia. What causes it? When does it occur?

A

Multifocal ischemic change

  • Cause: impaired blood flow
  • Occurs after CVA
24
Q

What are RFs of vascular dementia?

A
  • HTN
  • Hyperlipidemia
  • Smoking
25
Q

What are sx of vascular dementia?

A
  • Memory loss
  • Difficulty planning/organizing
  • Confusion, apathy
  • Wandering
  • Poor judgement, reasoning
  • Difficulty w/ math, problem solving
  • Agitation, aggression, hallucinations, delusions
  • Mood/behavior changes
  • Inappropriate laughing/crying
26
Q

Define: Delirium

A

Acute, confused state that occurs in response to an identifiable trigger

27
Q

What are causes of delirium?

A

“I WATCH DEATH”

  • Infection
  • Withdrawal
  • Acute metabolic
  • Traumatic injury
  • CNS lesion
  • Hypoxia
  • Def of vitamins
  • Edocrine
  • Acute vascular
  • Toxins
  • Heavy metals
28
Q

What are differences btwn dementia & delirium?

A

Dementia:

  • Slow & insidious (mos-yrs)
  • Not reversible

Delirium:

  • Acute (days-mos)
  • Potentially reversible
29
Q

How does dementia present?

A
  • Short term memory loss
  • Word finding difficulty
  • Visuospatial dysfunction
  • Executive dysfunction
  • Apathy
  • Apraxia
30
Q

What is the workup for dementia?

A
  • Neuropsychological assessment: MMSE
  • MRI preferred, PET scan
  • Labs: B12, T4, TSH, RPR, CBC, CMP, lipids, ApoE
31
Q

How do you tx dementia?

A
  • Aerobic exercise (45mins)
  • Mental stimulation
  • Mood/behavior tx: SSRIs
  • Psychostimulants for apathy
  • Trazodone for insomnia
  • Those w/ lewy bodies: Memantine
32
Q

How do you tx Alzheimers?

A
  • Cholinesterase inhibitors
  • Donepezil (for mild-mod)
  • Rivastigmine
  • Memantine (for mod-severe)
33
Q

What medication do you want to avoid in dementia?

A

Paroxetine *due to anticholinergic effect

34
Q

What is the most common cause of rapidly progressive dementia?

A

Jakob-Creutzfeldt disease (human form of mad cow disease)

- Check for PRNP gene mutation

Foundations II (Cholley) (25 decks)

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