Dementia And Delirium

Question 1

Define dementia

Answer 1

An umbrella term

It is an irreversible, progressive syndrome with cognitive, function and behavioural deficits.

Question 2

Define delirium

Answer 2

An acute impairment of attention, alertness or perception

Question 3

Name some causes of delirium

Answer 3

Withdrawal from drugs, infection, electrolyte imbalance, etc

Question 4

Which class of antidepressants is more likely to cause delirium

Answer 4

Tricyclics

Question 5

Which anticonvulsants can cause delirium

Answer 5

Carbamazepine or phenytoin

Question 6

Withdrawal from benzodiazepines while in hospital for delirium or dementia is advised as it will help reduce confusion. True or false.

Answer 6

FALSE

If in hospital for these conditions, do not start withdrawal from BDZ

Question 7

Which class of drugs can cause both acute delirium and, with long term use, structural changes making you more susceptible to dementia?

Answer 7

Anticholinergics. The more anticholinergics a patient is taking, the more likely they will be hospitalised for confusion

Question 8

Which type of dementia is the most common

Answer 8

Alzheimer’s (50-70%)

Question 9

Donepezil and rivastigmine, used to treat Alzheimer’s, are two examples of which class of drugs?

Answer 9

Cholinesterase inhibitors

Question 10

ADRs of cholinesterase inhibitors?

Answer 10

You are increasing acetylcholine, therefore SLUDGE BBB

Question 11

Name the only treatment option for DLB dementia

Answer 11

Quetiapine (not curative, just helps with some Sx)

Question 12

Define DLB

Answer 12

Dementia of Lewy bodies

Question 13

The Sx experienced in vascular dementia is dependent on…

Answer 13

The area of the brain to which blood supply is reduced

Question 14

Non-pharmacological treatment of vascular dementia?

Answer 14

Reduce risk factors - smoking, diet, exercise

Question 15

Pharmacological treatment of vascular dementia ?

Answer 15

Anti-platelets (aspirin)

Question 16

Alcohol related dementia is caused by a deficiency of…?

Answer 16

Thiamine (vitamin B1).

This is because alcohol reduces its absorption

Question 17

Alzheimer’s drugs are not useful in alcohol related dementia. True or false?

Answer 17

True

Question 18

Treatment for alcohol related dementia is limited to… (2 options)

Answer 18

• stop drinking

- IV thiamine (needs to be IV because only high concentrations can cause it to cross BBB)

Question 19

Define BPSM in dementia

Answer 19

Behavioural and psychological symptoms

Question 20

Name some behavioural symptoms that can be treated with antipsychotics

Answer 20

Delusions, hallucinations, aggression

Question 21

All hallucinations and delusions experienced by dementia / delirium patients need to be treated. True or false? Why?

Answer 21

False.

Some of these delusions are calming and harmless

Question 22

Apathy and depression are psychological symptoms that can be treated with antipsychotics in dementia / delirium patients. True or false?

Answer 22

False. Cannot be treated with antipsychotics

Question 23

Drugs for treatment of BPSM are used for how long before they start to be withdrawn?

Answer 23

3 months

Question 24

Name 2 antipsychotics that can be used to treat behavioural / psychological Sx in dementia / delirium patients.

Answer 24

Haloperidol, olanzapine, citalopram

Question 25

Does of antipsychotics in dementia / delirium are higher or lower than their usual dose?

Answer 25

Lower

Question 26

If a patient is already on an antipsychotic but is aggressive still and needs to be calmed down, which class of drugs may be administered?

Answer 26

Benzodiazepines