Dementia and Delirium Flashcards Preview

Clinical Disciplines II- Exam 1 (Melicia) > Dementia and Delirium > Flashcards

Flashcards in Dementia and Delirium Deck (36)
Loading flashcards...
1

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

2

Dementia can be...

progressive, disabling, fatal

3

What are some of the cognitive deficits seen in dementia?

memory

apaxia

aphasia

agnosia

disturbed executive functioning- ability to think, plan, organize?

4

What is agnosia?

Failure to recognize objects

5

DSM-5 criteria for dementia?

evidence in cog. decline from a previous level of performance in one or more of following
-learning/memory
-executive func.
-complex attention
-perceptual motor
-social cognition

6

What can you use to assess pt if you are concerned for dementia?

mini mental status exam

(up to 30 pts)

7

MMSE score of.... is considered abnormal

24

8

Delirium is also known as...

acute confusional state

acute mental status change

AMS

organic brain syndrome

reversible demential

toxic or metabolic encephalopathy

9

Why are we concerned about delirium?

Very prevalent (1/3 of pts presenting to ED)

high morbidity and mortality

10

persistence of delirium results in...

poor long term outcomes

11

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

12

What can be used to help dx delirium?

Confusion Assessment Method (CAM)

13

What is included in CAM?

1.Acute change in mental status and fluctuating course

2.Inattention

3.Disorganized thinking

4.Altered level of consciousness

need 1 + 2 + (3 OR 4) for dx

14

What is the spectrum of delirium?

hyperactivity or agitated delirium

hypoactive delirium

mixed

15

.....is an important neurotransmitter for cognitive processes

Acetylcholine

16

What is delirium caused by?

anticholinergic drug overdose, reversed by physostigmine

17

Is delirium assoc. with an increased or decreased serum anticholinergic activity?

INCREASED

18

What labs may be elevated in pt with delirium?

increased CRP

increased interleukin 1B

increased TNF

19

Effect of inflammatory aspect of delirium?

Inflammation can break down blood-brain barrier, allowing toxic medications and cytokines access to CNS

20

What are some predisposing factors for delirium?

Advanced age

Dementia

Func. Impairment in ADLs

Medical comorbidity

Hx of ETOH abuse

Male gender

Sensory impairment( vision/hearing)

21

What are some precipitating factors for delirium?

-Acute CV events
-Acute pulmonary events
-Bed rest
-Drug withdrawal (sedatives, alcohol)
-Fecal impaction
-Fluid or lyte disturbances
-Indwelling devices
-Infections (esp. respiratory, urinary)
-Meds
-Restraints
-Severe anemia
-Uncontrolled pain
-Urinary retention

22

Which surg. are assoc. with 50% postop delirium?

cardiac surg, AAA repair

hip fx

(others: 15%)

23

What are some preoperative risk factors for delirium?

Age 70+

Cognitive impairment

Physical functional impairment

Hx ETOH abuse

Abn serum chemistries

Intrathoracic and aortic aneurysm surgery

24

When is the peak onset for postop delirium?

on 2nd day post op

25

Postop delirium is assoc with?

postop pain

postop anemia

use of benzos and opioids (esp. meperidine)

26

What is recommended to prevent postop delirium?

limit sedation

provide adequate analgesia

27

What should be included in hx for dementia/delirium?

time course of cognitive changes

med review

alcohol

28

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

29

Should you order cerebral imaging if you are concerned for delirium or dementia?

NO

rarely helpful unless head trauma or new focal neuro findings

30

Should you order EEG and CSF if you are concerned for delirium or dementia?

NO

rarely helpful except with assoc. seizure activity or signs of meningitis

31

management for dementia/delirium?

interdisciplinary effort

multifactoral approach

failure to dx/manage delirium --> costly, life threatening comps/loss of func.

32

keys to effective management?

identify/tx reversible conditions

maintain behavioral control

anticipate/prevent complications

restore func.

33

What are some drugs to reduce/eliminate?

anticholinergics, anticonvulsants, antidepressants, antihistamines, antipsychotics, H2 blocking agents, etc.

34

If absolutely necessary what can be used to help with behavioral problems?

Haloperidol

Use lorazepam in sedative and alcohol withdrawal, and history of neuroleptic malignant syndrome

35

What should you assess for if you give a pt Haloperidol?

akathisia and extrapyramidal effects

monitor for QT interval prolongation

36

What can you use to help rehabilitate pt?

use orienting stimuli (clocks/calender)

adequate socialization

use of eyeglasses/hearing aids

mobilize ASAP

ensure adequate nutrition/fluids

educate fam