Neurocognitive Flashcards
Define delirium MPE
It is primarily the disturbance of consciousness and impairment cognitive functioning as a result of diffuse brain dysfunction. Sudden and significant decline from a previous level of functioning.
Clinical syndrome of confusion, fluctuating consciousness and disorientation, with visual illusions and auditory hallucinations and labile affect.
Clinical presentation of delirium
A CHIP DIET
Awareness and attention is disturbed
Consciousness that is fluctuating
Hallucinations (auditory) and visual illusions
Incoherent speech
Psychomotor agitation
Disturbance of the sleep wake cycle
Impaired cognition (memory, abstract thinking and orientation)
Emotional dysfunction and lability
Thought disorder
Causes of Delirium
Drugs: alcohol intoxication or withdrawal, antidepressants, anti Parkinson sedatives
Infection: UTI, encephalitis, pneumonia, septicaemia
Metabolic: hypoglycaemia, electrolyte disturbances, thyroid function, hepatic failure CKD
Trauma, Toxic, Tumor
Oxygen deprivation: hypoxia
Psychiatric conditions
Structural eg SOL
DSM Delirium
Disturbance in attention and awareness
Of sudden onset and the severity of the disturbance fluctuates
An additional cognitive symptom
A and C not explained by another neuro cognitive disorder
There a direct physiological cause
Management of delirium
Identify those with predisposing factors
- age>65, brain disease or damage, ICU or high care pt, drug- medication intoxication and interaction, untreated pain
Address the likely cause:
-UE, LFT, Thyroid function, urinalysis, FBC or ESR, CXR or ECG
Provide supportive care
-place at quiet well lit place, explain problem, monitor vitals, fluid and nutrition support
Prevent Complication
Management of behavioural symptoms
-start medication if risk to the safety of self or other pt or people, withdraw unnecessary medication and keep the symptomatic meds at a minimum
- haliperadol or chlorpromazine
-lorazepam oral or IM
Dementia definition(DSM)
An irreversible, slow-onset progressive decline, from the previous level of function, of one ore more cognitive domain(CALMEPLS) that impairs and severely effects daily functioning. Delirium not exclusive and this not explained another psychiatric disorder
Clinical features of dementia
Complex Attention disturbances not simple attention
Learning and memory: memory impairment and agnosia
Executive function: disturbances in planning, organising and completing tasks
Perceptual-motor: apraxia, disturbances in construction
Language: aphasia
Social cognition: social withdrawal, personality changes
Differentiate between Dementia and Delirium D-STAR C2OP2
Duration
-hours to weeks
-months to years
Speech
-incoherent, rapid
-word finding difficulties
Thought
-disorganised, delusion
-impoverished
Attention
-impaired
-usually intact earlier
Reversibility
-usually reversible
-irreversible
Course
-fluctuating
-slow progressive decline
Consciousness
-altered
-intact
Onset
-abrupt, acute
-insidious
Perception
-visual illusions and auditory hallucinations
Psychomotor activity
Increased or decreased
Normal
Cortical vs Subcortical
Symptoms
-Memory, language and perceptual disturbances and praxia disturbances
-behaviour changed and emotion instability, motor slowing and executive dysfunction, extra pyramidal symptoms
Affect to brain
-temporal, parietal and frontal cortex
-thalamus, striatum, basal ganglia
Example
-Alzheimer’s, vascular and diffuse Lewis body
-Parkinson’s disease dementia, Huntington and progressive supranuclear palsy
Pseudodementia
Also known as depressive cognitive disorder. Condition that mimics dementia but caused by depression i.e. symptoms of dementia that is explained or secondary to another psychiatric condition-dementia
These conditions include:
Cognitive dysfunction-
Memory impairment
Concentration
Executory dysfunction
And
Depression:
Anhedonia
Apathy
Insomia
All these are usually reversible
