Flashcards in delirium, dementia, concussions Deck (56):
a more profound deficit that includes disorientation, bewilderment, and difficulty following commands.
consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.
a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states.
means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state
state of unarousable unresponsiveness
Response to motor examination in comatose patients
reaction to noxious stimuli
Localizing responses, such as moving the examiner's hand away from the body, are not consistent with coma
Flexion and extension responses to painful stimuli are consistent with coma, and some patients have no response at all
-reactivity tom voice and physical stimulation
-cranial nerves, vestibule-ocular reflex
a form of paralysis from injury to the anterior brainstem with sparing of the RAS, leaving the patient awake and aware but with limited ability to communicate.
Catatonic states and severe abulia
syndromes that inhibit the patient from responding appropriately due to limited, not global, impairment of the brain.
A few clinical signs suggest the diagnosis of a locked-in syndrome, abulia, and catatonic states.
In locked-in syndrome, most patients have spared vertical gaze (particularly upward gaze) allowing them to follow commands.
Abulic patients will have occasional spontaneous purposeful movements.
Catatonic patients often have limb position postures that are not typical of coma.
what percent of elderly hospitalized its experience delirium?
what type of drugs can cause delirium?
delirium. conical presentation:
Hours to days
what test detects delirium?
Confusion assessment method (CAM)
Treat the underlying condition
Reassurance, reorientation, limit aggravating factors
Pharmacologic? Antipsychotics with limited evidence
Mild cognitive impairment
Normal pressure hydrocephalus
dementia laboratory eval:
Additional tests depending on history:
RPR/T.pallidum, HIV, autoimmune testing
MRI preferred over CT
alzheimers dementia clinical features:
Generalized and focal atrophy
Reduced hippocampal volume
Atrophic medial temporal lobe
-Functional brain imaging with [18F] FDG-PET, functional MRI (fMRI), perfusion MRI, or SPECT reveals distinct regions of low metabolism (PET) and hypoperfusion (SPECT, fMRI)
hippocampus, the precuneus (mesial parietal lobes), the lateral parietal and posterior temporal cortex
how do you measure Alzheimers progression?
-measured with MMSE, MoCA, and the clinical dementia rating scale
what is the most common type of dementia?
what is the second most common type of dementia?
dementia with Lewy bodies
pathologic hallmark of dementia with lewy bodies?
abnormal aggregates of protein in the cytoplasm
features of Lewy body D?
differentiating dementia with lewy bodies and Parkinson's:
In DLB, dementia should occur before or concurrently with onset of parkinsonism
-in parkinsons, Parkinson's comes first, then dementia
Similar to slightly faster rate of cognitive decline than AD
Shorter survival time than AD
same as AD, but neuroleptics with care
~30 - 50% have severe sensitivity to neuroleptics
Mostly motor symptoms
Death of cells in the substantia nigra
parkinsons motor symptoms:
Postural instability (walking/gait difficulty)
Cognitive decline usually later
~30% of PD patients
Age of onset of PD >=60
Increased severity of parkinsonism
cardinal features of Parkinson's dementia:
impaired visuospatial function
less prominent memory deficits
relatively preserved language function
parkinsons dementia tx:
No therapies have been shown to modify the course of the disease or influence prognosis
Changes in behavior, personality, language
Behavioral variant (bvFTD)
Primary progressive aphasias:
behavioral changes of frontemporal dementia:
Diagnosis may be difficult
Rule out psychosis
Differential includes Lewy body disease, AD
primary progressive aphasia:
-insidious onset and gradual progression of a language impairment (ie, aphasia) manifested by deficits in word finding, word usage, word comprehension, or sentence construction
-Nonfluent vs. Semantic
most common form of prion disease:
neuropathology CJD features:
proliferation of glial cells
absence of an inflammatory response
presence of small vacuoles within the neuropil, which produces a spongiform appearance
CJD clinical features:
Rapidly progressive cognitive decline
CJD MRI abnormalities:
T2 hyperintensities in the putamen and head of the caudate
Vascular (multi-infarct) dementia:
Multiple brain insults accumulated over time (step wise decline)
vascular dementia risk factors:
Cardiovascular risk factors
Uncontrolled hypertension, hyperlipidemia, type 2 diabetes, heart disease
Normal pressure hydrocephalus (NPH):
large ventricle size with normal opening pressures
Gait difficulty and urinary urgency/incontinence first, then cognitive changes
Lumbar puncture to aid in diagnosis
Shunt placement can lead to improvement in symptoms
most common form of sports-related TBI:
concussion clinical presentation:
When patients report persistent neurobehavioral impairments after concussion
Chronic Post-concussion Syndrome when symptoms present >1year after injury
post-concussion syndrome assessment :
Comprehensive neurological examination
Personal and family history of migraine/sleep disturbance/mood disorders
concussion eval on field:
Seizure? Prolonged loss of consciousness?
Evidence of cervical spine disease?
Emergency medical services!