| Cognitive Disorders | Dementia | Delirium |
| What is this? | Impairment in cognitive fxn with global deficits. Normal level of consciousness. | Acute disturbance of consciousness with altered cognition that develops over a short period of time (hours) |
| What causes? | DEMENTIAS: DEGENERATIVE DZ (Parkinson's Huntington), ENDOCRINE (thyroid, PTH, pituitary), METABOLIC, EXOGENOUS (EtoH, Electrolytes, B12 def, glucose, hepatic, renal, Wilson's, EXOGENOUS, NEOPLASIA, TRAUMA, INFECTION, AFFECTIVE D/O, STROKE/STRUCTURE | I WATCH DEATH: Infection, Withdrawal, Acute metabolic/substance Abuse, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrine, Acute vascular/MI, Toxins/drugs, Heavy metals |
| What do they present with? | Memory impairment and one of 4 A's of dementia: Aphasia (language impairment), Apraxia (can't do motor fxn- brush hair), Agnosia (can't recognize previously known objects), Impaired executive fxn (planning, organizing) | Waxing and Waning consciousness! Perceptual disturbances (hallucinations, delusions, illusions). Combative, anxious, paranoid or stupor. Decreased attention span and short-term memory with reversed sleep-wake cycle. Increased symptoms at night (sundowning |
| How do you diagnose? | 1) Hx/PE with serial mini-mentals | Got to find what's causing: 1) Vitals, pulse ox and glucose with neuro and PE 2) Meds (insulin, anticholinergics, steroids, narcotics, benzos) 3) Substance abuse 4) Med problems 5) organ failure (liver, kidney) 6) Infection (UTI common in elderly) 7) Labs |
| What do yo order to r/o other causes? | 2) R/o other causes: CBC, RPR, CMP, ESR, UA, HIV, TFTs, B12, head CT or MRI | What to run a lot of tests in order to differentiate underlying cause of dementia. |
| What is used to treat? | Cholinesterase inhibitors and antipsychotics for agitation. Benzos are avoided b/c may worsen disinhibition and agitation. | 1) Treat underlying cause 2) Normalize fluids/electrolytes 3) Optimize sensory environment 4) Low dow antipsychotics (haldol) for agitation/psychosis 5) May need physical restraints |
| What do you want to remember? | The 4 A's of Dementia: 1) Amnesia 2) Apraxia (can't remember motor activities) 3) Aphasia (impaired language) 4) Agnosia (can't recognize objects) | Waxing and Waning LOC; UTIs common cause in elderly |
| Who gets this d/o? | People >85 y/o with Alzheimers (50%) and multi-infarct dementia (25%) | Kids, elderly and hospitalized patients (ICU psychosis) |
| Level of Attention | Usually alert | Fluctuating LOC (impaired) |
| Onset | Gradual | Acute |
| Course | Progressive deterioration | Fluctuating LOC from hour to hour |
| Consciousness | Intact | Clouded |
| Hallucinations | Occur in approximately 30% in advanced disease | Present (often visual or tactile) |
| Prognosis | Irreversible but up to 15% are due to treatable causes | Reversible |