E2 Delirium & Dementia

Question 1

Delirium also called

Answer 1

acute confusional state

Question 2

Delirium

Answer 2

-Transient disorder of cognitive function, consciousness, or perception
-Can be sudden or gradual onset
-Hyperactive confusional state & Hypoactive confusional state

Question 3

Hyperactive delirium

Answer 3

-Acute disturbance in attention or awareness
-Typically develops over 2-3 days
-Usually seen in ICUs, post-surgery, withdrawal, hospitalized elderly

Question 4

Hyperactive delirium Risk Factors

Answer 4

-Medications
-Acute infection/ sepsis
-Surgery
-Hypoxia
-Electrolyte or metabolic disfunction
-Insomnia

Question 5

Manifestations of hyperactive delirium

Answer 5

-Restlessness
-Irritability
-Difficulty concentrating
-Insomnia
-Tremulousness
-Poor appetite

Question 6

Fully developed hyperactive delirium symptoms

Answer 6

-Hallucinations
-Person completely inattentive
-Grossly altered perception

Question 7

Physical symptoms of hyperactive delirium

Answer 7

dilated pupils, increased HR, diaphoretic, increased temp

Question 8

Fully developed hyperactive delirium can lead to

Answer 8

excited delirium syndrome (ExDS) can cause death
-More common in pts with mental illness or intoxication

Question 9

Symptoms of excited delirium syndrome

Answer 9

combative, aggressive, cause pain, rapid breathing

Question 10

Treatment of hyperactive delirium

Answer 10

-Remove risk factors
-Usually self-resolves in 2-3 days but can persist for weeks
-Try to help them sleep
-Try not to give meds that can alter perception
-Get them home ASAP

Question 11

Hypoactive delirium is associated with

Answer 11

-Right-sided frontal basal-ganglion disruption (part of brain associated w/ coordinated movements & alertness)

Question 12

Hypoactive delirium is most common in those with

Answer 12

Metabolic disorders
-Liver or kidney failure

Question 13

Manifestations of hypoactive delirium

Answer 13

-Decreased alertness & attention span
-Decreased ability to perception and interpretation of the environment
-Forgetful
-Apathetic
-Slow speech
-Frequently falls asleep

Question 14

What is the goal of the treating delirium?

Answer 14

Identify cause and remove causative agents, modify risk factors when possible

Question 15

Individuals who have ____ at baseline have a MUCH higher risk of delirium

Answer 15

Dementia
But there are differences

Question 16

Delirium can be _____

Answer 16

prevented

Question 17

Define Dementia

Answer 17

-Acquired deterioration and progressive failure of cerebral functioning
-Umbrella term for Cognitive impairment
-Impaired intellectual processes: memory, language, judgement, decision making, orientation
-Some genetic-predisposition

Question 18

Some one may not be aware of dementia onset and may present as

Answer 18

agitated, wandering, aggression

Question 19

Pathophysiology of dementia

Answer 19

-Neuron degeneration
-Compression of brain tissue
-Atherosclerosis of cerebral vessels
-Brain trauma
-Infection
-Neuro-inflammation

Question 20

____ and ____ can cause dementia like qualities

Answer 20

HIV & Creutzfield-Jacob disease

Question 21

Onset of dementia

Answer 21

Generally slow, and symptoms are usually irreversible

Question 22

Treatment of Dementia

Answer 22

-No cure
-Treatment directed at restoring and optimizing functional capacity and accommodating with lost abilities

Question 23

________ is the leading cause of severe cognitive dysfunction in the elderly

Answer 23

Alzheimer’s Disease

Question 24

How many Americans have it and who is most likely to get it

Answer 24

6 million Americans
2/3 Women

Question 25

Cause of Alzheimers

Answer 25

Exact is unknown -Genetic associations more common in early onset -Sporadic late-onset AD is most common and does not have specific genetic association

Question 26

How is Alzheimers diagnosed

Answer 26

-Ruling out other conditions -like vascular brain tumor or anything like that

Question 27

Risk factors for AD

Answer 27

-Being older than 65 -Family history -Inheriting genes for the disease -Existing mild cognitive impairment -Down syndrome -Unhealthy Lifestyle (drinking/smoking) -Previous head trauma -Isolation

Question 28

Pathophysiology of AD

Answer 28

Accumulation of neuritic plaques and intraneuronal neurofibrillary tangles of tau preotein -Plaques disrupt nerve impulse transmission and kill neurons -Loss of synapses and Acetylcholine -Brain atrophy from loss of neurons

Question 29

What part of the brain does AD usually effect

Answer 29

Cerebral cortex and hippocampus

Question 30

When do pathophysiological changes of AD occur

Answer 30

Decades prior to symptoms -Starts as mild short-term memory loss to total loss of cognitive and executive function

Question 31

Vascular Dementia

Answer 31

-2nd most common type of dementia -related to cerebrovascular disease -R/T large artery disease, cardioembolism, small vessel diesease, stroke -Risk factors: DM, HPL, HTN, Smoking -Treat: prevent risk factors

Question 32

Frontotemporal Dementia

Answer 32

-Rare -AKA Picks Disease -Familial association with age of onset less than 60 -R/T gene mutations of encoding tau protein -No Treatment

Question 33

3 distinct clinical syndromes of Frontotemporal Dementia

Answer 33

1. Behavioral Variant (change in personality & judgement 2. Progressive non-fluent behavior (Prob with language & writing) 3. Semantic dementia (problem forming words & sentences)

Question 34

MOA of Donepezil

Answer 34

Works centrally in the brain to increase levels of acetylcholine by inhibiting acetylcholinesterase Mild to moderate AD

Question 35

Adverse Effects of Donepezil

Answer 35

Normally none to mild, resolve on own -GI upset -drowsy/dizzy -Insomnia -Muscle Cramping -Bradycardia -Reflex tachycardia -Syncope

Question 36

When is Donepezil given?

Answer 36

PO at bedtime, best with food to minimize GI effects Avoid NSAIDs to avoid GI upset

Question 37

MOA of memantine

Answer 37

Blocks the stimulation of NMDA receptors believed to be associated with AD Moderate to severe AD

Question 38

Adverse effects of memantine

Answer 38

Uncommon -Confusion -Hypotension -Headache -Dizziness -Constipation (take fiber)

Question 39

Memantine helps prevent neuronal damage bc it ______ in brain

Answer 39

decreases level of Ca2+

Question 40

Memantine is often given in conjunction with

Answer 40

Colon esterase