Neuro week: confusion Flashcards
(29 cards)
Dominant symptoms of hypoactive and hyperactive delirium
Hyperactive: restlessness, agitation
Hypoactive: drowsiness, inactivity
What score on MMSE suggests dementia/delirium
<24
What drugs might be given to tranquilise a delirious person if they are at risk of harm to self or others
- Haloperidol
- Lorazepam if Parkinson’s or Lewy Body Dementia
Describe the pathogenesis of Alzheimer’s
- Decreased Ach
- Amyloid plaques
- Tau plaques neurofibrillary tangles
Risk factors for Alzheimer’s
- Genetics
- Female
- Down’s syndrome
Describe the pathogenesis of vascular dementia
Multiple infarcts throughout cortex
Risk factors for vascular dementia
- Smoking
- hypertension
- T2DM
- high cholesterol
Describe the pathogenesis of Lewy Body dementia
Deposition of alpha synuclein protein in brainstem and cortex
Which types of dementia are slowly progressive/ which have stepwise deterioration
- Alzheimer’s
- Vascular dementia
- Frontotemporal dementia
- Dementia with Lewy Bodies
Slowly progressive:
- Alzheimer’s
- Frontotemporal dementia
- Dementia with Lewy Bodies (fluctuation of symptoms)
Stepwise deterioration:
-Vascular dementia
Differences between delirium and dementia wrt:
- onset
- duration
- deterioration
ONSET
- acute in delirium
- gradual in dementia
DURATION
- hours to weeks in delirium
- months to years in dementia
DETERIORATION
- fluctuating in delirium
- progressive in dementia
What kind of drugs precipitate/worsen delirium
Anticholinergics (including antipyschotics, Parkinson drugs, TCA)
What are the 4 psychomotor disturbances that can occur with delirium
- Rapid, unpredictable shifts from hypo to hyper-activity
- Increased reaction time
- Increased/decreased speech flow
- Enhanced startle reaction
What are predisposing factors for delirium
- underlying brain dz (dementia, stroke, Parkinson)
- age >65, frailty
- polypharmacy
- renal impairment
- visual/hearing impairment
- sleep deprivation
- hip fracture
What are causes of delirium
PINCH ME
- Pain
- Infection eg UTI, LRTI
- Nutrition (B12/ folate/ thiamine)
- Constipation
- Hydration (lack of)
- Medication eg opioids, corticosteroids, catheter
- Environment eg hypothermia
What must be ruled out when a patient appears delirious
Hyperglycaemia and hypoglycaemia
4 features of delirium
- acute confusion
- fluctuating cognitive impairment
- associated with behavioural abnormalities
- impaired short term memory
Blood tests to request in investigation delirium + why
- blood sugar (hyper/hypoglycaemia may cause delirium)
- TFTs (hyper/hypothyroidism may cause delirium)
- CRP, U&Es (check for infection)
Most common cause of dementia
Alzheimer’s
What is classified as early onset dementia
symptoms <65yo
What type of dementia involves fluctuation of symptoms
Lewy body dementia
What type of dementia involves spontaneous Parkinsonism:
rigidity, bradykinesia, tremor, shuffling gait
Lewy body dementia
Does delirium or dementia cause impaired conciousness
Delirium
Does delirium or dementia cause a disrupted sleep-wake cycle
Delirium
Does delirium or dementia cause perceptual disturbance
BOTH
common in delirium
only occurs in later stages in dementia
