Wk 4 Dementia & Delirium Flashcards
Acute confusional state, aka organic brain syndrome
Delirium
Delirium is a transient disorder of… (3)
Cognitive function, consciousness, or perception
Delirium is typically acute and
associated with other medical conditions
__ withdrawal can contribute to delirium
Alcohol
Metabolic disorders such as __ can contribute to delirium
hypoglycemia
Increased accumulation of __ from liver or kidney failure can contribute to delirium
Metabolites
These three things can contribute to delirium
Brain surgery, tumors, trauma
Post __ can contribute to delirium
Anesthesia
These three states can contribute to delirium
Fever, electrolyte imbalances, dehydration
Acute disturbance in attention or awareness
Hyperactive delirium
Hyperactive delirium typically develops over
2-3 days
Hyperactive delirium is commonly seen in
ICUs, post op, withdrawal, and hospitalized elderly
Risk factors for hyperactive delirium
medications like bentos or narcotics, acute infection or sepsis, hypoxia, electrolyte and metabolic dysfunction, insomnia
Hyperactive delirium is related to…
Autonomic nervous system overactivity
What symptoms does someone with hyperactive delirium have?
Restless, irritable, can’t concentrate, can’t sleep, poor appetite, tremors
Severe delirium is called
Fully developed delirium
Patients with fully developed delirium
Hallucinate, completely inattentive, can’t pay attention to what’s going on, can’t rationalize, can’t be brought into reality, high levels of restless movement, dilated pupils, fever, diaphoretic
If can’t control developed delirium it can turn into
Excited delirium syndrome
Excited delirium syndrome: The patient becomes
Combative, aggressive, pain, tachypnea, can cause death!
Excited delirium syndrome most common in…
Mental illness or prior mental illness
Excited delirium syndrome less common in..
the elderly but it can occur
Treatment for excited delirium syndrome
Try to remove the risk factors, try to help them sleep, medications
Excited delirium syndrome usually resolves in
2-3 days, but can persist for weeks, especially if still hospitalized
Hypoactive delirium most associated with
right-sided frontal basal ganglion disruption
Hypoactive delirium affects the part of the brain associated with
Coordinated movements and alertness
Hypoactive delirium most common in metabolic disorders such as
Liver and kidney failure, build up of metabolites
Someone with hypoactive delirium presents with
Decreased alertness and attention span, decreased perception of the environment, slow speech, sleepy, apathetic
Hypoactive delirium aka
Catatonic
Goal to treat delirium
Identify cause and remove causative agents, modify risk factors when can
If a patient has dementia, they have a
much higher risk of becoming delirious
Delirium can be
prevented!
Can give __ for hyperactive delirium for the risk factors that we cannot do anything about
antipsychotics, these are short term treatments
If delirium persists for weeks…
It needs to be followed up by the HCP because it’s not delirium anymore
Delirium age
Usually older
Delirium onset
Actue, hospitalizations
Delirium associated conditions
UTI, thyroid disorder, hypoxia, hypoglycemia
Delirium course
Fluctuating, reversible
Duration of delirium
hours, days, sometimes months
Delirium attention
Inability to focus or sustain attention
Delirium sleep wake is
disrupted
Behavior of someone with delirium
Agitated, withdrawn, depressed
Speech pattern of someone with delirium
Incoherent, disorganized
Thoughts and perceptions of someone with delirium
Disorganized, delusions, hallucinations
Dementia is an…
Acquired deteriorated and progressive failure of cognitive function
Dementia cognitive processes affected
Memory, language, judgement, decision making,
Dementia patients may present
Agitated, frustration, wandering, aggression
Pathophysiology of dementia
neuron degeneration, compression of brain tissue
In dementia there is atherosclerosis
in cerebral vessels
Possible causes of dementia
Brain trauma, infection, neural inflammation
Two infections that can contribute to dementia
HIV and Cruetzfeldt Jakob disease
Onset of dementia
Slow onset, irreversible
Manifestations of dementia disease
Memory loss, decrease LOC, overall slowing
No cure for dementia, treatment aimed at
Restoring and optimizing function, such as OT
Alzheimer’s disease accounts for __ % of dementia
50-75%
Vascular dementia accounts for __% of dementia
20-30%
Lewy body dementia accounts for __% of dementia
10-25%
Frontotemperal accounts for __% of dementia
10-15%
A lot of dementia is
Mixed, can have more than one type at once
Leading cause of severe dysfunction in the elderly
Alzheimer’s disease
Being a woman makes you
much more likely to get Alzheimer’s disease, 2/3 are women
Genetic Alzheimers associated with
early onset
Sporadic late onset Alzheimer’s
Older age, more common, not exact genetic association
Alzheimer’s is a
rule out disease
Clinical criteria for Alzheimer’s disease
Mental status exam, brain imaging
Risk factors for Alzheimer’s
Older than 65, family history, existing cognitive impairment, drinking, smoking, unhealthy diets, previous head trauma, and social isolation
Alzheimer’s pathophysiology: Accumulation of
neuritic plaques (Amyloid) and intraneuronal neurofibrillary tangles of tau protein
Alzheimer’s pathophysiology: Tau protein is a key factor that…
Accelerated nerve degeneration
Alzheimer’s pathophysiology: Neuritic plaques disrupt
nerve impulse transmission and kill neurons
Alzheimer’s pathophysiology: Neuritic plaques more centralized in the…
cerebral cortex and hippocampus, these are typically associated with memory
Alzheimer’s pathophysiology: These contribute to memory and cognitive decline
Loss of synapses, decreased acetylcholine, and other neurotransmitters
Alzheimer’s pathophysiology: Loss of neurons leads to
brain atrophy
Alzheimer’s pathophysiology: All of these changes occur
decades prior to symptoms
Initial manifestations of Alzheimer’s disease
Subtle, difficult to identify, typically progressively more difficult to remember current events
Alzheimer’s patients eventually end up in a
Nonverbal vegetative state, and it leads to death
Second most common type of dementia
Vascular, related to CVD
Vascular dementia related to…
CVD, CAD, cardioembolism, small vessel disease, stroke… all causing hypoperfusion to the brain
Risk factors for vascular dementia
DM, HTN, hyperlipidemia, smokers
Treatment for vascular dementia
treat the risk factors
Frontotemporal dementia
really, rare, used to be known as pick disease
Age of onset for frontotemporal dementia
Less than 60
Frontotemporal dementia is related to
Gene mutations of encoding the tau protein
3 distinct clinical syndromes of frontotemporal dementia
Behavioral variant, progressive non-fluent behavior, semantic dementia
Semantic dementia
Problems forming words and sentences
Behavioral variant dementia
changes in personality
Progressive non-fluent behavior dementia
Problems with language and writing skills
How do you test for frontotemporal dementia?
Genetic testing
Treatment for frontotemporal dementia
There is none
Dementia onset
insidious and progressive
