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Clinical neuroscience > L12 - Confusion > Flashcards

L12 - Confusion Flashcards

1
Q

Causes of confusion on the elderly

A 
Delirium
Dementia 
Drugs
Depression 
Endocrine/ metabolic defects
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2
Q

Delirium

A

Acute change in consciousness (feeling drowsy) and cognition that fluctuates

  • inattention
  • confusion
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3
Q

Cognition

A

Ability to gain and understand new knowledge
E.g making new memories
Problem solving
Understand language

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4
Q

Depression

A

Change in mood and feeling of self worth

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5
Q

Dementia

A

Cognitive decline due to diseases of the brain
Progressive
Impairment in memory, intellect and personality

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6
Q

Drugs that can cause confusion

A

Morphine
Cocaine
Alcohol
Zopiclone

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7
Q

Metabolic disturbances that can cause confusion

A

Hyper/ hypothyroidism
Hyper/ hypocalcaemia
Vitamin B12 deficiency
Normal pressure hydrocephalus

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8
Q

Early and late onset dementia

A

Early - before 65 yrs old

Late - after 65 yrs old

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9
Q

Types of dementia

A 
Alzheimer’s disease
Lewy Body dementia 
Vascular dementia 
Fronto - temporal dementia 
AIDS dementia complex
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10
Q

Tests to assess cognitive function

A

Mini mental state examination (MMSE)

Montreal cognitive assessment (MOCA) - used by neurology department

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11
Q

Macroscopic changes of Alzheimer’s disease

A

Global brain atrophy
Mostly frontal, parietal and temporal lobe
Affects hippocampus - memory loss
Sulcus widening
Enlarged 3rd and 4th interventricular space

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12
Q

Microscopic changes of Alzheimer’s disease

A

Senile amyloid plaques from the breakdown of beta amyloid precursor proteins
Increased neurofibrillary tau tangles - increases acetylcholinesterase therefore decreasing Ach
Neuronal death

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13
Q

Treatment of Alzheimer’s disease to treat symptoms

A

Acetylcholinesterase inhibitors increases acetylcholine

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14
Q

Early onset genetic factors

A
  • beta Amyloid precursor protein mutation
  • presenilin 1
  • presenilin 2
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15
Q

Late onset genetic factors

A

Apolipoprotein E gene - increased permeability of the brain to amyloid plaques

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16
Q

Presenting complaint of Alzheimer’s disease

A

Memory loss
Loss of vision-spatial awareness - get lost
Difficulty in using language, calculations and everyday activities

17
Q

Medication

A

Acetylcholinesterase inhibitors:

  • donepezil
  • galantamine
  • rivastigmine

Glutamate inhibitors - preventing excitotoxicity
- memantine

18
Q

Pathophysiology of Lewy body dementia

A 
Aggregation of alpha synuclein protein 
Found in cytoplasms
Deposits in the:
- substantia nigra 
- temporal lobe 
- frontal lobe 
- cingulate gyrus
19
Q

Lewy body presenting complaint

A
  • fluctuating cognition with variation in attention and alertness
  • visual hallucinations
  • Parkinsonism - festigating gait and flexed posture
20
Q

How does Parkinson’s disease differ from Lew body dementia?

A

Parkinson’s disease:

  • early Parkinson’s symptoms
  • late cognitive decline
  • tremor
  • bradykinesia
  • lead pipe rigidity

Lewy body dementia:

  • early cognitive decline
  • late Parkinson’s symptoms
  • no tremor of rigidity
21
Q

How to treat Lewy body dementia

A

Acetylcholineesterase inhibitors:

  • donepezil
  • galantamine
  • rivastigmine

Glutamate inhibitor:
- memantine

22
Q

Fronto- temporal dementia

A

2nd common cause of early onset dementia
55 - 65 yrs old
Atrophy of frontal and temporal lobes

23
Q

Presenting complaint of fronto- temporal dementia

A

Frontal lobe:

  • altered behaviour
  • altered personality
  • bad social conduct - less control over appropriateness
  • Broca’s dysphasia
  • primitive reflexes I.e. grasp reflex and palmomental reflex

Temporal lobe:

  • hippocampus - short/ long term memory impairment
  • Wernicke’s dysphasia
24
Q

Palmomental reflex

A

Stroke thenar eminence in baby, open mouth

Also seen in fronto - temporal dementia

25
Q

Vascular dementia

A

Caused by ischaemic or haemorrhagic stroke - cerebrovascular event

26
Q

Risk factors of vascular dementia

A 
Hypertension
Hypercholesterolaemia 
Smoking 
Diabetes 
Vascular disease
27
Q

Treatment of vascular dementia

A

Treat the risk factors

28
Q

Progression of vascular dementia

A

Step - wise deterioration of cognitive function with focal neurological symptoms

  • lacuna stroke - brain cognition decreases but then stabilises
  • recurrent
29
Q

AIDS - dementia complex

A

Increased prevalence
HIV infected macrophages enter the brain and cause indirect damage to neurones
Rapidly progressive
Insidious onset

30
Q

Presenting complaint of AIDS dementia complex

A 
Ataxia 
Cognitive impairment
Psychomotor retardation 
Tremor 
Dysarthria - joint pain 
Incontinence
31
Q

Treatment of AIDS dementia complex

A

Treat HIV with antivirals

32
Q

Common investigations for all dementia cases

A

Within 6 months of new diagnosis:

  • FBC
  • U+ Es
  • LFTs
  • CRP
  • thyroid function test
  • random blood sugar
  • vitamin B12 and folate
  • routine syphilis tests if indicated
33
Q

Bio-psycho social model

A

Refer to health care professional to manage symptoms e.g. district nurses and Age UK

  • feelings of isolation
  • impairment in daily activities
  • financial burden
34
Q

Types of delirium

A

Hyperactive: increased motor activity and increased excitability
Hypo-active: decreased motor activity and low mood with decreased interaction
Mixed

35
Q

Causes of delirium

A

Drug toxicity:

  • withdrawal of alcohol, coffee, cocaine or benzodiazepines
  • opiates, anti - histamine, dopamine agonists, levodopa

Endocrine

  • hyper or hypothyroidism
  • Addison’s disease
  • Cushing’s disease

Liver failure

Intracranial

  • stroke
  • epilepsy
  • cerebral abscess
  • haemorrhage

Renal failure - hyperureamia

Infection

Urinary and faecal retention

Metabolic

  • hypoxia
  • electrolyte imbalance
36
Q

Delirium investigations

A 
FBC
LFTs
U+Es
CRP 
Thyroid function test 
Blood sugar 
Blood culture - sepsis

Bedside tests:

  • urine dip +/- culture
  • oxygen saturation

Radiological

  • CXR
  • CT (if appropriate)

Confusion screening

Review drug history

Rule out causes

37
Q

Treatment of delirium

A

Treat underlying cause
Rehydrate
Calm environment
Haloperidol if essential

38
Q

Difference between delirium and dementia

A

Delirium:

  • rapid onset
  • fluctuating
  • hallucinations
  • impaired consciousness
  • speech a can be slow or fast
  • reduced GCS

Dementia:

  • slow progression
  • normal GCS
  • hallucinations rare
  • steady decline
  • speech slow
39
Q

How to assess consciousness

A

Check pulse and breathing

Sternal rub
Trapezius squeeze
Fingernail pressure test

Clinical neuroscience (20 decks)

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