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Y3 PSYCHIATRY > Delirium and Memory Problems > Flashcards

Delirium and Memory Problems Flashcards

1
Q

What is the most common mental health problem in hospitalised patients above the age of 65?

A

Delirium

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2
Q

What are the main features of delirium?

A 
Impaired consciousness
Disturbed cognition
Psychomotor disturbance
Emotional disturbance
Disturbed sleep-wake cycle
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3
Q

What might be seen clinically if a patient has impaired consciousness?

A

Clouding
Drowsiness
Stupor
Coma

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4
Q

What might be seen clinically if a patient has disturbed cognition?

A

Disorientated for time and place
Impaired memory and attention
Impaired thinking
Perceptual disturbance (hallucinations, delusions)

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5
Q

What are the 2 main psychomotor variants of delirium?

A

Hypoactive
Hyperactive
Can get mixed picture

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6
Q

What might be seen clinically if a patient has hypoactive delirium?

A

Confusion
Sedation
Depression (misdiagnosis)

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7
Q

What might be seen clinically if a patient has hyperactive delirium?

A

Agitation
Aggression
Hallucinations, delusions
Disorientation

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8
Q

Describe the course of delirium

A

Fluctuating, transient course
Rapid onset
Can last days to months depending on cause

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9
Q

What drugs can typically cause delirium?

A 
Anticholinergic
Anticonvulsant
Parkinson drugs
Steroids
Opiates
Alcohol
Illicit drugs
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10
Q

Withdrawal from what substances can typically cause delirium?

A

Alcohol
Benzodiazepines
Barbiturates
Illicit drugs

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11
Q

List some metabolic abnormalities that can typically cause delirium

A

Hypoxia
Hypoglycaemia
Hypo/hyperthyroidism
Hypopituitarism

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12
Q

No identifiable cause excludes a diagnosis of delirium. True/False?

A

False

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13
Q

List the main risk factors for delirium

A 
Elderly
Existing dementia
Sensory deficits
Perioperative
Previous episode
Immobility
Social isolation, stress
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14
Q

Sedating drugs can worsen delirium. True/False?

A

True

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15
Q

How is delirium due to alcohol withdrawal managed with medication?

A

Benzodiazepine (chloridazepoxide, diazepam)

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16
Q

What is the general management of delirium?

A

1ST LINE = environmental measures (reality oreintation, sensory impairment, light, noise, basic needs)
Antipsychotic - haloperidol
Lorazepam in PD, LWB dementia, neuroepileptic sensitivity

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17
Q

Who typically gets hyperactive delirium?

A

Elderly with recent injury e.g. hip fracture

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18
Q

What time of day is delirium typically worse?

A

Night

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19
Q

What is the shortest type of memory?

A 
Sensory memory (less than 1 sec)
Short-term (less than 1 minute)
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20
Q

List the 2 main domains of long-term memory and their function

A 
Explicit memory (conscious)
Implicit memory (unconscious)
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21
Q

Procedural memory is part of what - implicit or explicit memory? What kind of memory does it enable?

A

Implicit memory

Remembering skills and doing tasks

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22
Q

Declarative memory is part of what - implicit or explicit memory? What kind of memory does it enable?

A

Explicit memory

Remembering facts and events

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23
Q

What are the 2 main domains of declarative memory and their memory functions?

A 
Episodic memory (events, experiences)
Semantic memory (facts, concepts)
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24
Q

What is anterograde amnesia?

A

Difficulty acquiring new material and remembering events since onset of illness/injury

25
What is retrograde amnesia?
Difficulty remembering information prior to onset of illness/injury
26
List some typical reports of memory problems
``` Forgetting a message Losing track of conversation Forgetting to do things Inability to navigate to familiar places Misplacing things Struggling with names ```
27
What are the main domains assessed in cognitive screening?
``` Memory Attention, concentration Executive function Visuo-spatial function Language ```
28
List diagnostic investigations used in delirium
``` Formal cognitive testing Urine analysis FBC, U+Es, LFTs Thyroid function Blood glucose CRP B12 + folate CXR/ CT brain EEG (diffuse background slow wave activity) ```
29
Which two illnesses have a strong association with development of depression?
Stroke | MI
30
List precipitating causes of delirium
PINCH ME PAIN ILLNESS: urinary retention INFECTION: UTI, lungs, stomach NEUROLOGICAL: withdrawal, alcohol CONSTIPATION CATHETER CARDIOEMBOLIC HYDRATION HYPO: thyroid, natraemia, kalaemaia, thermia, glycaemia, xia MEDICATION: new meds/ change in meds ENVIRONMENTAL: hospital, surgery
31
List the criteria for diagnosing dementia
``` 2 or more of: Forgetfulness Memory loss Confusion Poor reasoning and logic Personality change Poor judgement Ability to focus Visual perception ```
32
Compare the memory impairment in dementia, delirium and depression
DEMENTIA: Recent and remote impairment DELIRIUM: Recent impairment DEPRESSION: Remote intact, concentration poor
33
List cognitive tests used to diagnose dementia
``` 4AT (rapid screening for delirium) MMSE Bedside tests (GPCOG, 6CIT) MoCA (rapid screening for mild cognitive dysfunction) ACER (between MMSE and neurophysiology) Frontal assessment battery Neurophysiology ```
34
What is the cute off for diagnosis of dementia using the MMSE?
<24/30
35
Clock drawing tests the function of which lobes of the brain?
Fronto-parietal lobes
36
What is the purpose of neurophysiological assessment?
Whether intellectual/ behavioural decline is linked to disease of CNS
37
Define 'dementia'
Syndrome due to disease of brain, which is irreversible and progressive, with global cognitive decline over months-years, and reduced emotional control, social ability and motivation
38
List non-pharmacological management options for dementia
``` Environmental measures (sleep, exercise, medications, carer education) Post diagnostic counselling Advance planning Practical and legal advice inc. driving OT assessment ```
39
What is 'mild cognitive impairment'?
Minor problems with cognition - their mental abilities such as memory or thinking - that are worse than expected for a healthy person of their age. Increased risk of developing dementia
40
Alzheimer's disease typically follows what pattern of memory loss? Which lobe of the brain is affected first?
Short-term memory loss first | Medial temporal lobe
41
Vascular dementia follows what pattern of decline?
Step-wise decline in cognition
42
List the three main variants of fronto-temporal dementia
Behavioural variant Primary progressive aphasia Semantic dementia
43
List red flags for dementia presentation
``` Fast progression Young patient Neurological sings FHx of rare/ young dementia Clues in PMHx e.g. HIV ```
44
A SPECT scan is most useful for diagnosing which type of dementia?
Fronto-temporal dementia
45
A DaT scan is most useful for diagnosing which type of dementia? What is the classical appearance?
Lewy body or Parkinson's dementia | Full stop sign
46
An MRI scan is most useful for diagnosing which type of dementia?
Younger patients, fast progression, atypical presentation
47
How does Alzheimer's disease present on imaging?
Cortical atrophy Dilated ventricles Widened sulci Narrowed gyrus
48
Where do small vessel changes typically occur in the brain in vascular dementia?
Periventricular white matter
49
What is the mechanism of action of anti-cholinesterase inhibitors?
Block cholinesterase and increase ACh in synapse
50
Which anti-cholinesterase inhibitors are first line in Alzheimer's disease?
Donepezil Rivastigmine Galantamine
51
Which anti-cholinesterase inhibitors are first line in DLB and PD? What symptom do they help control?
Rivastigmine Donepezil Visual hallucinations
52
List side effects of anti-cholinesterase inhibitors
GI (nausea, diarrhoea) Headache Muscle cramps Bradycardia
53
Anti-cholinesterase inhibitors are contraindicated in...
Active peptic ulcers Severe asthma Severe COPD
54
Which medication should be used in Alzheimer's disease when anti-cholinesterase inhibitors are contraindicated? What do they help prevent?
Memantine | BPSD (Behavioral and psychological symptoms of dementia)
55
List side effects of memantine
``` Hypertension Sedation Dizziness Headache Constipation ```
56
What other class of drug can be considered for prescribing in dementia?
Antidepressants
57
Behavioural difficulties in fronto-temporal dementia can be controlled with which medication?
Trazadone
58
Antipsychotics are contraindicated in which type of dementia?
Lewy body dementia
59
List aetiology of dementia
GENETIC: Huntingdons's, wilson's, porphyria INFECTIOUS: Syphillus, prions, encephalitis CVD METABOLIC: Hypothyroidism, thiamine (alcohol) CEREBRAL TUMOURS DEGENERATIVE: Alzheimer's, parkinson's DEMYELINATION TRAUMA: Major head injury NORMAL PRESSURE HYDROCEPHALUS

Y3 PSYCHIATRY (23 decks)

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