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Neurology Week 1 > Dementia and Delirium > Flashcards

Dementia and Delirium Flashcards

1
Q

Dementia

A

Major neurocognitive disorder
Blanket term to describe a cluster of symptoms including memory loss, confusion, poor judgement, language, executive function.

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2
Q

Causes of dementia

A 
Alzheimers dz
Vascular:  stroke, tia
Parkinsons
Frontotemporal dementia
Normal pressure hydrocephalus
Dementia with lewy bodies
Delerium/depression
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3
Q

Alzheimers Disease

A

Progressive neurological disorder that results in memory loss, personality changes, global cognitive dysfxn and functional impairments.
Prominent loss of short term memory early on

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4
Q

Alzheimers diagnosis

A

Diagnosis of exclusion
Clinical diagnosis based off history
MRI may show bilateral hippocampal atrophy

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5
Q

MMSE grading scale for AD

A

20 - 26: mild functional dependence
10 - 20: moderate, more immediate dependence
<10: severe, total dependence

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6
Q

MMSE of 24/30 is suggestive of?

A

Dementia

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7
Q

Pathology of AD

A

Amyloid rich senile plaques
Neurofibrillary tangles
Neuronal degeneration

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8
Q

Most frequent cause of death from AD

A

Aspiration pneumonia.

2nd is infected decubital ulcerations

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9
Q

Cholinesterase Inhibitor MOA

A

Stop the breakdown of Acth
Increase acth levels in the brain
May slow progression of symptoms for perhaps 6-12 months

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10
Q

Cholinesterase Inhibitor Types

A

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Reminyl)

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11
Q

Doneoezil (Aricept)

A

Only FDA approved tx for any stage of alzheimers dz.

Well tolerated once daily dose

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12
Q

Rivastigmine (Exelon)

A

Approved for use in mild to moderate alzheimers.
BID dosing w/ food
Slowly titrate up to avoid SE

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13
Q

Memantine (Namenda)

A

NMDA receptor antagonists
Helps regulate glutamate activity
Approved for moderate to severe alzhemiers

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14
Q

Selegiline (Eldepryl)

A

Prevents breakdown of dopamine

May not be helpful, many SE

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15
Q

Antidepressants for AD

A

SSRI’s

Zoloft, paxil, celexa

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16
Q

Antipsychotics for AD

A

reduce hallucinations, delusions, aggression, hostility.

17
Q

Anxiolytics for AD

A

Lorazepam, oxazepam

18
Q

Vascular Dementia (VD)

A

Onset associated with CVA
Abrupt onset followed by stepwise deterioration
Infarcts on cerebral imaging

19
Q

Frontotemporal Dementia

A 
Characterized by focal atrophy of the frontal and temporal lobes in absence of alzheimer pathology.
Pick's dz was first recognized subtype
Characterized by pick bodies
May be familial
Peak in 6th decade
20
Q

Normal-pressure Hydrocephalus

A

Pathologically enlarged ventricle size with normal opening pressure on LP.
Triad of dementia, gair disturbance and urinary incontinence.

21
Q

Normal-pressure Hydrocephalus Triad

A

Wacky (dementia)
Wobbly (gait disturbance)
Wet (incontinence)

22
Q

Normal-pressure Hydrocephalus Tx

A

Ventriculoperitoneal shunt

23
Q

Normal-pressure Hydrocephalus Dx

A

MRI

Miller fisher test - gait test before and after removal of excess CSF

24
Q

Dementia with Lewy Bodies (DLB)

A

Second most common form of dementia after AD

Associated with parkinsonism

25
Q

DLB CHaracteristics

A

Dementia accompanied by delerium, visual hallucinations and parkinsonism.

26
Q

Parkinsons Disease

A 
Characterized by
Brady and Akinesia
Rigidity
Resting tremor
Postural instability
Dementia occurs in the last half typically
27
Q

How many parkinsons patients develop dementia?

A

78%

28
Q

Progressive supranuclear palsy

A

Steele richardson olszewski syndrome
Restricted up and down eye movement
fall backwards as opposed to parkinsons pt’s that fall forward

29
Q

Creutzfeldt-Jacob Disease

A

AKA mad cow
Progressive and fatal
Caused by a prion
Rapid onset dementia, motor deficits, seizures

30
Q

Dementia from syphillis and HIV

A

It happens.

31
Q

Delirium

A

A sudden and significant decline in mental functioning that is not from preexisting dementia
Disturbances of conciousness

32
Q

4 Major causes of delirium

A

Underlying medical condition
Substance intoxication
Substance withdrawal
A combo

33
Q

Prodrome to delirium

A

Restlessness
Anxiety
Sleep disturbance

34
Q

Delirium fluctuation course

A

Develops over hours to days

Symptoms fluctuate throughout the day

35
Q

Delirium arousal/psychomotor disturbance

A

Hyperactive
or
Hypoactive

36
Q

Delirium duration

A

Typically resolves in 10-12 days

May last up to 2 months

37
Q

What causes delirium?

A

I WATCH DEATH
infxn, withdrawl, acute metabolic, trauma, CNS pathology, hypoxia
Deficiencies, endocrinopathies, acute vascular, toxins or drugs, heavy metals

Neurology Week 1 (10 decks)

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