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Delirium

Geriatric Medicine

QuestionAnswer
A mental state marked by the mingling of ideas w/consequent disturbance of comprehension/understanding, and bewilderment confusion
chronic organic brain syndrome = dementia
Acute organic brain syndrome, acute confusional state, acute dementia; "noisy restlessness" = delirium
short term memory loss w/o delirium or dementia (Korsakov psychosis) amnestic syndrome
Acute/subacute alteration in mental status, disorder of attention, improvement or normalization of mental function after underlying condition treated = delirium
predisposing factors for delirium decreased sensory function, sensory deprivation, sleep deprivation, immobilization, transfer to new environment, psychological disturbances, males, >3 new meds
10 common causes of delirium metabolic disorders, infections, decreased CO, stroke, drugs, intoxication, hypo/hyperthermia, acute psychoses, transfer to unfamiliar surroundings, fecal impaction/urinary retention
chronic deterioration of mental function sufficiently severe to interfere with daily living = dementia
Onset: delirium vs dementia delirium: acute; dementia: insidious
Disease course: delirium vs dementia delirium: fluctuating ; dementia: generally stable
Duration: delirium vs dementia delirium: hours to weeks; dementia: months to years
Awareness: delirium vs dementia delirium: reduced; dementia: clear
Attention: delirium vs dementia delirium: hypo/hyper alert; dementia: usually normal
orientation in delirium mistakes familiar/unfamiliar
memory: delirium vs dementia delirium: immediate/recent impaired; dementia: recent > remote impaired
thinking: delirium vs dementia delirium: disorganized; dementia: impoverished
perception: delirium vs dementia delirium: illusions/hallucinations; dementia: usually normal
speech: delirium vs dementia delirium: incoherent/ hesitant/ slow/ rapid; dementia: word finding difficulty
sleep-wake cycle: delirium vs dementia delirium: always disrupted, often reversed, short & fragmented; dementia: often fragmented
illness/toxicity in delirium vs dementia: delirium: either or both present; dementia: often absent
tertiary syphilis can cause: dementia
prevalence of dementia over age 65 5-10% have some level of dementia (50% in >85 yo)
How is Alzheimer's diagnosed? clinical diagnosis of exclusion; post-mortem neurofibrillary tangles, plaques
Alzheimer's generally presents in the __ decade of life 7-8th
mean survival associated with Alzheimer's 8-10 years
DSMIV TR criteria for dementia of the Alzheimer's type memory impairment and at least 1 of (aphasia, apraxia, agnosia, disturbance in executive function or occupational functioning) deficits do not occure exclusively during a delerium
__% of older adults in primary care settings suffer from depression 37
Mild stage of Alzheimer's symptoms suble and often undetected, decline of short term memory
Moderate stage of Alzheimer's impaired language abilities and ability to think abstractly and exercise judgment (personality changes), decline of visual and spatial skills
Severe stage of Alzheimer's loss of long term memory, problems sleeping, weak, unable to walk or talk, incontinent, completely dependent on the caregiver
Is emotional lability more common in primary degenerative dementia or vascular dementia vascular
Are focal neuro signs/hx of stroke/TIA more common in primary degenerative dementia or vascular dementia vascular
Is hypertension/hx more common in primary degenerative dementia or vascular dementia vascular
Vascular dementia occurs more in men or women? men
normal memory loss "forgetfulness" associated with aging, doesn't cause impairment, not progressive benign senescent forgetfulness
important aspects of patient history when evaluating dementia active medical problems, list drugs, cardiovascular and neurological, characterize the symptoms, assess the social situation, ask about special problems
Who has the highest rate of suicide? older white males
important aspects of PE when evaluating dementia BP, cardiovascular, neurologic, Folstein MMSE (<24/30)
management of dementia cholinesterase inhibitors, treat underlying medical conditions, physical and mental activity, use memory aids, good nutrition, manage complications, provide ongoing care, patient and family education, social service info, family counseling
therapeutic effect of cholinesterase inhibitors best for mild-moderate dementia, shown to slow progression
therapeutic use of NMDA antagonist more for moderate-severe dementia; shown to slow decline in function
Is delirium preventable? Yes: provide humane care, adequate light, warmth, familiar staff
Disturbance of consciousness in conjunction with reduced ability to focus, sustain or shift attention = delirium
Deterioration of cognitive function, memory = Dementia
Rapid onset of cognitive symptoms, mental status fluctuations, anxiety, irritability = delirium
Delirium = acute change in consciousness; serious medical condition (increased morbidity / mortality)
Mild cognitive impairment: pathogenesis = hippocampal atrophy
Alzheimer dz pathophysiology Extracellular deposition of amyloid-beta protein, intracellular neurofibrillary tangles, loss of neurons. 50-90% reduction in choline acetyltransferase in cortex & hippocampus
Most common causes of dementia 1) Alzheimer. 2) Vascular dementia. 3) Cortical Lewy body disease
Vascular dementia clinical features Stepwise / incremental progression. Often causes gait abnormalities / other focal deficits
Lewy body disease clinical features Lewy bodies (as seen in PD). Quicker onset. Rigidity simultaneous with dementia. Visual hallucinations; paranoia. Avoid neuroleptics/antipsychotics
Alzheimer risk factors Age, FH, hx head trauma, CVA, obesity, DM, APOE4 allele, Down syndrome
Tests to measure cognitive impairment MMSE. Animal naming test. Clock drawing test. 7-minute neurocognitive screen.
Location of strokes most often associated with depression Left frontal lobe
Drugs associated with increased incidence of depression BB, CNS drugs, benzos, steroids, NSAIDs, cimetidine, centrally acting alpha agonists (clonidine, methyldopa)
Created by: Abarnard