Flashcards in Dementia and Delirium Deck (36)
What is dementia?
CHANGES in memory/thinking over time
A syndrome of impairment in memory or thinking severe enough to interfere with daily activities, work or social relationships
Dementia can be...
progressive, disabling, fatal
What are some of the cognitive deficits seen in dementia?
disturbed executive functioning- ability to think, plan, organize?
What is agnosia?
Failure to recognize objects
DSM-5 criteria for dementia?
evidence in cog. decline from a previous level of performance in one or more of following
What can you use to assess pt if you are concerned for dementia?
mini mental status exam
(up to 30 pts)
MMSE score of.... is considered abnormal
Delirium is also known as...
acute confusional state
acute mental status change
organic brain syndrome
toxic or metabolic encephalopathy
Why are we concerned about delirium?
Very prevalent (1/3 of pts presenting to ED)
high morbidity and mortality
persistence of delirium results in...
poor long term outcomes
DSM 5 dx criteria for delirium?
Disturbance in attention (reduced ability to focus) and awareness (reduced orientation to the environment)
develops over a short period of time, and behavior tends to fluctuate during the course of a day
What can be used to help dx delirium?
Confusion Assessment Method (CAM)
What is included in CAM?
1.Acute change in mental status and fluctuating course
4.Altered level of consciousness
need 1 + 2 + (3 OR 4) for dx
What is the spectrum of delirium?
hyperactivity or agitated delirium
.....is an important neurotransmitter for cognitive processes
What is delirium caused by?
anticholinergic drug overdose, reversed by physostigmine
Is delirium assoc. with an increased or decreased serum anticholinergic activity?
What labs may be elevated in pt with delirium?
increased interleukin 1B
Effect of inflammatory aspect of delirium?
Inflammation can break down blood-brain barrier, allowing toxic medications and cytokines access to CNS
What are some predisposing factors for delirium?
Func. Impairment in ADLs
Hx of ETOH abuse
Sensory impairment( vision/hearing)
What are some precipitating factors for delirium?
-Acute CV events
-Acute pulmonary events
-Drug withdrawal (sedatives, alcohol)
-Fluid or lyte disturbances
-Infections (esp. respiratory, urinary)
Which surg. are assoc. with 50% postop delirium?
cardiac surg, AAA repair
What are some preoperative risk factors for delirium?
Physical functional impairment
Hx ETOH abuse
Abn serum chemistries
Intrathoracic and aortic aneurysm surgery
When is the peak onset for postop delirium?
on 2nd day post op
Postop delirium is assoc with?
use of benzos and opioids (esp. meperidine)
What is recommended to prevent postop delirium?
provide adequate analgesia
What should be included in hx for dementia/delirium?
time course of cognitive changes
What labs should you check for dementia/delirium?
based on H&P
+/- CBC, lytes, renal func. test
+/- UA, LFTs, serum drug levels, ABGs, CXR, ECG, cultures
Should you order cerebral imaging if you are concerned for delirium or dementia?
rarely helpful unless head trauma or new focal neuro findings
Should you order EEG and CSF if you are concerned for delirium or dementia?
rarely helpful except with assoc. seizure activity or signs of meningitis
management for dementia/delirium?
failure to dx/manage delirium --> costly, life threatening comps/loss of func.
keys to effective management?
identify/tx reversible conditions
maintain behavioral control
What are some drugs to reduce/eliminate?
anticholinergics, anticonvulsants, antidepressants, antihistamines, antipsychotics, H2 blocking agents, etc.
If absolutely necessary what can be used to help with behavioral problems?
Use lorazepam in sedative and alcohol withdrawal, and history of neuroleptic malignant syndrome
What should you assess for if you give a pt Haloperidol?
akathisia and extrapyramidal effects
monitor for QT interval prolongation