Forgetfulness Flashcards
What are the features of delirium?
Fluctuating level of consciousness
Acute
Metabolic, infective, toxic, drug induced
Inattention
Waxing and waning between aggression and lethargy
How may onset of dementia differ between AD, VD, LBD, and FTD
AD - slow insidious gradual decline
VD - step wise
LBD - fluctuating levels of consciousness
FTD - slow and insidious but younger onset than AD
What investigations would you like to carry out in a patient with suspected dementia?
Bedside
- ECG for AF if VD
- Full examination inc thyroid status
- MMSE
Bloods
- Urine analysis and cultures
- FBC, U&E, LFTs, TFTs, Glucose
- Thiamine, B12 and Folate
- Blood cultures
Investigations
- MRI / CT head
- CXR for pneumonia
What memory enhancing drug may be administered in the treatment of AD?
Rivastigmine
What symptoms may prompt a diagnosis of a brain tumour over dementia?
Personality changes
Seizures
Nausea and vomiting
What questions may you ask when investigating cognition as part of the HPC?
What may you ask about regarding behaviour and personality?
ST memory - Can you remember names, appointments, dates, taking medication every day?
LT memory - Can you remember when you got married, what your first job was?
Visuospatial memory - Can you remember places, people or items?
Language - Do you have difficulty with finding the right words when talking?
Behaviour - Any changes to your behaviour? (sexual disinhibition, wandering around, social withdrawal)
Personality - Any changes to your personality? (aggressive outburst, verbal / physical aggression)
What other psychiatric diagnosis should you rule out?
Depression
Anxiety
Psychosis
What organic causes of forgetfulness should you inquire about in the history?
Constitutional - Feeling ill or poorly? Fever?
PARKINSONS - Tremor? Small handwriting? Changes in walking?
How may you risk assess a patient with forgetfulness?
ADLs - Finances? Washing, dressing, cleaning, feeding?
Dangerous events - Leaving cookers or doors open? Falls? Have neighbours found you wandering the streets confused?
Driving - Do you drive? Near accidents?
Harm - Self harm or to others? Suicide?
What may you ask additionally at the end (or even the start) of the consultation in a patient who presents with forgetfulness?
Have you brought anyone with you?
Would I be okay to talk to them and ask some questions?
What modality is affected first in Alzheimer’s dementia?
What symptoms often follow this?
SHORT TERM MEMORY LOSS
Followed by confusion, irritability, aggression, LT memory loss, mood swings and incontinence
Unlike vascular (step wise) and lewy body (fluctuating), this is a slow progression with an insidious onset, characterised by
- SOCIAL WITHDRAWAL
- PARANOIA
- ANXIETY
What features are typical of vascular dementia?
Stepwise
Then a gradual cognitive decline after one or more CVA
Incontinence
Depression
Delusions
With neurological symptoms
- Hemiparesis
- Aphasia
- Sensory deficits
What features are typical of lewy body dementia?
Fluctuating with parkinsonian features
Incoherent speech
Variable attention
Well-formed visual hallucinations unrelated to dopamine therapy
History of parkinsonism emerging simultaneously with cognitive impairment
How may you distinguish forgetfulness caused by depression vs dementia?
Depression
- Persistent dysphoric mood
- anhedonia
- IMPAIRED RECALL
RECOGNITION MEMORY IS SPARRED
Low energy, appetite, sleep, concentration
Psychomotor retardation
Feelings of worthlessness and guilt
Recurrent thoughts of death
