Delirium, Dementia, Alzheimer Flashcards
(36 cards)
Cognitive failure
dysfunction/loss of cognitive function
ex: delirium (acute)
ex: demential (chronic)
Delirium
acute, transient (comes and goes), flunctuating changes in mental state; attention, cognition & consciousness levels (lethargy-> drowsy -> agitation), usually reversible
Incidence
15-50% amongst hospitalized elders, post surgery, etc
signs & symptoms (3/7)
- shifting levels of attention-difficulty focusing
- altered level of consciousness (LOC)-less aware environment
- fluctuating changes of cognition-ex: transient (temporary) memory loss, disorganized
- sensory misperceptions common (illusions), hallucination
- disturbed psychomotor activities (restlessness, picking at things)
- sleep-wake cycle disturbances-symp. worsen at night
diagnosis
- run test & imaging search for causes, hx
- immediate medical evaluation & treatment
- can be life threatening
- R/O (rule out) dementia & depression
- neurological signs & symptoms (ex:paralysis), which would not show right away
Key diagnostic aspects, 3
- acute onset: s&s develop over hours/days
- fluctuating s&s (during course of day)
- evidence of med. condtn., toxin, w/drawal (ex: potentionlly reversible)
causes of delirium, 3
- drugs:
- analgesic (narcotics, etc)
- anticholiergics (cardiovascular & antiparkinsons drugs etc)
- psychotropic drugs (antidepressants, steroids)
- prescribed, abused, overdose, or w/drawal - Infection:
- Urinary tract infection (UTI),
- pneumonia - dehydration & causes of decrease cardiac output (ex: acute blood loss
- MI (heart attack)
- -stroke: high bl. pressure, TIA)
-metabolic disorders (malnutrition
-hypoxia etc)
-intoxicants (alcohol)
-hypo/hyperthermia
acute psychoses
predisposing factor
- aging
- male
- damaged brain (head injury, CVA, pre-existing dementia)
- impaired sensory fnctng. & sensory deprivations (hospital light on all night/uncomfortable hospital beds) (anyone who gets older)
precipitating factors (causes)
*-immobilization, fractures (death nail for heart attack, weaker everyday when staying in bed)
-drugs
-infection
-dehydration
-sleep deprive, shock, exhaustion
-malnutrition, under-nutrition
transfer to unfamiliar environment
-psychomotor stress (restraints)
-decreased sensory stimulation
-fecal impaction
Therefore, delirium common complication of hospitalization
prognosis
- increase morbidity & mortality
- 35-40% hospitalized elders experiencing delirium die w/in a year due to vulnerability from serious health problems
prevention
- prepare OA for changes in location
- place familiar objects surrounding
- maximize sensory input (lighting, clocks, calendars)
treatment
- reverse underlying cause
- medications for delusions
- supportive: restore sleep/wake cycle, reassurance
Dementia (general)
a clinical syndrome involving a sustained loss of intellectual funct. & memory loss severe enough to cause dysfunction in daily living (de=loss, mentia=mind)
Key features
- gradually progressing course (over months & years)
- no disturbance of consciousness (vs. delirium)
reversible dementia
- R/O reversible & potentially reversible; 20% of all dementia
- responds to tx
- damage may be reversed
causes of potentially reversible dementia
- drugs toxicity ex: alcoholism (acute brain reaction to acute lack of vit. B-1) common, causes delirium, dementia, depression, falls
- heavy metals (lead), organic poison (carbon monoxide)
- Trauma
- Infection (viral, HIV)
- autoimmune disorders (multiple sclerosis)
dementia (irreversible)
a chronic, irreversible, progressive, incurable structural, damage to brain tissue
Types of dementia, 3
- degenerative disease of the CNS (AD)
- vascular dementia (Multi-infarct dementia MID)
- Mixed: AD & MID; Korsakoff Syndrome
AD (degenerative disease of the CNS)
-2/3 of dementia in geriatric population, onset >65, F>M
Lewy Body Dementia:
- > DLB=Dementia of Lewy Body type [also occur in late PD]
- > Lewy Body (clumps of specific protein, don’t need to know
- > 3rd most common after AD & MID, onset
- > onset >60, M>F
- > lewy body proteins=decreased & fluctuating alertness, halluc., PD signs
Frontotemporal Lobe (FTD,aka Pick’s disease):
- > common cause young-onset dimentia, onset <65, M=F, ->Tau proteins in brain,
- > 50% heredity
- > less memory affected, variants: increased behavior & increased language impact
L.A.T.E (limbic-predominant age-related TDP-43 Encephalopathy)
->recently discovered on autopsy, similar to AD
Vascular dementia:
Multi-infarct dementia (MID)
- 15% of dementias in geriatirc population (M>W, >60)
- course: step-wise deterioration
- more changes of HBP (high blood pressure), neurological signs (ex: unilateral weakness, sensory deficit, loss of speech, gait earlier than AD)
- occlusive cerebrovascular disease
Korsakoff syndrome (Mixed AD & MID)
chronic memory disorder often proceed by acute Wernicke Encephalophaty=severe lack Vit B-1, ex: due to alcohol, infection, AIDS, cancer, malabsorption
AD (in details)
a progressive neurological disease which affects the brain, causing mental deterioration
incidence
- most common form of irreversible dementia,
- 2/3rds of dementia in geriatric population
- 4th leading cause of death in OA (after heart disease, cancer & stroke)
- single major cause of institutionalization of OA
- by 85, 25% of popul., by 90, 50% of popul.
pathophysiology
presence of neurofrillary tangles, prions (misfolded proteins) & beta-amyloid deposits leading to neuron death & formation of plaque
