Demetia And Delirium Flashcards
What is dementia?
It is a syndrome (a collection of symptoms) with cognitive and behavioural symptoms
It has an insidious onset (patient don’t know have it)
Chronic with slow deterioration (progressive)
What are the cognitive symptoms of dementia?
The symptoms the patient experiences depends on the the lobe(s) of the brain affected.
Impairment of memory (temporal)
Orientation (parietal)
Learning capacity (frontal)
Judgement (frontal)
What are the non-cognitive symptoms of Demetria?
Behavioural symptoms:
Agitation and Aggression (don’t know where they are)
Wandering
Sexual disinhibition (frontal lobe)
Psychotic:
Visual and Auditory Hallucinations
Persecutory dellusions
Depression and anxiety
Sleep symptoms:
Insomnia
Daytime Drowsiness
How do you diagnose dementia?
It is a diagnosis of exclusion
What things do you have to exclude to diagnose dementia?
Hypothyroidism
Hypercalcaemia
B12 deficiency
Normal pressure hydrocephalus
How diagnose demetia?
Cognitive decline
Resulting impairment in activities of daily living
Clear consciousness
What are some types of dementia?
Alzheimer’s Disease
Vascular demetia
Dementia with Lewy bodies
AIDS Dementia complex.
What macroscopic changes occur with Alzheimer’s disease?
Global atrophy
Sulcal widening
Enlarged ventricles (3rd and 4th)
What microscopic changes occur with Alzheimer’s disease?
Senile plaques (AB protein)- Amyloid precursor protein (APP) broken down to AB protein
Neurofibrillary tangles - Hyperphospholylated Tau proteins.
Causes: Neuronal death.
Decrease: ACh, NA, 5HT, Somatostatin
What is vascular dementia?
Cognitive impairment caused by ischaemia or haemorrhage secondary to cerebrovascular disease.
Pathologically = at least one area of cortical infarction
What are the risk factors for vascular demetia?
Stroke, hypertension, hypercholesterolaemia, diabetes, smoking
To treat: treat risk factors
How does vascular dementia present?
Stepwise (sudden decrease in cognitive impairment)
Focal neurological symptoms. -Symptoms depends on where the lesion is.
What is a Lewy Body?
Aggregation of a-synuclein protein
Spherical
Intracytoplasmic deposition
Where are Lewy Bodies deposited in dementia?
Substantia Nigra
Temporal lobe
Frontal lobe
Cingulate Gyrus
How does LBD present?
Fluctuating cognition and alertness Vivid visual hallucinations Spontaneous features of Parkinsonism. Repeated falls (shuffling gait) Sensitive to neuroleptic malignant syndrome. -So no anti-psychotics in LBD.
What is Neuroleptic Malignant Syndrome?
Side effect to anti-psychotics (sudden drop in dopamine)
What are the symptoms of Neuroleptic Malignant syndrome?
F - Fever
E - Encephalopathy (confusion)
V - Vital signs instability (tachycardia, tachypnoea, fluctuating BP
E - Elevated enzymes (Creatinine Phosphokinase)
R - Rigidity
What is frontotemporal dementia?
Atrophy of frontal and temporal lobe
Second most common cause of early onset dementia (<65yrs)
What are the symptoms of frontotemporal demetia?
Symptoms are based on lobe dysfunction:
Loss of inhibition Inappropriate social behaviour Loss of motivation without depression Repetitive / ritualistic behaviours Non-fluent aphasia ( Broca’s dysphagia)
What is ADC?
AIDS-complex dementia.
Prevalence of ADC is on the rise.
Increased life expectancy of patients who have developed AIDS or HIV positive patients.
Occurs when HIV infected macrophages enter the brain and cause damage to neurones.
Onset is insidious but once established the progression is rapid.
What are the clinical features of ADC?
Cognitive Impairment Psychomotor retardation Tremor Ataxia Dysarthria Incontinence
How do Psychiatrists manage dementia?
Bio-Phyco-Social model
What pharmalogical treatment can be used to treat dementia?
Acetylcholinesterase inhibitors (donepazil, Rivastigmine) - modest efficacy for improving cognition in mild to moderate AD.
NMDA Antagonists (memantine) - reduced overstimulation of glutamate activity.
What should you discuss with a patient and carer with dementia?
Explain the disease in a sensitive way
How problems can be managed
Results of special investigations (bloods)
Ability to drive a car (can no longer drive)
Management of financial resources (will)
What things should you arrange with the family of a Demetia patient?
Need for day-care
Need for respite-care
Resources available for careers
Placement for Nursing / Residential home.
What is delirium?
Insult to the brain that leads to acute neuronal cell damage cause by hypoxia and/or inflammation.
How does delirium present?
Acute / Rapid onset
Clouded consciousness
Fluctuating Course
Transient Visual Hallocinations
What are the three types fo delirium?
Hypoactive
Hyperactive
Mixed
How does a hypoactive delirium present?
Withdrawn
Quiet
Sleepy behaviour
Less likely to be recognised
Fluctuating mood
Poorly systematised transient delusions
Symptoms worse at dawn and dusk.
How does hyperactive delirium present?
Restless
Agitated
Aggressive behaviour.
Fluctuating mood
Poorly systematised transient delusions
Symptoms worse at dawn and dusk.
What could cause acute confusion states?
Nutritional - B12/folate deficiency
Intracranial -Trauma, Haemorrhage, infections
Extracranial infections - UTI, pneumonia, sepsis
Iatrogenic - sepsis after chemo, sedatives
Alcohol -Intoxication withdrawal
Endocrine Hyper/hypothyroidism, hyper/hypoglycaemia
Metabolic - Hypoxia, Renal/ Metabolic system failure
How do you manage delirium?
Treat the underlying cause.
Prognosis is poor if not treated correctly.
What is prognosis of delirium?
Increased risk of dementia
Mortality
Length of stay in hospital
Risk of new admission into long term care.
