Delirium + dementia

Question 1

What is the definition of delirium?

Answer 1

Transient (<6m) acute change in consciousness + cognition due to underlying pathology
REVERSIBLE

Question 2

Causes of delirium?
acronym?

Answer 2

PINCH ME
Pain
Infection - UTI/URTI
Nutrition low
Constipation
Hydration low
Metabolic
Endocrine + Electrolytes

Question 3

Rf for delirium?

Answer 3

age
pHx delirium
having dementia
all increase risk

Question 4

Sx for delirium?

Answer 4

Clouded consciousness + inattention

Acutely (<6m) with fluctuation + disturbed sleep wake cycle + disordered thinking

often complex hallucination

Question 5

Types of delirium?

Answer 5

hyperactive = agitation, persecutory delusions + vivid hallucinations

Hypoactive = withdrawn, low GCS

Mixed

Question 6

Dx for delirium?
investigations

Answer 6

confusion bloods
ECG
consider CXR, Urine dip/MSU, CT head

Question 7

What is tested in confusion bloods?

Answer 7

FBC, U+E, LFT, ESR/CRP, B12+Folate, Ca2+, TSH, Coagulation, Glucose, blood cultures

Question 8

What screening tool is used for delirium?
what does it stand for?

Answer 8

4AT
Alertness
AMT4 (age, dob, time, place)
Attention
Acute course

88% specific

Question 9

What is delirium confirmed with?
In GP?

Answer 9

short CAM (confusion assessment method)

GP = GPCOG

Question 10

What does the short CAM test?

Answer 10

confusion
inattention
disorganised thinking
altered consciousness

Question 11

Tx for orient Px with delirium?

Answer 11

reduce noise
same staff
clocks on wall
sleep wake cycle
family time

Question 12

Tx for agitated Px with delirium?

Answer 12

1. calm verbally
2. PO/IM haloperidol
   (Parkinsons = benzodiazepine)

Question 13

What are some delirium triggering medications?

Answer 13

TCA
Opiates
BB
Steroids
L-DOPA
Benzos

Question 14

What is the definition of dementia?

Answer 14

progressive decline in cognitive function in alert Px for 6+ months, brain pathology
IRREVERSIBLE

Question 15

Which dementias affect the cortical regions?

Answer 15

alzheimers - MC
Fronto-temporal
Vascular (+ Lewy body dementia)

Question 16

Which diseases affect the subcortical regions?

Answer 16

Parkinsonism
Huntingtons
Alcohol
AIDS

Question 17

Alzheimers dementia
% of dementias?
what is it caused by?

Answer 17

60% all dementia

B-amyloid plaques (phosphorylated TAU protein neurofibrillatory tangles) widespread in cortex with axon damage + low Ach

Question 18

RF for alzheimers?
ratio F:M?

Answer 18

APP gene mutations
CVD RFs
fHx
genetic (APO-E4, Downs, PSEN1+2)
F (60%) : M high

Question 19

Sx of alzheimers?

Answer 19

4As
Aphasia (difficulty communicating)
Agnosia (can’t recognise familiar objects/voices)
Apraxia (unable to speak/move)
Amnesia (memory loss)
in GRADUAL decline

Question 20

Vascular dementia
% of dementias?
cause?

Answer 20

20-30%
CVD results in cortical infarct

Question 21

RF of vascular dementia?
Sx of vascular dementia?

Answer 21

CVAs, other IHD

4As, more SEVERE in STEPWISE DECLINE

Question 22

Lewy body dementia
% of dementias?
what is it caused by?
RF?

Answer 22

5%

Deposits of eosinophilic ubiquitin + alpha synuclein in basal ganglia + cortex

Parkinsons (25%), fHx, age

Question 23

Sx of lewy body dementia?

Answer 23

REM sleep disorder
vivid visual hallucinations
Parkinsonism (after dementia)
often fluctuating consciousness

Question 24

what is the most rapid declining dementia?

Answer 24

Lewy body

Question 25

Fronto temporal dementia % of dementias? what is it caused by? RF?

Answer 25

5% Pick bodies (Tau + ubiquitin) in frontal/temporal lobes Fix, affects 50-60y, TDP43 + C9orf72, MAPT

Question 26

Sx of frontotemporal dementia?

Answer 26

frontal: apathy (lack of interest) mood disorder low executive function hyperphagia + hypersomnia + crying Temporal: trouble with grammar

Question 27

What is the precursor to dementia called?

Answer 27

mild cognitive impairment

Question 28

Dx of dementia? what investigations are done?

Answer 28

Confusion bloods, syphillis, HIV MSE /30 (>25 good)

Question 29

What screening exam is done for dementia?

Answer 29

Addenbrooke's cognitive examination (ACE-III)

Question 30

what is ACE-III out of? what is a good result and what is abnormal?

Answer 30

/100 >88 = good <82 = abnormal

Question 31

What imaging is done for dementia? what are we trying to rule out?

Answer 31

CT (r/o SOL + NPH - normal pressure hydrocephalus) MRI head SPECT/DaT SCAN

Question 32

What would be seen in an MRI head in someone with Alzheimers dementia?

Answer 32

Diffuse cortical + hippocampal atrophy, succal widening and bigger ventricles Micro: Tau, B amyloid, low Ach axons

Question 33

What would be seen in an MRI head in someone with Vascular dementia?

Answer 33

1 or more white cortical infarct

Question 34

What would be seen in an MRI head in someone with Lewy body dementia?

Answer 34

cortical deposit / BG deposit / normal Micro: ubiquitin + alpha synuclein

Question 35

What would be seen in an MRI head in someone with fronto temporal dementia?

Answer 35

frontal and temporal deposits Micro: Pick bodies (ubiquitin + Tau)

Question 36

When would you do a SPECT and DaT scan and what would you see?

Answer 36

SPECT = Ddx AD + FTD DaT = LBD (2 dots instead of commas for BG)

Question 37

What MDT members are involved in the care of a Px with dementia?

Answer 37

PT OT SALT Neuro GP

Question 38

what is the medical Tx for Alzheimers dementia?

Answer 38

1. Achase-i (Rivastigmine/galantamine/donepazil) - mild/mod dementia 2. NDMA-i (Memantine) - mod/severe dementia

Question 39

SE of memantine?

Answer 39

dizzy, headache, SOB

Question 40

With alzheimers dementia medications, what do you not Give?

Answer 40

do not give antipsychotics

Question 41

what is the medical Tx for vascular dementia?

Answer 41

vascular RF, statins + aspirin

Question 42

what is the medical Tx for Lewy body dementia?

Answer 42

same as AD (Achase-i!!!) do not give antipsychotics benzos are fine to give

Question 43

what is the medical Tx for frontotemporal dementia?

Answer 43

SSRI, Antipsychotic do not give Achase-i - worsens Sx

Question 44

What services are available for dementia Px?

Answer 44

Alzheimer's society Dementia UK

Question 45

Name some other types of dementia / dementia symptom diseases?

Answer 45

Prion HAND NHP Alcohol Wilsons pseudo dementia Neurosyphillis

Question 46

What is Prion disease? Caused by? Sx?

Answer 46

Creutzfeldt-Jakob disease Caused by abnormal infectious protein in brain 'prion', which misfold + build up in brain spongiform encephalitis associated with boring vaccine Rapid dementia + <1y death

Question 47

What is HAND? what does it stand for?

Answer 47

HIV associated neuro disorder

Question 48

What is normal pressure hydrocephalus? Sx? Dx? what would be seen? Tx?

Answer 48

Excess CSF in ventricles Wet - loss of bladder control Wacky Wobbly Dx with CT (widened ventricles) in 65+y M Tx with VP shunt

Question 49

How does alcohol cause dementia like Sx?

Answer 49

Dependence Wernickes + Korsakoff

Question 50

What is Wilsons disease? what Sx does it cause and why is it similar to dementia? Dx? Tx?

Answer 50

Auto recessive ATP 7B hypercopperaemia Wing beating tremor, Parkinsonism, dementia, Kayser Fleischer rings (eyes) Dx = low serum caeruloplasmin, high urine copper Tx = D - Penicillinamine

Question 51

What is and causes pseudo dementia?

Answer 51

Depression Px 'I don't know' answers Normal MSE Recent bereavement No confabulation

Question 52

What is neurosyphilis? Sx? Tx?

Answer 52

3^ with other Sx Tabes dorsalis, Argyll robinson pupil, dementia and psychosis Tx = IM Penicillin V