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Clinical neuroscience > Dementia and delirium? > Flashcards

Dementia and delirium? Flashcards

1
Q

What is dementia?

A
  • A chronic, progressive syndrome of insidious onset
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2
Q

What are the cognitive symptoms of dementia?

A
  • Impaired memory (temporal lobe involvement)
  • Impaired orientation (temporal lobe involvement)
  • Impaired learning capacity (temporal lobe involvement)
  • Impaired judgement (frontal lobe involvement)
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3
Q

What are the non-cognitive symptoms of dementia?

A
  • Behavioural symptoms
  • Depression and anxiety
  • Psychotic features
  • Sleep symptoms
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4
Q

What are the behavioural symptoms of dementia?

A
  • Agitation
  • Aggression (frontal lobe involvement)
  • Wandering
  • Sexual disinhibition (frontal lobe involvement)
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5
Q

What are the psychotic features of dementia?

A
  • Visual and auditory hallucinations
  • Persecutory delusions
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6
Q

What are the sleep symptoms of dementia?

A
  • Insomnia
  • Daytime drowsiness (decreased cortical activity)
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7
Q

Before we can diagnose dementia what do we need to do?

A
  • Exclude organic causes of cognitive decline
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8
Q

What are some other conditions that can present with features of dementia?

A
  • Hypothyroidism
  • Hypercalcaemia
  • B12 deficiency
  • Normal pressure hydrocephalus (abnormal gait, incontinence, confusion)
  • Exclude delirium
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9
Q

What features do we need to look for when making a dementia diagnosis?

A
  • Features of progressive decline
  • Impairment of activities of daily living in a patient with a normal conscious level
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10
Q

What are the different types of dementia?

A
  • Alzheimer’s disease
  • Vascular dementia
  • Dementia with Lewy bodies
  • Frontotemporal dementia
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11
Q

What are the macroscopic features of Alzheimer’s disease?

A
  • Global cortical atrophy
  • Sulcal widening
  • Enlarged ventricles (primarily lateral and third affected)
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12
Q

What are the microscopic features of Alzheimer’s disease?

A
  • Plaques composed of amyloid beta
  • Tangles of hyperphosphorylated tau
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13
Q

How do plaques and tangles affect neurones?

A
  • Kill neurones
  • Since neurogenesis is limited in the CNS, any neurones that die are unlikely to be replaced
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14
Q

Which neurones are predominantly affected by Alzheimer’s disease?

A
  • Cholinergic neurones
  • Noradrenergic
  • Serotonergic
  • Those expressing somatostatin
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15
Q

What causes vascular dementia?

A
  • Cerebrovascular disease (multiple small strokes)
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16
Q

What are the risk factors for vascular dementia?

A
  • Previous stroke/MI
  • Hypertension
  • Hypercholesterolaemia
  • Diabetes
  • Smoking
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17
Q

How does vascular dementia present?

A
  • Stepwise, maybe with focal neurological features
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18
Q

What is dementia with Lewy bodies?

A
  • Essentially the same disease as Parkinson’s
  • But if dementia precedes movement disorder we call it dementia with Lewy bodies
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19
Q

What is the pathology of dementia with Lewy bodies?

A
  • Aggregation of alpha synuclein
  • Forms spherical intracytoplasmic inclusions
20
Q

Where are the main deposits of intracytoplasmic inclusions found across the brain?

A
  • Substantia nigra
  • Temporal lobe
  • Frontal lobe
  • Cingulate gyrus
21
Q

How does dementia with Lewy bodies present?

A
  • Fluctuating cognition and alertness
  • Vivid visual hallucinations
  • Parkinsonian features (may cause repeated falls)
22
Q

Why can we not give patients with dementia with Lewy bodies antipsychotics?

A
  • Neuroleptic malignant syndrome, a psychiatric emergency
23
Q

What are the symptoms of neuroleptic malignant syndrome?

A
  • Fever
  • Encephalopathy
  • Vital signs instability (tachycardia, tachypnoea, fluctuating BP)
  • Elevated creatine phosphokinase
  • Rigidity
24
Q

What is frontotemporal dementia?

A
  • Second most common cause of early onset dementia
  • Frontal and temporal lobe atrophy
25
Q

What are the symptoms of frontotemporal dementia?

A
  • Behavioural disinhibition
  • Inappropriate social behaviour
  • Loss of motivation without depression (caused by damage to anterior cingulate cortex)
  • Repetitive/ritualistic behaviours
  • Non fluent (Broca type) aphasia
26
Q

What is the pathology of AIDS associated dementia?

A
  • Entry of HIV infected macrophages into the brain is thought to lead to indirect damage to neurones
  • Insidious onset but rapid progression once established
27
Q

What are the clinical features of AIDs associated dementia?

A
  • Cognitive impairment
  • Psychomotor retardation (slow thoughts and movements)
  • Tremor
  • Ataxia
  • Dysarthria
  • Incontinence
28
Q

How is dementia managed?

A
  • Using the bio-psycho-social model
29
Q

What is the biological aspect of dementia management?

A
  • Drugs such as acetylcholinesterase inhibitors and NMDA antagonists
30
Q

Give some examples of acetylcholinesterase inhibitors used to treat dementia?

A
  • Donepezil
  • Rivastigmine
  • Galantamine
31
Q

Give some examples of NMDA antagonists

A
  • Memantine
  • Useful for treating agitation
32
Q

What is the social aspect of dementia management?

A
  • Explain diagnosis sensitively
  • Talk about problems that will arise and how they will be managed
  • Give results of any special investigations
  • Deal with the topics of driving and finances
  • Day care and respite care
  • Residential/nursing home placement
33
Q

What is delirium?

A
  • Sometimes called acute confusional state
  • Often reversible, due to organic cause
  • Associated with a variety of insults to the brain which may cause neuronal damage and inflammation
  • Dementia can predispose to episodes of delirium
34
Q

What are the features of delirium?

A
  • Rapid onset of confusion
  • Clouded consciousness
  • Fluctuating course
  • Maybe transient visual hallucinations
  • Often exaggerated emotional responses (e.g. aggression)
35
Q

What are the different types of delirium?

A
  • Hypoactive
  • Hyperactive
36
Q

What are the features of hypoactive delirium?

A
  • Withdrawn
  • Quiet
  • Sleepy
  • More likely to be missed/confused with something else
37
Q

What are the features of hyperactive delirium?

A
  • Restless
  • Agitated
  • Aggressive
  • Mood may rapidly fluctuate
  • Persecutory delusions
  • Symptoms worse at start and end of day
38
Q

What are the causes of delirium?

A
  • Nutritional
  • Intracranial
  • Extracranial infections
  • Iatrogenic
  • Alcohol
  • Endocrine
  • Metabolic
39
Q

What are the nutritional causes of delirium?

A
  • Vitamin deficiencies
40
Q

What are the intracranial causes of delirium?

A
  • Strokes
  • TIAs
  • Epilepsy
  • Infection etc
41
Q

What are the extracranial infectious causes of delirium?

A
  • UTI
  • Pneumonia
42
Q

What are the alcohol-related causes of delirium?

A
  • Intoxication
  • Withdrawal (including delirium tremens)
43
Q

What are the endocrine causes of delirium?

A
  • Thyroid
  • Pancreas
44
Q

What are the metabolic causes of delirium?

A
  • Hypoxia
  • Renal
  • Hepatic
45
Q

What is the management of delirium?

A
  • Find and treat the underlying cause
46
Q

What is the prognosis of delirium?

A
  • Increases risk of dementia
  • Associated with mortality
  • Patients have lengthy hospital stays and have a high risk of readmission

Clinical neuroscience (19 decks)

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