organic causes of memory problems

Question 1

transient causes of confusion

Answer 1

Delirium
Post-ictal confusion
Migraine
Delirium tremens
Physical ill-health and chronic illness.
Intoxication – covered in substance misuse session
Medications

Question 2

what is delirium

Answer 2

acute confusional state associated with a physical insult or injury or environmental factors

Question 3

3 types of delirium

Answer 3

hypoactive
hyperactive
mixed

Question 4

what is post-ictal confusion

Answer 4

abnormal condition following a seizure
-feel like they have the worlds worst hangover
-drowsiness, nausea, confusion, exhaustion

Question 5

delirium tremens

Answer 5

alcohol withdrawal delirium

Question 6

chronic illnesses that cause memory problems

Answer 6

Encephalitis

Hypoglycaemia

Hypothyroidism/Hyperthyroidism

Vit B12 deficiency

Anaemia

Electrolyte disturbances

Question 7

medications that can cause memory difficulties

Answer 7

Analgesics – particularly opioid medications and gabapentinoids

Steroids

Benzodiazepines

Narcotics – zopiclone, zolpidem

NSAIDS

H2 receptor antagonists – digoxin, beta-blockers

Question 8

enduring causes of memory problems

Answer 8

-acquired brain injury
-dementia
-alcohol related dementia

Question 9

causes of cognitive difficulties arising from primary damage to the brain

Answer 9

-trauma
-hypoxia
-stroke
-aneurysm
-intracranial tumours
-surgical intervention

Question 10

alcohol related dementia

Answer 10

Neuronal damage secondary to long term, excessive alcohol consumption. Predominantly affects the frontal lobes.

Leads to deficits in memory , planning, motivation and executive function

Question 11

what is anterograde amnesia

Answer 11

difficulty in acquiring new material and remembering events since the onset of the illness or injury

Question 12

what is retrograde amnesia

Answer 12

difficulty in remembering information prior to the onset of the illness or injury

Question 13

what is 4AT

Answer 13

Rapid assessment test for delirium
Quick, pragmatic, validated
Aimed at detecting moderate-severe cognitive impairment

ALERTNESS, AMT-4, ATTENTION, ACUTE OR FLUCTUATING COURSE

Question 14

bedside cognitive tests

Answer 14

-GPCOG
-6CIT
-clock drawing test

Question 15

what is the GP-COG interview

Answer 15

Six questions - ask how the patient is compared to when s/he was well, say 5 -10 years ago

Question 16

what is MoCA

Answer 16

-rapid screening instrument for mild cognitive dysfunction
-assesses multiple cognitive domains

Question 17

what is addenbrookes cognitive exam

Answer 17

Scored out of 100 with 5 domains;
Orientation and attention
Memory
Fluency
Language
Visuospatial functioning

Question 18

presentation of delirium

Answer 18

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

Question 19

treatment of delirium

Answer 19

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

Question 20

management of post-ictal confusion

Answer 20

-supportive

Question 21

presentation of delirium temors

Answer 21

-auditory hallucinations
-visual hallucinations (usually of tiny things like insects)
-tactile hallucinations - things crawling on skin
-confusion
-disorientation
-sweating
-high bp

Question 22

treatment for delirium tremors

Answer 22

-benzodiazepines regularly and targeted to symptoms
-consider fluid, electrolyte and vitamin replacement

Question 23

complications of delirium temors

Answer 23

can be fatal due to high risk of seizures