Week 8 Delirium and Dementia

Question 1

What is the DSM IV Criteria for delirium?

Answer 1

1. Disturbance oc consciousness with reduced ability to focus, sustain or shift attention
2. A change in cognition or the development of a perceptual disturbance that is not better accounted for by dementia
3. Disturbance develops over a short period of time and tends to fluctuate during the course of the day
4. evidence from hx, physical exam, or labs that disturbance caused by direct physiological consequences of a general medical condn

Question 2

What is the DSM IV criteria for dementia?

Answer 2

Cognitive impairment to 2 domains
-memory
-and 1 of: aphasia, apraxia, agnosia, or disturbance to executive function
Impairment to social or occupational fxn
-decline from previous level of fxn
-no delirium
-not due to depression

Question 3

List some differences between delirium and dementia.

Answer 3

Delirium
-acute, clouded consciousness, highly distractible
-major disruption in sleep cycle
-physical illness common
Dementia
-progressive, insidious, clear consciousness, normal attention in early stages, mild disruption in sleep cycles, physical illness uncommon

Question 4

List the behavior networks affected by the following: delirium, Alzheimers, dementia with lewy body, frontotemporal dementia, primary progressive aphasia

Answer 4

1. delirium: attention matrix
2. AD: episodic memory
3. DLB: attention and executive control
4. FTLD: emotional salience network
5. primary progressive aphasia: language network

Question 5

What are risk factors for delirium?

Answer 5

1. age
2. preexisting cognitive decline
3. comorbidities
4. ill physical condn
5. alcohol abuse or withdrawal
6. use of benzodiazepines or opiates
7. liver or renal failure

Question 6

What is the treatment for delirium?

Answer 6

• ID and correct underlying causes
• stop anticholinergics, BZs, opiates
• give thiamine if EtOH or malnutrition
• use neuroleptics or a2 agonists

Question 7

List the misfiled proteins and fibrils that are associated with the following diseases: FTLD, AD, PD, DLB, HD

Answer 7

1. FTLD: tau of TDP-43
2. AD: amyloid b, tau
3. PD: a-synuclein Lewy bodies
4. DLB: same as PD
5. HD: huntingtin deposits

Question 8

What areas of the brain are vulnerable to AD lesions?

Answer 8

• plaques start in hippocampus and spreads to multimodal association areas
• nucleus basalis- Ach heavy

Question 9

How can Alzheimers be diagnosed?

Answer 9

• MRI scan for lesions
• decreased temporal parietal deoxyglucose PET scan
• CSF biomarkers: low Abeta, high tau

Question 10

What are treatment options for AD?

Answer 10

• mostly supportive

- Cholinesterase inhibitors and NMDA receptor antagonists helps improve symptoms of AD

Question 11

What is the clinical criteria for DLB (dementia with lewy body)?

Answer 11

1. Dementia (memory disorder need not be prominent)
2. Two of the following=probable, one=possible
   - fluctuating cognition, attention and alertness
   - recurrent visual hallucinations
   - spontaneous motor features of parkinsonism

Question 12

What are key differences between FTD and AD?

Answer 12

1. age: FTD diagnosed earlier
2. memory loss more prominent in early Alzheimers
3. behavior changes usually first noticeable changes in FTD, also present later in AD
4. problems with visual spatial (getting lost)-more common in AD
5. FTD has more problems with speech
6. hallucinations and delusions uncommon with FTD