organic causes of memory problems Flashcards
transient causes of confusion
Delirium
Post-ictal confusion
Migraine
Delirium tremens
Physical ill-health and chronic illness.
Intoxication – covered in substance misuse session
Medications
what is delirium
acute confusional state associated with a physical insult or injury or environmental factors
3 types of delirium
hypoactive
hyperactive
mixed
what is post-ictal confusion
abnormal condition following a seizure
-feel like they have the worlds worst hangover
-drowsiness, nausea, confusion, exhaustion
delirium tremens
alcohol withdrawal delirium
chronic illnesses that cause memory problems
Encephalitis
Hypoglycaemia
Hypothyroidism/Hyperthyroidism
Vit B12 deficiency
Anaemia
Electrolyte disturbances
medications that can cause memory difficulties
Analgesics – particularly opioid medications and gabapentinoids
Steroids
Benzodiazepines
Narcotics – zopiclone, zolpidem
NSAIDS
H2 receptor antagonists – digoxin, beta-blockers
enduring causes of memory problems
-acquired brain injury
-dementia
-alcohol related dementia
causes of cognitive difficulties arising from primary damage to the brain
-trauma
-hypoxia
-stroke
-aneurysm
-intracranial tumours
-surgical intervention
alcohol related dementia
Neuronal damage secondary to long term, excessive alcohol consumption. Predominantly affects the frontal lobes.
Leads to deficits in memory , planning, motivation and executive function
what is anterograde amnesia
difficulty in acquiring new material and remembering events since the onset of the illness or injury
what is retrograde amnesia
difficulty in remembering information prior to the onset of the illness or injury
what is 4AT
Rapid assessment test for delirium
Quick, pragmatic, validated
Aimed at detecting moderate-severe cognitive impairment
ALERTNESS, AMT-4, ATTENTION, ACUTE OR FLUCTUATING COURSE
bedside cognitive tests
-GPCOG
-6CIT
-clock drawing test
what is the GP-COG interview
Six questions - ask how the patient is compared to when s/he was well, say 5 -10 years ago
what is MoCA
-rapid screening instrument for mild cognitive dysfunction
-assesses multiple cognitive domains
what is addenbrookes cognitive exam
Scored out of 100 with 5 domains;
Orientation and attention
Memory
Fluency
Language
Visuospatial functioning
presentation of delirium
duration varies
-rapid onset (1-2 days from precipitating insult)
-disorientation, time, place, person
-fluctuating confusion, often worse at night
-agitation and distress
-inattention
-auditory or visual hallucinations
-aggression, fear and confusion
treatment of delirium
treat underlying cause
-low stimulus environment
-assistance with activities and medication
-pharmacological intervention to assist with distress, agitation and aggression
-consider low dose anti-psychotic
-use of appropriate legal measures to allow for treatment
management of post-ictal confusion
-supportive
presentation of delirium temors
-auditory hallucinations
-visual hallucinations (usually of tiny things like insects)
-tactile hallucinations - things crawling on skin
-confusion
-disorientation
-sweating
-high bp
treatment for delirium tremors
-benzodiazepines regularly and targeted to symptoms
-consider fluid, electrolyte and vitamin replacement
complications of delirium temors
can be fatal due to high risk of seizures
