Delirium and dementia

Question 1

Define delirium

Answer 1

Acute onset of confusion/ change in behaviour
- With a fluctuating course

Can be hypoactive (most common), hyperactive or mixed

Question 2

Delirium features

Answer 2

Altered cognition
- Inattention
- Decreased concentration
- Confused
- Slow response

Altered physical function
- Decreased mobility
- Restlessnes
- Change in appetite

Altered perception
- VIsual/ auditory hallucinaton

Question 3

Delirium causes

Answer 3

I WATCH DEATH

I- Infection
- Sepsis, UTI, encephalitis, pneumonia.

W- withdrawl
- Alcohol, benzos

A- Acute metabolic disturbance
- Hypercalcaemia
- Hypoglycaemia
- Acidosis
- Uraemia

T- Toxins, drugs
- Opioids
- Alcohol
- Overdose

C- CNS
- Stroke, intracranial bleeds
- Post-ictal

H- Hypoxia/ respiratory failure

D- Dehydration/ deficiency
- B12, thiamine, niacin

E- endocrine
- DKA
- Thyrotoxicosis

A- Acute vascular
- Subarachnoid bleed
- Hypertensive crisis

T- Trauma

H- heavy metals

Question 4

Dementia types

Answer 4

Alzheimer’s
- Most common
- Primarily memory, language dysfunction

Vascular
- Next most common
- Step wise decline, associated with high cardiovascular risks and previous strokes.

Lewy body
- Characterised by cognitive decline, hallucinations and parkinsonism.

Fronto-temporal
- Typically in younger patients.
- Characterised by drastic behavioral and language dysfunction.

Mixed

Others: Huntington’s, Korsakoff’s, CKD

Question 5

Features of dementia

Answer 5

2 or more of:

M- Memory and language dysfunction

A- Attention deficits

P- Personality changes

L- Language dysfunction

E- Executive function

V- Visuospatial disorder

Question 6

Mini mental state exam

Answer 6

Tool to screen dementia
- Especially AD
- <20= cognitive impairment

Features
- Orientation
- Language/ repetition
- Recall

In AD, would show
- Impaired recall
- Nominal dysphasia
- Disorientation
- Constructional dyspraxia
- Impaired executive functioning.

Question 7

Risk factors for vascular dementia

Answer 7

> 60 years old

Obesity

Hypertension

Smoking

Hyperlipidaemia

Question 8

Management of vascular dementia

Answer 8

1. Antiplatelet + lifestyle
   Reduce BP
   - Control glucose
   - Stattins

Question 9

Drugs that can cause delirum

Answer 9

Opiods

L-dopa

Antipsychotics

Antihistamines

Corticosteroids

Question 10

List assessment tools for delirum

Answer 10

CAM
- confusion assessment method

Question 11

Components of 4AT test for delirium

Answer 11

Attention

Alertness

AMT4
- Name, DoB, place, current year.

Acute change/ fluctuating cause

Question 12

Pathological findings in dementia

Answer 12

Amyloid plaques & neurofibrillary tangles

Question 13

Pathology of vascualr dementia

Answer 13

Multiple infarcts to large number of brain regions

Changes in white matter near lateral ventricles/ white matter atrophy

Haemorrhage

Question 13

Pathology of vascualr dementia

Answer 13

Multiple infarcts to large number of brain regions

Changes in white matter near lateral ventricles/ white matter atrophy

Haemorrhage

Question 14

Features of vascular dementia

Answer 14

Problems with executive function

Poor attention

Disinhibited behaviour

Memory defficulty

Question 15

Define semantic dementia

Answer 15

Cognitive and language deficit
- Loss in comprehension of words and semantic processing.

Question 16

Types of frontotemporal dementia

Answer 16

Behaviour variant

Primary progressive aphasia

Primary non-fluent aphasia

Question 17

Define primary progressive aphasia

Answer 17

Type of frontotemporal dementia

Semantic
- Loss of comprehension and expression of words (semantic memory)

Non-fluent aphasia
- Difficulty with grammar: understanding complex sentences.