Module 8: Delirium And Dementia

Question 0

Nonstructural causes of delirium?

Answer 0

#Infectious
#Toxic/metabolic
#Epileptic

Question 1

Definition of delirium?

Answer 1

#Disturbance of consciousness with reduced focus or attention
#Change in cognition (memory deficit, disorientation, language disturbance) or development of perceptual disturbance
#must be acute and fluctuating

Question 2

Structural causes of delirium?

Answer 2

#Vascular – hemorrhage
#Traumatic – epidural hematoma, subdural hematoma, concussion, diffuse axonal injury
#Neoplastic

Question 3

Most likely infectious cause of delirium?

Answer 3

Encephalitis

Question 4

Drug causes of delirium?

Answer 4

#Sedatives – benzodiazepines, barbiturates, alcohol
#Pain medications – opiates, salicylates
#Psychotropic agents – PCP, TCA overdose
#Antibiotics – penicillins, cephalosporins
#Anticonvulsants

Question 5

Metabolic causes of delirium?

Answer 5

#Hypoxia/hypercarbia (oxygen) #Hyperthermia/hypothermia (temperature)
#Hypoglycemia/glycemia (sugar)
#Hyponatremia/hypernatremia (salt)
#Hypercalcemia
#Hyperthyroidism
#thiamine deficiency
#Hepatic/renal disease

Question 6

Management of delirium?

Answer 6

#Behavioral (family stays, window, constant reorientation)
#Pharmacologic – low-dose atypical neuroleptics

Question 7

Avoid these drugs in delirium patients?

Answer 7

#Benzodiazepines
#Haloperidol (elongates QT, parkinsonism)

Question 8

Prognosis of delirium?

Answer 8

#50% required institutions
#Many die within one year

Question 9

Definition of dementia?

Answer 9

Memory impairment and one or more of:
#Aphasia
#Apraxia (difficulty with motor tasks)
#Agnosia (failure to recognize)
#Impaired executive function (failure to plan, organize, think abstractly)

Question 10

Everyone with dementia should get?

Answer 10

#TSH
#B12
#Imaging
#Depression screening

Question 22

Subacute versus chronic causes of dementia?

Answer 22

#Metabolic (B 12)
#Structural (mass lesion, SDH)
#Infections (CJD

Versus

#neurodegenerative
#Vascular

Question 23

Dementia types? Examples?

Answer 23

Cortical (Alzheimer, vascular dementia, FTD) versus

subcortical (overall slowness of thought and decreased motivation – HIV, Parkinson’s, Huntington)

Question 24

Etiologies of dementia?

Answer 24

#Neurodegenerative – Alzheimer, Lewy body, Pick, frontotemporal, Huntington, Parkinson
#Structural – hydrocephalus, subdural hematoma, mass lesion, radiation encephalopathy
#Vascular – multi-infarct, hypoperfusion, CADASIL
#infectious – HIV, PML, SSPE, CJD
#neoplasm 
#Immune mediated – paraneoplastic, multiple sclerosis
#Metabolic – thyroid, B12, Korsakoff, Wilson,

Question 25

Triad of normal pressure hydrocephalus? Caused by pressure on what specifically? Diagnosed with? Treat?

Answer 25

Wet, Wobbly, wacky

Pressure on the frontal subcortical fibers by large ventricles

Diagnosed with subjective improvement of gait after CSF removal by LP

Ventriculoperitoneal shunt

Question 26

Most common form of dementia? Risk factors? Accumulation of?

Answer 26

Alzheimer disease

# advanced age
#Low education
#Family history/genetic mutation in beta-APP, PS/1, PS2
#Down syndrome

Beta-Amyloid plaque

Question 27

Clinical features of Alzheimer disease?

Answer 27

#Loss of short-term memory
#Intellectual decline
#Loss of visuospatial orientation
#Paranoid delusions and agitation
#late loss of motor functions and continence