Delirium and dementia Flashcards
What are the 3 types of delerium
- hyperactive
- hypoactive
- mixed
state 10 causes of delirium
- surgery/ post GA
- infection
- intracranial/ infection/ bleed/ injury
- stroke/ mi
- drugs/ drug withdrawl
- metabolic: uraemia, liver failure, malnutrition, electrolyte disturbance
- hypoxia
- nutritonal deficiency eg B12 or thiamine
- pain
How should delirium be investigated?
- look for infection: cxr, dipstik, cultures
- bloods: fbc, ue, crp, lft, troponin if ?MI, glucose, haematinics
- ECG
- ABG
- septic screen
- malaria films
- CT head
Give 3 RFs for delirium?
- > 65 yrs
- dementia/ previous cognitive impairment
- hip fractures
- acute illness
- psychological agitation
How is delirium differentiated from dementia?
- CAM score
- Acute change from cognitive baseline and fluctuating course
AND - inattention
AND - altered consciousness
OR - disorganised thinking
how should delirium be managed?
- treat underlying cause
- reorientate pt: clocks, calendars, reminders of time and location
- encourage family and friends visit
- monitor fluid intake and encourage oral to prevent constipation
- mobilise and encourage activity
- sleep schedule: minimise napping and optimise night time sleep
- remove catheters and cannulas if not necessary
- watch out for infection
- review medication
State 6 early signs and symptoms of dementia?
- subtle short term memory loss
- difficulty communicating thoughts
- rapid agitation and mood swings
- disregard for grooming and personal care
- difficulty identifying humour
- frequent falls and trips
- lapse in judgement
- misplacing things
- lack of initiative or apathy
- visuo- spacial skill loss
- getting confused often
- personality change
- slow muddled speaking
- change in mood
name and describe one quick screening tool for dementia
4AMT: age, dob, place, year
Minicog: ask the pt to recall 3 objects after drawing a clock. If all 3 recalls= no demenitia, if 1-2 recalled then look at clock- if good then theyre ok, if not then dementia. If no words then dementia
name 2 longer tests for dementia
- Montreal cognitive assessment
- addenbrookes cognitive examination
How should suspected dementia be investigated?
- bloods: B12, folate, TFT, fbc, u+e, lft, ca2+, thiamine, glucose, crp
- MRI brain for haematoma, vascular pathology, SOLs
- EEG: if suspect frontotemporal dementia, CJD or seizure disorder
Give 5 causes of chronic memory loss other than dementia?
- alcohol/ drug abuse
- repeated head trauma (CTE)
- pellagra
- whipples disease
- CJD
- huntingdons
- HIV/ neurosphyillis
- cryptocccus
- B12/ folate defiency
- hypothyroidism
- depression
- parkinsons
How should dementia be managed (non pharm)
- aromatherapy
- multisensory stimulation
- massage
- music
- animal therapy
- social support (personal care, meal prep. medication prompting, day care activity centres)
- orientation boards
- blister packs
- psychotherapies: cognitive stimulation therapy, validation therapy, reminiscence therapy, behaviour therapy
- optomise physical health
- risk assessment: neglect, cooking, cleaning, driving, finances, abuse, aggression, wandering
What drugs may be useful in dementia and which should be avoided?
- acetylecholinesterase inhibits: donepezil and rivastigmine 1st line for AD and benefit behaviour change in lewy body - need pulse monitoring and ECG after starting treatment
- Vit E may slow functional decline
- antiglutamatergic- memantine in severe cases- good for agitated and challenging behaviour
- SSRIs and mirtazapine may help depression and anxiety
- avoid antipsychotics, sedatives and TCAs
What are the subtypes of dementia
- vascular dementia
- lewbody dementia
- frontotemporal dementia
- Alzheimer dementia
Describe the clinical features of lewbody dementia
- varying levels of attention or alertness
- visual hallucinations
- parkinsonism in later stages
- radid eye movement sleep behaviour disorder
