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Clinical neuroscience > L12 - Confusion > Flashcards

L12 - Confusion Flashcards

(39 cards)

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1
Q

Causes of confusion on the elderly

A 
Delirium
Dementia 
Drugs
Depression 
Endocrine/ metabolic defects
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2
Q

Delirium

A

Acute change in consciousness (feeling drowsy) and cognition that fluctuates

  • inattention
  • confusion
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3
Q

Cognition

A

Ability to gain and understand new knowledge
E.g making new memories
Problem solving
Understand language

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4
Q

Depression

A

Change in mood and feeling of self worth

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5
Q

Dementia

A

Cognitive decline due to diseases of the brain
Progressive
Impairment in memory, intellect and personality

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6
Q

Drugs that can cause confusion

A

Morphine
Cocaine
Alcohol
Zopiclone

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7
Q

Metabolic disturbances that can cause confusion

A

Hyper/ hypothyroidism
Hyper/ hypocalcaemia
Vitamin B12 deficiency
Normal pressure hydrocephalus

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8
Q

Early and late onset dementia

A

Early - before 65 yrs old

Late - after 65 yrs old

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9
Q

Types of dementia

A 
Alzheimer’s disease
Lewy Body dementia 
Vascular dementia 
Fronto - temporal dementia 
AIDS dementia complex
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10
Q

Tests to assess cognitive function

A

Mini mental state examination (MMSE)

Montreal cognitive assessment (MOCA) - used by neurology department

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11
Q

Macroscopic changes of Alzheimer’s disease

A

Global brain atrophy
Mostly frontal, parietal and temporal lobe
Affects hippocampus - memory loss
Sulcus widening
Enlarged 3rd and 4th interventricular space

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12
Q

Microscopic changes of Alzheimer’s disease

A

Senile amyloid plaques from the breakdown of beta amyloid precursor proteins
Increased neurofibrillary tau tangles - increases acetylcholinesterase therefore decreasing Ach
Neuronal death

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13
Q

Treatment of Alzheimer’s disease to treat symptoms

A

Acetylcholinesterase inhibitors increases acetylcholine

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14
Q

Early onset genetic factors

A
  • beta Amyloid precursor protein mutation
  • presenilin 1
  • presenilin 2
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15
Q

Late onset genetic factors

A

Apolipoprotein E gene - increased permeability of the brain to amyloid plaques

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16
Q

Presenting complaint of Alzheimer’s disease

Study These Flashcards
A

Memory loss
Loss of vision-spatial awareness - get lost
Difficulty in using language, calculations and everyday activities

17
Q

Medication

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A

Acetylcholinesterase inhibitors:

  • donepezil
  • galantamine
  • rivastigmine

Glutamate inhibitors - preventing excitotoxicity
- memantine

18
Q

Pathophysiology of Lewy body dementia

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A 
Aggregation of alpha synuclein protein 
Found in cytoplasms
Deposits in the:
- substantia nigra 
- temporal lobe 
- frontal lobe 
- cingulate gyrus
19
Q

Lewy body presenting complaint

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A
  • fluctuating cognition with variation in attention and alertness
  • visual hallucinations
  • Parkinsonism - festigating gait and flexed posture
20
Q

How does Parkinson’s disease differ from Lew body dementia?

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A

Parkinson’s disease:

  • early Parkinson’s symptoms
  • late cognitive decline
  • tremor
  • bradykinesia
  • lead pipe rigidity

Lewy body dementia:

  • early cognitive decline
  • late Parkinson’s symptoms
  • no tremor of rigidity
21
Q

How to treat Lewy body dementia

Study These Flashcards
A

Acetylcholineesterase inhibitors:

  • donepezil
  • galantamine
  • rivastigmine

Glutamate inhibitor:
- memantine

22
Q

Fronto- temporal dementia

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A

2nd common cause of early onset dementia
55 - 65 yrs old
Atrophy of frontal and temporal lobes

23
Q

Presenting complaint of fronto- temporal dementia

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A

Frontal lobe:

  • altered behaviour
  • altered personality
  • bad social conduct - less control over appropriateness
  • Broca’s dysphasia
  • primitive reflexes I.e. grasp reflex and palmomental reflex

Temporal lobe:

  • hippocampus - short/ long term memory impairment
  • Wernicke’s dysphasia
24
Q

Palmomental reflex

Study These Flashcards
A

Stroke thenar eminence in baby, open mouth

Also seen in fronto - temporal dementia

25
Vascular dementia
Caused by ischaemic or haemorrhagic stroke - cerebrovascular event
26
Risk factors of vascular dementia
``` Hypertension Hypercholesterolaemia Smoking Diabetes Vascular disease ```
27
Treatment of vascular dementia
Treat the risk factors
28
Progression of vascular dementia
Step - wise deterioration of cognitive function with focal neurological symptoms - lacuna stroke - brain cognition decreases but then stabilises - recurrent
29
AIDS - dementia complex
Increased prevalence HIV infected macrophages enter the brain and cause indirect damage to neurones Rapidly progressive Insidious onset
30
Presenting complaint of AIDS dementia complex
``` Ataxia Cognitive impairment Psychomotor retardation Tremor Dysarthria - joint pain Incontinence ```
31
Treatment of AIDS dementia complex
Treat HIV with antivirals
32
Common investigations for all dementia cases
Within 6 months of new diagnosis: - FBC - U+ Es - LFTs - CRP - thyroid function test - random blood sugar - vitamin B12 and folate - routine syphilis tests if indicated
33
Bio-psycho social model
Refer to health care professional to manage symptoms e.g. district nurses and Age UK - feelings of isolation - impairment in daily activities - financial burden
34
Types of delirium
Hyperactive: increased motor activity and increased excitability Hypo-active: decreased motor activity and low mood with decreased interaction Mixed
35
Causes of delirium
Drug toxicity: - withdrawal of alcohol, coffee, cocaine or benzodiazepines - opiates, anti - histamine, dopamine agonists, levodopa Endocrine - hyper or hypothyroidism - Addison’s disease - Cushing’s disease Liver failure Intracranial - stroke - epilepsy - cerebral abscess - haemorrhage Renal failure - hyperureamia Infection Urinary and faecal retention Metabolic - hypoxia - electrolyte imbalance
36
Delirium investigations
``` FBC LFTs U+Es CRP Thyroid function test Blood sugar Blood culture - sepsis ``` Bedside tests: - urine dip +/- culture - oxygen saturation Radiological - CXR - CT (if appropriate) Confusion screening Review drug history Rule out causes
37
Treatment of delirium
Treat underlying cause Rehydrate Calm environment Haloperidol if essential
38
Difference between delirium and dementia
Delirium: - rapid onset - fluctuating - hallucinations - impaired consciousness - speech a can be slow or fast - reduced GCS Dementia: - slow progression - normal GCS - hallucinations rare - steady decline - speech slow
39
How to assess consciousness
Check pulse and breathing Sternal rub Trapezius squeeze Fingernail pressure test

Clinical neuroscience (20 decks)

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