**PSYCH Y4** Dementia and Delirium

Question 1

most common type of dementia?

Answer 1

Alzheimers (50%)
- Alzheimer’s dementia tends to progress steadily over time.

• vascular 20-25% (second most common)
• lewy bodies 15-25%
• pick’s disease/frontotemporal dementia <5%

Question 2

what histological changes to the brain happen with Alzheimers?

Answer 2

amyloid plaques and neurofibrillary tangles (NFT)

• build up of these stop transmission of information
• found in grey matter, hippocampus
• cannot be seen on MRI/CT nut frontal atrophy can be seen

Question 3

which gene provides a risk for Alzheimers?

Answer 3

APOE4

E4 apolipoprotein E gene

• x3-4 risk in first degree relatives
• PICALAM, CL1 and CLU are variants

Question 4

which gene provides a protection for Alzheimers?

Answer 4

E2 allele

Question 5

what are protective lifestyle factors of alzheimers?

Answer 5

high educational attainment (delayed detection?)
NSAIDs
HRT

and then the obvs healthy life style, vit C E etc

Question 6

which dementia tends to have a sudden onset?

Answer 6

vascular

secondary to cerebrovascular disease e.g. stroke or small vessel disease

Question 7

which dementia has vivid hallucinations and psychotic symptoms as a feature?

Answer 7

lewy body

Question 8

is lewy body dementia rapidly progressive or steadily?

Answer 8

rapidly

Question 9

which dementia commonly has features of parkinsonism?

Answer 9

lewy body

early of spontaneous motor features of parkinsonism e.g. bradykinesia, tremor, rigidity etc

Question 10

what is delirium?

Answer 10

acute confusional state due to variety of causes

Question 11

what are common causes of delirium?

Answer 11

PINCH ME

P - pain 
I - infection 
N - nutrition and hydration 
C - constipation and urinary retention 
H - hyper/hypo blood sugar, electrolytes 

M - medications e.g. opiates, sedatives, steroids, recreational
E - environment change

also: surgery, stress, hypoxia, distrubed sleep etc

Question 12

how do diagnose a delirium?

Answer 12

look for underlying cause

• psychiatric history
• MSE
• physical exam
• ask about baseline (family, carers)

Bloods: FBC, CRP, U&E, LFTs, TFTs, bone profile

Infection screen: urinalysis, MSU, C&S

Imaging: CXR

Other: ECG

Question 13

how to treat delirium in a pt withdrawing from alcohol?

Answer 13

chlordiazepoxide

• to prevent seizures and withdrawal symptoms and Wernicke’s encephalopathy
• also high dose thiamine and Vit B and Vit C to prevent Wernicke’s encephalopathy

Question 14

failure to treat delirium in a pt who is withdrawing from alcohol can lead to what condition?

Answer 14

Korsakoff’s psychosis (50-80% of those with Wernicke’s encephalopathy)

• apathy
• loss of insight
• inability to learn new info
• confabulation