Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Mental Health > Demetia and Delirium > Flashcards

Demetia and Delirium Flashcards

1
Q

Define cognitive impairment

A

A disturbance of higher cortical functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is meant by higher cortical functions?

A

Memory

Thinking

Judgement

Language

Perception

Awareness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is cognitive impairment variable?

A

It can affect a single or multiple higher cortical functions.

It can be static or progressive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Is cognitive impairment a specific illness?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If cognitive impairment is not a specific illness, what is it?

A

A description of someone’s condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define dementia

A

A persistent and disabling cognitive impairment with a decline in memory and thinking sufficient to impair personal ADL’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does ADL stand for?

A

Activities of daily living

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do patients with dementia have problem with?

A

Processing incoming information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do patients with dementia have problem with as a result of not being able to process incoming information?

A

Maintaining and directing attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What level of consciousness do people with dementia display?

A

Clear consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long must a person have these symptoms before being diagnosed with dementia?

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What can often happen despite the commonness of dementia?

A

Missed diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is dementia static or progressive?

A

Nearly always progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is meant by ‘the inverse care law applies to dementia’?

A

Those who are most dependent and vulnerable often have the least awareness of their disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What diseases can cause dementia?

A

Alzheimer’s disease

Vascular dementia

Frontotemporal dementia

Dementia with Lewy bodies

Huntington’s disease

Other causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the features of early stage dementia

A

Forgetfulness and other memory symptoms

Subtle changes in mood and behaviour, e.g. loss of motivation

Usually little intrusion into day to day activities if they are not too demanding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the features if mid-stage dementia

A

More prominent memory problems

Difficulty with language and executive function may emerge

Marked changes in behaviour

More obvious disability

Complex events may be difficult to deal with e.g. managing finances

Usually require frequent support

Awareness of disability may start to diverge from reality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the features of late stage dementia

A

Severe and pervasive memory problems

Severe disorientation and failure to recognise familiar people

Marked behavioural changes e.g. restlessness, disinhibition, severe apathy

Basic aspects of personal function begin to fail and generally require more or less continuous supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the course and onset of Alzheimer’s

A

Gradual, insidious onset with slow progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the early symptoms of Alzheimer’s

A

Usually memory impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What neurological symptoms are associated with Alzheimer’s?

A

None

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the mood and behavioural changes that can accompany Alzheimer’s

A

May be minimal initially, but pre-existing anxiety may worsen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the structural brain imaging seen in Alzheimer’s

A

Volume loss in the medial temporal lobe, posterior cingulate and precuneus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the course and onset of vascular dementia

A

May be gradual or more abrupt onset

Erratic course

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe the early symptoms seen in vascular dementia

A

Variable, but may be prominent dysexecutive features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What neurological features accompany vascular dementia?

A

Highly variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What mood and behavioural changes may accompany vascular dementia?

A

Depression is common after a stroke

Emotional lability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What structural brain imaging changes are seen with vascular dementia?

A

May be evidence of infarcts, bleeds and white matter ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the course and onset of frontotemporal dementia

A

Gradual onset but may progress quickly especially in younger patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Describe the early symptoms seen in frontotemporal dementia

A

Loss of executive function and impaired social behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What neurological features are seen with frontotemporal dementia?

A

Frontal release signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What mood and behavioural changes may be seen in frontotemporal dementia?

A

Apathy

Loss of volition

Disinhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What changes in structural brain imaging can be seen with frontotemporal dementia?

A

Frontotemporal atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the course and onset of Lewy body dementia

A

Fluctuating episodic course

May initially look like delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What early symptoms may present in Lewy body dementia?

A

Perceptual disturbance (hallucinosis) and Parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What neurological features can accompany Lewy body dementia?

A

Lots!

Mainly Parkinsonism

37
Q

What mood and behavioural changes can accompany Lewy body dementia?

A

May be paranoia and suspicion arising from psychotic symptoms

38
Q

What changes appear on structural brain imaging in Lewy body dementia?

A

No specific abnormalities

39
Q

Describe the course and onset of alcoholic dementia

A

May be a gradual onset but cognitive status fluctuates with drinking and withdrawal episodes

40
Q

What early symptoms present in alcoholic dementia?

A

Memory problems and dysexecutive features

41
Q

What neurological features accompany alcoholic dementia?

A

None

42
Q

Describe the mood and behavioural changes that may accompany alcoholic dementia

A

Depression commonly associated with alcohol misuse problems

43
Q

What structural brain imaging changes can occur?

A

Age-disproportionate cortical and white matter atrophy

44
Q

How many stages are there in the process of assessing dementia?

A

2

45
Q

What do the two stages of assessing dementia look at?

A

The syndrome of dementia and then the disease that causes it

46
Q

What questions are important to ask as part of taking a history of dementia?

A

What is the course of symptoms over time?

Is there evidence of disability or impact on day to day life?

Why have they presented now?

Has anything happened/changed recently?

Have there been any changes in general health?

47
Q

What aspects should make up an examination of a patient with dementia?

A

Cognitive screening assessment

Check for new physical findings if prompted by the history

48
Q

What investigations should be conducted when assessing a patient with dementia?

A

‘Dementia screen’ of blood - doesn’t screen for dementia itself but screens for other active problems which may be contributing

Structural brain imaging (CT or MRI)

Functional brain imaging

Specialised tests in special situations

49
Q

What specialised tests may be used to assess dementia?

A

EEG

Lumbar puncture

50
Q

What does management of dementia consist of?

A

Information and explanation

Psychological support

Practical advice

Carer support

51
Q

What do some (but not all) types of dementia need as part of management?

A

Drug treatments

52
Q

What types of drugs are indicated for Alzheimer’s disease?

A

Cholinesterase inhibitors

NMDA receptor antagonists

53
Q

What cholinesterase inhibitors are used to treat Alzheimer’s disease?

A

Donzepil

Rivastigmine

Galantamine

54
Q

What NMDA receptor antagonist is used to treat Alzheimer’s disease?

A

Memantine

55
Q

When should cholinesterase inhibitors be used in Alzheimer’s?

A

For mild to moderate disease

56
Q

When should NMDA receptors antagonists be used in Alzheimer’s?

A

In moderate to severe disease?

57
Q

What drugs should be avoided in patients with Alzheimer’s?

A

Anticholinergic drugs

Benzodiazepines

Antipsychotic tranquillisers

58
Q

What drugs should be used to treat patients with Lewy body dementia?

A

Rivastigmine

59
Q

Define delirium

A

Acute onset of cognitive deterioration

60
Q

What are the symptoms of delirium

A

Impairment of cognition (typically fluctuating)

Disturbances of attention and conscious level

Abnormal psychomotor behaviour and affect

Disturbed sleep-wake cycle

61
Q

Over what time period does onset?

A

Acute - usually within hours or days

62
Q

When are symptoms of delirium at their worst?

A

Fluctuate throughout the day and worst at night

63
Q

What is the earliest stage of delirium?

A

Clouding of consciousness characterised by additional deficits

64
Q

What additional deficits can characterise early delirium?

A

Vague rambling conversation

Drifting off the point

Undue distractibility

65
Q

In what modality does perceptual disturbance usually occur in delirium?

A

Visual

66
Q

How does visual perceptual disturbance present in delirium?

A

Usually fluctuating on a continuum from normal through various stages of perceptual distortion to hallucination.

67
Q

What are the 2 behavioural sub-types of delirium?

A

Hyperactive

Hypoactive

68
Q

What characteristics occur in a patient in a hyperactive delirious state?

A

Heightened arousal

Restlessness

Irritability

Wandering

Carphologia

69
Q

What characteristics occur in a patient in a hypoactive delirious state?

A

Quiet

Sleepy

Inactive

Unmotivated

70
Q

Which type of delirium is most commonly over looked?

A

Hypoactive delirium

71
Q

What classes of drugs can cause delirium?

A

Psychotropic drugs

Antiparkinsonian drugs

Anticholinergic drugs

Opiates

Diuretics

Recreational drug use and withdrawal

72
Q

What psychotropic drugs can cause delirium?

A

Anti-depressants

Anti-psychotics

Benzodiazepines

73
Q

What is used to assess delirium?

A

Confusion Assessment Method (CAM)

74
Q

What 4 features suggest delirium using the CAM?

A
  1. Acute onset and fluctuating course
  2. Inattention
  3. Disorganised thinking
  4. Altered level of consciousness
75
Q

How is the onset and course of delirium assessed?

A

Usually obtained from family member/nurse

Shown by positive responses to questions e.g. any change in mental status? Did this behaviour fluctuate?

76
Q

How is inattention assessed in delirium?

A

Did the patient have difficulty focusing attention e.g. easily distracted or difficulty following what was said?

77
Q

How is disorganised thinking assessed in delirium?

A

Was the patient’s thinking incoherent, e.g. rambling, unclear flow of ideas.

78
Q

Once a patient presents with delirium what immediate actions must be taken?

A

Collateral history

Identify and treat underlying causes

Check if patient fits the SIRS

Cognitive assessment with AMT 10/MMSE

Complete ‘know me better’ profile with carers

Heighten level of supervision

79
Q

What can cause delirium?

A

Trauma

Hypoxia

Increasing age or fragility

NoF#

Alcohol withdrawal

Drugs

Environment changes

Lack of sleep

I’m a balanced electrolytes

Urinary retention/constipation

Infection/sepsis

Uncontrolled pain

80
Q

What kind of trauma can cause delirium?

A

Head injury

Intracranial event

81
Q

How can hypoxia causing delirium occur?

A

PE

CCF

MI

COPD

Pneumonia

82
Q

What is management of delirium related to?

A

The underlying cause

83
Q

How is delirium treated if it is caused by hypoxia/electrolytes?

A

Treat hypoxia/electrolyte imbalance

Follow sepsis guidelines

84
Q

How is delirium treated if it is caused by constipation?

A

PR to exclude impaction

Ensure good hydration

Laxatives and enemas if required

Encourage to sit out on toilet if appropriate

85
Q

How is delirium treated if it is caused by urinary retention?

A

Treat underlying cause

Only catheterise if necessary

86
Q

How is delirium treated if it is caused by pain?

A

Utilise other routes of analgesia administration

Use non-verbal pain scores

87
Q

How does delirium affect the prognosis of acutely ill patients?

A

Worsens it

88
Q

How does delirium worsen an acutely ill patient’s prognosis?

A

Lead to increased length of stay

Increased complications e.g. falls/infection

89
Q

How does delirium have a relationship with more persistent cognitive impairment?

A

Pre-existing cognitive impairment is a risk factor for delirium

Delirium can take > 3 months to resolve in some cases leading to incorrect diagnosis of dementia

Some evidence that some types of delirium can precipitate dementia

Year 3 - Mental Health (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions