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Dementia Delirium

Clinical Medicine II

Acute (hrs to days) confusional state that is normally transient Delirium
Clinical hallmark signs of delirium ↓attention span and waxing/waning confusion
What is delirium often diagnosed for dementia or depression
What are two things to do to try and miss delirium thing delirium until proven otherwise, also may have pre-existing dementia (compare to baseline)
What are common situations w/ delirium hospitalized, ICU pt’s, post op, ~80% near death
What is the theory cause of delirium dec. Ach and and excess of dopamine
What is the most reversible cause of delirium medications
What is the D.E.L.I.R.I.U.M. causes of it Dementia, electrolyte d/o, lung, liver, heart, kidney, brain, Infx, Rx drugs, Injury, pain stress, Unfamiliar environment, Metabolic
Common drugs that precipitate delirium Anticholinergics, analgesics (narcotics), benzodiazepines, corticosteroids, antidepressants, parkinson’s medications, dig tox
What are 7 RF’s for delirium Cog impairments, sleep deprivation, immobilization, psychoactive meds, vision impairment, hearing impairment, dehydration
What are the three types of delirium hyperactive, hypoactive, mixed (nocturnal agitation daytime sedation)
What are the three diagnostic criteria the DSM states classifies delirium Disturbance of consciousness, acute (hrs-days), fluctuate throughout the day
Sxs of delirium Clouding of consciousness, difficult maintaining/ shifting attention, disorientation, illusions, hallucinations, fluctuating consciousness
What are two cognitive tests for delirium MMSE: Mini mental status exam and CAM: cognitive assessment method
Evaluation of delirium H&P: compare to baseline, Cognitive tests, Med list, lab evaluation: LFT’s, CMC (infx), BUN/Cr, glucoae and many more depending on the pt
What four features are we evaluating with CAM 1: acute onset w/ fluctuation, 2: inattention, 3: Disorganized thinking, 4: altered level of consciousness
With CAM, when can we classify it as deliurm need 1&2 with either 3 or 4
What is the management of delirium determine underlying cause and tx it: medical emergency! Tx sxs if necessary (antipsychotic to ↓ agitation), familiarize the room/situation
When does delirium usually reside by 1-2 weeks, lags behind the causative illness
How can we prevent delirium identify high risk pt’s, initiate appropriate interventions
An acquired sustained impairment in intellectual fxn w/ compromise in ¼ catagories dementia
What at the spheres of mental activity memory, language, visuolspatial skills, personality, (other: judgement, calculation, abstraction
What are the types of dementia, MC Alzheimer’s :MC, vascular, mixed, other
Types of dementia in late life alzheimer’s, vascular, lewy body, frontotemporal+pick dz, reversible
What does Alzheimer dementia affect progressive, memory, higher learning, reasoning, behavior, emotion
Characteristic signs of alzheimer’s dementia neurofibrillary tangles and neuritic plaquesdestroy cholinergic and other brain neuronal pathways, also serotnergic and noradrenergic pathways lost
2nd most common type of dementia, cause Vascular, results from multiple infarcts, ischemia, hypoperfusion, amyloid angiopathy, brain hemorrhage etc.
Main different b/w alzheimer’s and vascular dementia Vascular d/t infarcts, and CNS plaques cause focal neuro sxs
What is a lewy body eosinophilic inclusions in subcortical neurons of pt’s w/ Parkinson’s dz
Clinical classifications of DLB Fluctuations in cognition, visual hallucinations, parkinsonian motor signs
What is FTD Frontotemporal dementia: bilateral frontal lboe atrophy w/ intraneuronal inclusions (Pick bodies)
3 classifications of FTD Picks dz w/ pick bodies, frontotemporal atrophy w/o picks, and frontotemporal atrophy w/ motor neuron dz
What is a dz in the family of transmissible spongiform encephalopathy’s Creutzfeld-Jakob dz
Patho of Alzheimer’s Plaques: deposits of beta- amyloid precursor proteins Tangles: intracellular accumulations of cytoskeletal protein tau
Fxn of tau. Dz? makes mictrotubles stable in cytoskeleton, hyperphosphorylation of tau causes tangles w/ other tau strands→↓nutrients→nerve cell death
Two classifications of AD early onset 40-64yo late onset >65yo, survival 4-8yrs post dx
What is the genetic influence of AD “susceptibility” gene, Identical twins>fraternal twins, Slibling with AD 40-50%risk
How is EOFAD and LAFAD genetically inherited E: autosomal dominant? PS1,PS2, APP L: “susceptibility gene”
What are environmental factors would ↑ development of dementia head trauma
What gene is associated w/ AD Apolipoprotein E, APOE-4: 3-5fold risk, APOE 2: 2 fold protection (single alleles) worst 4/4 best 2/2
What is the diagnostic criteria for AD know it :D
What is the diagnostic workup doing r/o other causes
Is LOC affected w/ Alzheimer’s no, but usually is w/ delirium
Are neurologic sxs present in AD can yes with vascular dementia, but not w/ delirium
Created by: streetsmarts
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