Wk 4 Dementia + Delirium Flashcards
Delirium
also known as acute confusional states
- transient disorder of cognitive function, consciousness, or perception
- can be sudden or gradual onset
- usually associated with other medical conditions
Hyperactive confusional state
- acute disturbance in attention or awareness
- typically develops over 2-3 days
- usually seen in ICUs, post-surgery, withdrawal, or hospitalized elderly
Risk factors for hyperactive delirium
- medications (benzos, narcotics)
- acute infection/sepsis
- surgery
- hypoxia
- electrolyte or metabolic dysfunction
- insomnia
Manifestations hyperactive delirium
- restlessness, irritability, difficulty concentrating, insomnia, shaking/quivering, poor appetite
- fully developed delirium = hallucinations, person completely inattentive, grossly-altered perception
- often distressed and very confused, hard to calm down
- can lead to excited delirium syndrome -> can cause death
Treatment of hyperactive delirium
- remove risk factors, when possible
- usually self-resolves in 2-3 days but can persist for weeks
Hypoactive confusional state
- associated with right-sided frontal basal-ganglion disruption
- more common in those with metabolic disorders (liver or kidney failure), can lead to metabolite buildup in body
Hypoactive delirium manifestations
- decreased alertness and attention span
- decreased ability to perception and interpretation of the environment
- forgetful
- apathetic
- slow speech
- frequently falls asleep
Treatment and evaluation of delirium
goal = identify cause and remove causative agents, modify risk factors when possible
- individuals who have dementia at baseline MUCH higher risk of delirium (but there are differences in the condition)
- delirium can be prevented
Anti-psychotics
can be used to treat acute delirium that is a danger to the pt or the provider
- haldol, risperidone
Treating delirium
keep routine, bath, sleep, walking, up and talking, not giving lots of narcotics
Dementia
- acquired deterioration and progressive failure of cerebral functioning
- impaired intellectual processes -> memory, language, judgement, decision making, orientation
- may present as patient being agitated, wandering, and aggression
- there is a genetic-predisposition associated with many dementia related disorders
Pathophysiology of dementia
- neuron degeneration
- compression of brain tissue
- atherosclerosis of cerebral vessels
- brain trauma
- infection
- neuro-inflammation
Dementia onset
generally slow and symptoms usually irreversible
Dementia manifestations
often depend on cause of dementia
- memory loss
- decreased concentration and memory
- overall cognitive slowing
Several types of dementia
- alzheimer’s
- vascular
- lewy body
- frontotemporal
Alzheimer’s disease (AD)
- leading cause of severe cognitive dysfunction in the elderly
- exact cause unknown
- genetic associations -> more common in early onset AD
- sporadic late-onset AD is most common and does not have a specific genetic association
Diagnosis of AD
rule out other diseases
Risk factors for AD
- older than 65
- family hx of AD
- existing mild cognitive impairment
- down syndrome
- unhealthy lifestyle
- previous head trauma
- being shut off from a community or having poor engagement with other people for extended periods of time
Pathophysiology of AD
- accumulation of neuritic plaques and intraneuronal neurofibrillary tangles of tau protein
- tau protein = accelerates nerve cell degeneration
- more centralized in cerebral cortex and hippocampus, which is where memory is
- loss of neurons = brain atrophy
These changes occur DECADES prior to symptoms
starts as mild short-term memory loss to total loss of cognitive and executive function
Vascular dementia
- 2nd most common
- related to cerebrovascular disease
- r/t large artery disease, cardioembolism, small vessel disease, and stroke
- hypoperfusion to the brain
Vascular dementia risk factors
DM, HLD, HTN, smoking
to treat: prevent risk factors
Frontotemporal dementia
“pick disease”
- familial association with age of onset less than 60
- rare
- r/t mutations in genes that encode for the tau protein
- have to test genetics
3 distinct clinical syndromes with frontotemporal dementia
- behavioral variant (changes in personality and judgement)
- progressive non-fluent behavior (language and writing)
- semantic dementia (words and sentences)
