E2 Delirium & Dementia Flashcards
Delirium also called
acute confusional state
Delirium
-Transient disorder of cognitive function, consciousness, or perception
-Can be sudden or gradual onset
-Hyperactive confusional state & Hypoactive confusional state
Hyperactive delirium
-Acute disturbance in attention or awareness
-Typically develops over 2-3 days
-Usually seen in ICUs, post-surgery, withdrawal, hospitalized elderly
Hyperactive delirium Risk Factors
-Medications
-Acute infection/ sepsis
-Surgery
-Hypoxia
-Electrolyte or metabolic disfunction
-Insomnia
Manifestations of hyperactive delirium
-Restlessness
-Irritability
-Difficulty concentrating
-Insomnia
-Tremulousness
-Poor appetite
Fully developed hyperactive delirium symptoms
-Hallucinations
-Person completely inattentive
-Grossly altered perception
Physical symptoms of hyperactive delirium
dilated pupils, increased HR, diaphoretic, increased temp
Fully developed hyperactive delirium can lead to
excited delirium syndrome (ExDS) can cause death
-More common in pts with mental illness or intoxication
Symptoms of excited delirium syndrome
combative, aggressive, cause pain, rapid breathing
Treatment of hyperactive delirium
-Remove risk factors
-Usually self-resolves in 2-3 days but can persist for weeks
-Try to help them sleep
-Try not to give meds that can alter perception
-Get them home ASAP
Hypoactive delirium is associated with
-Right-sided frontal basal-ganglion disruption (part of brain associated w/ coordinated movements & alertness)
Hypoactive delirium is most common in those with
Metabolic disorders
-Liver or kidney failure
Manifestations of hypoactive delirium
-Decreased alertness & attention span
-Decreased ability to perception and interpretation of the environment
-Forgetful
-Apathetic
-Slow speech
-Frequently falls asleep
What is the goal of the treating delirium?
Identify cause and remove causative agents, modify risk factors when possible
Individuals who have ____ at baseline have a MUCH higher risk of delirium
Dementia
But there are differences
Delirium can be _____
prevented
Define Dementia
-Acquired deterioration and progressive failure of cerebral functioning
-Umbrella term for Cognitive impairment
-Impaired intellectual processes: memory, language, judgement, decision making, orientation
-Some genetic-predisposition
Some one may not be aware of dementia onset and may present as
agitated, wandering, aggression
Pathophysiology of dementia
-Neuron degeneration
-Compression of brain tissue
-Atherosclerosis of cerebral vessels
-Brain trauma
-Infection
-Neuro-inflammation
____ and ____ can cause dementia like qualities
HIV & Creutzfield-Jacob disease
Onset of dementia
Generally slow, and symptoms are usually irreversible
Treatment of Dementia
-No cure
-Treatment directed at restoring and optimizing functional capacity and accommodating with lost abilities
________ is the leading cause of severe cognitive dysfunction in the elderly
Alzheimer’s Disease
How many Americans have it and who is most likely to get it
6 million Americans
2/3 Women
Cause of Alzheimers
Exact is unknown
-Genetic associations more common in early onset
-Sporadic late-onset AD is most common and does not have specific genetic association
How is Alzheimers diagnosed
-Ruling out other conditions
-like vascular brain tumor or anything like that
Risk factors for AD
-Being older than 65
-Family history
-Inheriting genes for the disease
-Existing mild cognitive impairment
-Down syndrome
-Unhealthy Lifestyle (drinking/smoking)
-Previous head trauma
-Isolation
Pathophysiology of AD
Accumulation of neuritic plaques and intraneuronal neurofibrillary tangles of tau preotein
-Plaques disrupt nerve impulse transmission and kill neurons
-Loss of synapses and Acetylcholine
-Brain atrophy from loss of neurons
What part of the brain does AD usually effect
Cerebral cortex and hippocampus
When do pathophysiological changes of AD occur
Decades prior to symptoms
-Starts as mild short-term memory loss to total loss of cognitive and executive function
Vascular Dementia
-2nd most common type of dementia
-related to cerebrovascular disease
-R/T large artery disease, cardioembolism, small vessel diesease, stroke
-Risk factors: DM, HPL, HTN, Smoking
-Treat: prevent risk factors
Frontotemporal Dementia
-Rare
-AKA Picks Disease
-Familial association with age of onset less than 60
-R/T gene mutations of encoding tau protein
-No Treatment
3 distinct clinical syndromes of Frontotemporal Dementia
- Behavioral Variant (change in personality & judgement
- Progressive non-fluent behavior (Prob with language & writing)
- Semantic dementia (problem forming words & sentences)
MOA of Donepezil
Works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase
Mild to moderate AD
Adverse Effects of Donepezil
Normally none to mild, resolve on own
-GI upset
-drowsy/dizzy
-Insomnia
-Muscle Cramping
-Bradycardia
-Reflex tachycardia
-Syncope
When is Donepezil given?
PO at bedtime, best with food to minimize GI effects
Avoid NSAIDs to avoid GI upset
MOA of memantine
Blocks the stimulation of NMDA receptors believed to be associated with AD
Moderate to severe AD
Adverse effects of memantine
Uncommon
-Confusion
-Hypotension
-Headache
-Dizziness
-Constipation (take fiber)
Memantine helps prevent neuronal damage bc it ______ in brain
decreases level of Ca2+
Memantine is often given in conjunction with
Colon esterase
