Flashcards in Delirium and Dementia Deck (34):
What are the differences between delirium and dementia?
Delirium is an acute disorder; reversible; toxic and metabolic causes are common; consciousness levels fluctuate.
Dementia is a chronic disorder; irreversible; level of consciousness is normal; toxic and metabolic causes are not common; aphasia is common.
Delirium is more often characterized by ________-arousal, though the opposite can occur.
Delirium is present in ________ percent of ICU patients.
60% - 80%
Delirium predicts ________________.
mortality, a longer hospital stay, and increased likelihood of discharge to a nursing home
The brain is exquisitely sensitive to __________ perturbations.
List some common causes for delirium – and the reasons.
Drugs and toxins (OTC, illicit, and prescription): side effects can precipitate acute brain dysfunction
Metabolic: the brain is "exquisitely sensitive" to metabolic disruptions
Infections and inflammatory states: inflammation agitates neuronal function
Lesions/masses: pressure on cerebrum induces dysfunction
What things are useful in evaluating delirium?
Urine tox screen
History and physical
What things should you consider in treatment of delirium?
First importance: Try to find and address its etiology.
Avoid daytime naps/sedation
Make the patient's hospital room as human/familiar as possible (e.g., bring in pictures of family, a clock, a TV)
Describe the defining criteria of dementia.
Dementia is an acquired and persistent impairment in function – that is of sufficient severity to impair social/occupational function – in at least three of the following areas: memory, visuospatial acumen, complex cognitive function, emotion, personality.
What percent of dementia is caused by reversible etiologies?
10% - 20%
Some of the causes of reversible dementia include _____________.
drugs and toxins; neoplasms; hydrocephalus; hypothyroidism; B12 deficiency; inflammatory disease; depression; and mTBIs
What gene mutation has been correlated with late-onset Alzheimer's?
Frontotemporal dementia was formerly known as ____________.
What cells are typically lost in Parkinson's disease?
The dopaminergic cells of the substantia nigra
Huntington's disease often presents with ________________.
early personality changes, poor judgment, and antisocial behavior
So far there has not been a case of human _________ disease (a condition of elk in Colorado).
Impaired attention is characteristic of _____________.
What is the best way to distinguish between psychoses and delirium?
Delirium presents with fluctuating states of consciousness, while psychoses do not.
What is the accuracy of diagnosing Alzheimer's based on clinical data?
Other than the cholinesterase inhibitors, what other drug is prescribed to those with Alzheimer's?
Memantine – an NMDA antagonist
The most salient feature of frontotemporal dementia is _____________.
change in personality
Caudate atrophy presents in a disease with excessive repeats of which nucleotides?
CAG (this is Huntington's)
Incontinence, gait disruption, and personality changes may be a sign of ____________.
normal-pressure hydrocephalus – a reversible form of dementia
Most cases of Creutzfeldt-Jakob disease are __________.
How many cases of Alzheimer's are there in the U.S.?
What are the four types of dementia?
White matter (Binswanger's)
What is the prevalence of Alzheimer's by age group?
65 - 85 = 5% - 10%
Older than 85 = 40%
Describe the three stages of Alzheimer's.
I: mild amnesia, apathy, anomia
II: marked amnesia, fluent aphasia, neuropsychiatric features, visuospatial problems
III: mutism, dementia, incontinence
Which isoform of apolipoprotein E is protective? Which is detrimental?
2 = protective
4 = detrimental
_________ percent of those with Parkinson's develop dementia within 15 years.
Where is the substantia nigra?
What is the pathology of Binswanger's?
Vascular dementia that affects white matter (Blood White matter)
What is the classic symptom of multi-infarct dementia?
Step-wise progression of dementia – indicating discrete strokes!