Dementia and Delirium symposium

Question 1

What investigations would you ask for?

Answer 1

urine dipstick, fbc, u/e, LFT, thiamine, folate, thyroid, blood glucose, ecg (arrhythmia/ ischaemia), calcium, vit d, cultures.
imaging CXR,CT head

Question 2

collateral history question?

Answer 2

memory, personality change, attention, language (repeats questions), executive function driving/dressing, visuospatial perception (recognising objects)
MAPLEV

Question 3

what is delirium?

Answer 3

confusion/change in behaviour with acute onset and fluctuating course

altered cognition, decreased concentration
altered physical function, less mobility, restless

Question 4

types of delirium?

Answer 4

hyper- heightened arousal, restless distressed
hypo- sleepy withdrawn quiet
or mixed

Question 5

confusion assessment method

Answer 5

acute onset and fluctuating course, inattention and distractibility plus 3 or 4

Question 6

sqid?

Answer 6

are they more confused than normal

Question 7

delirium causes?

Answer 7

drugs withdrawal, toxicity/ dehydration
environment/ energy
level of pain
infection/inflammation
respiratory failure (hypoxia, hypercapnia)
impaction of faeces
urinary retention
metabolic disorders: thyroid hypoglycaemia

Question 8

pharmacological treatment with delirium?

Answer 8

1st line- lorazepam
2nd- haloperidol

Question 9

avoid haloperidol in?

Answer 9

LBD, parkinsons

Question 10

why dont you give lorazepam iv?

Answer 10

makes available much quicker, can cause death

Question 11

how do you find out someone is in urinary retention?

Answer 11

palpation, or bladder scan

Question 12

how long does it take for delirium resolve?

Answer 12

can take up to months

Question 13

what is dementia?

Answer 13

syndrome due to disease of the brain, chronic or progressive nature in which there is impairment in more than one cognitive domain accompanied by IMPAIRMENT OF FUNCTION

Question 14

most common type of dementia?

Answer 14

alzheimers then vascular

Question 15

alzheimers macroscopic?

Answer 15

cortical atrophy, neurofibrillary tangles and amyloid plaques and reduction in acetylcholine

Question 16

vascular dementia details?

Answer 16

1 large stroke or small tia
step wise

Question 17

FTLD features?

Answer 17

personality changes difficulties in language and behaviours, usually 60s

Question 18

LBD triad?

Answer 18

visual hallucination
cognitive fluctuations,
parkinsonism

Question 19

other cause of dementia

Answer 19

korsakoffs, thamine
cjd prion
huntingtons
hypothyroidism
folate

Question 20

VANISHED?

Answer 20

V: vascular, vitamin deficiency: B1, B6, B12, folate
A: Alzheimer disease, autoimmune: cerebral vasculitis, systemic lupus erythematosus
N: normal pressure hydrocephalus, neoplasia
I: infection, e.g. Creutzfeldt-Jakob disease, herpes simplex encephalitis, prion diseases, tertiary syphilis, HIV/AIDS, PML
S: substance abuse, serum abnormalities e.g. hyperammonaemia, uraemia, Wilson disease
H: hormones: hypothyroidism, hyperparathyroidism
E: electrolyte disturbances: e.g. hyponatraemia, hypokalaemia, hypocalcaemia, hypercalcaemia etc.
D: depression (pseudodementia)

Question 21

pseudodementia?

Answer 21

people with depression seem to have dementia but dont

Question 22

which medication can cause decrease in acetylcholine?

Answer 22

bladder, psychiatry

Question 23

what percent of risk factors of dementia are modifiable?

Answer 23

35

Question 24

what is cognition?

Answer 24

correctly interpret input from sensory organs, make an appropriate judgement, initiate a verbal or motor response, keep a record of above

Question 25

stroop inhibition test?

Answer 25

read out word not its colour and vice versa

Question 26

addenbrookes cognitive examination cut off?

Answer 26

below 88, dementia wont get missed but may be incorrect diagnosis
below 82- confident it is dementia but some cases may get missed

Question 27

diagnosis of dementia is?

Answer 27

clinically based

Question 28

what do we see in Alzheimers CT head?

Answer 28

cortical atrophy, medial temporal lobe atrophy, widening of sulci, larger ventricles

Question 29

vascular dementia mri head?

Answer 29

hyperintense regions - white matter small vessel ischaemic changes

Question 30

Lewy body scan?

Answer 30

dAT scan-

Question 31

FTLD scan?

Answer 31

frontal and temporal atrophy asymmetric

Question 32

biological treatment for mild/moderate AD?

Answer 32

acetylcholinesterase inhibitors donepezil, galantamin, rivastigmine

Question 33

treatment for severe AD?

Answer 33

NMDA receptor antagonist memantine

Question 34

vascular risk factors?

Answer 34

diet smoking, aspirin, antihypertensive statins