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26 Cards in this Set
- Front
- Back
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Delirium, Dementia, Amnestic and other Cog. Disorders
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All feature inpairment in memory, language, and/or attention as primary symptom
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Subdivisions of delirium, dementia, and amnestic disorders
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All subdivided by etiology:
due to a GMC effects of a substance multiple etiologies NOS categories |
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Primary Differences between the disorders
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Delirium: primary disturbance is in level of consciousness. Impairments in orientation, judgment, and attention. Acute onset
Dementia: Cog. deficits in memory, language, and intellect. Gradual onset. Amnestic disorder: impairment in memory |
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Criteria for Delirium
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1. disturbance of consciousness (reduced awareness of ev't, difficulty focusing or sustaining attention, often easily distracted)
2. Change in cognition (memory deficit, disorientation, language disturbance, disorientation, memory loss [recent and not accounted for by dementia] Develops over a few hours-a few days; fluctuates during the day and tends to worsen at night |
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Prodromal Period for Delirium
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*altered sleep patters
*unexplained Fatigue *fluctuating mood *sleep phobia *resltlessness *anxiety *nightmares |
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Clinical Features of Delirium
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Arousal
Language & Cognition Perception Orientation Mood Sleep & Wakefulness Neurological Functionng |
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Delirium:
Changes in Arousal Changes in Language & Cognition |
Arousal: may be increased or decreased (hypervigilant, reslelessness, increased alertness, sewathing, depressed)
Language and cognition: abnormal production and comprehension of speech (nonsensical rambling and incoherent speech, mute, impaired memory) dysarthia- can't articulate dysnomia- can't name objects dysgraphia- can't write |
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Delirium:
Changes in Perception, orientation, and mood |
Perception: inablity to discriminate sensory stimuli (misinterpertations, personilze events, conversations that don't pertain to them, auditory and visual illusions, paranoia, sleep phobia)
Orientation: worse in the morning (orientation to time, place, person and situation, disorientation to time is common) Mood: rapid fluctuations (unprovoked anger and rage, fear- hypervigillance, sleep phobia, apathy, euphoria) |
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Delirium: changes in sleep and neurological functioning:
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Sleep & Wakefulness: usually abnormal (in saytime- random sleepiness, nightime- resless and combatice, sleep fragmented- vivid nightmeres are common)
Neurological Functioing- tremors gait apraxia, dysphagia, poor coordination |
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Course of Delirium:
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once cause is eliminated it usually recedes gradually during 3-7 days
memory for events during delirium is usualy spotty |
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High Risk groups for Delirium
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*older adults, younger children
*people who hae cerebral difficulties after a storke of HIV related infections *post cardiotomy patients *Burn Patients *people with drug dependence *Brain damage *sleep depriviation *malnutrition |
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Differential Diagosis for Delirium
Delirium Vs. Dementia |
vs. Dementia:
Delirium- acute onset, wide fluctuations in symptoms with periods of relativ lucidity, cloud consciousness, most likely reversible, acute onset Dementia- are usually alert, sx not reversible, less likely to have ussues with attention and orientation, slow steady onset |
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Differential Diagosis for Delirium
Delirium Vs. other psychotic and other mental disorders |
schizophrenia: sx are more constant and organized, no cloudiness of consciousness
Factitious disorders: inconsistent sx |
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Types of Delirium:
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Delirium due to a GMC:
infection induced (HIV, Pnemonia etc) metabolic disturbances, congesitve heart failure, postoperative states, intercranial causes (head trauma) sensory deprivation and env't changes (elderly- confusion in hospital) Medication induced Delirium Substance intoxication Delirium Substance Withdrawl Delirium Delirium due to multiple etiologies Delirium NOS |
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Criteria for Dementia
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more gradual onset than delirium
multiple cognitive deficits that include: *some degree of memory impairment *agnosia- can't remember the names of objects *aphasia- difficulty understanding language, concentration difficulties affect speech *apraxia- can't perform simple motor tasks (dress, eat, cook) *executive functioing impairment interfere with occupational or usual functioining represent a decline from previous functioning and not a consequence of delirium no clouding of consciousness delirium can be superimposed on dementia nad diagnosed if dementia is present w/o delirium Due to a GMC, substance, or multiple etiologies |
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Memory Impairment in Dementia
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Immediate recall (primary memory)- ability to immediatley repeat a series of numbers. problems with Attention, concentration, following instructions, loss of ability to retain new information
Recent memory (secondary memory)- delayed (5 minutes), repeating of 3 objects Remote memory (tertiary memory) - in early stages still intact, need collateral information Confabulation (filling in the gaps of memory incorrectly, or making up stories to fill in the gaps) may occur |
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Aphasia in Dementia
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verbal, written language
difficulty communicating with others Broca's aphasia: production of speech is impaired. can comprehend and understand language but poor articulation Wernicke's aphasia: can speak but can't comprehend laguage so speech isnt' sensible. Often seen in alzheimers disease, ascual afementia and affects paretal or temporal lobes |
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Agnosia in dementia
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loss of ability to visually recognize things.
altered perception types of agnosia depends on sensory system invovled |
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apraxia in dementia
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loss of ability to carry out selected motor activities ex: brushing teeth, chewing food, etc.
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Executive functioining problems in dementia
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loss in ability to think abstractly, plan, initaite, end complx behavior
difficulty coping with new tasks MSE should asses each of these areas |
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Differential Diagnosis of Dementia
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vs delirium- delirium is acute, altered consciousness
depression- more crying, hopelesness, guilt, better insight into cog. problems, medications should help amnestic disorders- memory problems without aphasia, agnosia, apraxia psychotic disorders- usually earlier onset, not result of GMC or substance |
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Dementia of the Alzheimer's Type
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Symptoms parallel other dementia sx.
progressive memory decline over 8-10 years Early signs: can be subtle *impaired memory *Difficulty with problem solving *preoccupation with past events *decreased spontaneity *decreased speed and accuracy *forget names, misplace objects, forget what they are about to do *often have insight into difficulties |
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Demenita of the Alzheimer's type middle and later stages
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Middle stages- anomnia (difficulty w/word findings)
*relies on family memebrs as a surrogate memory, acoidence of unfamiliar activities, condussion, afression, frusteration, socially undesiarable behaviors) Later stages- physical effects no longer ambuatory, mute, bedridden |
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Vascular Dementia (can result from a stroke)
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Resutls from one large or multiple CVA's
2x more common in men stepwise progression of cognitive deterioration risk facotrs: hypertension, obesity, heart disease, stress, smoking |
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Other types of Dementia
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Dementia due to HIV diease
Due to Pick's disease Due to Parkinson's Disease Due to Hungtington's Disease Due to Head Trauma Other Medical conditions Due to multiple etiologies NOS |
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Amnestic Disorders
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Blackouts: heavy drinking (temporary)
Korsakoff's syndrome: lack of thiamine. Alcohol dependence, malnourishment, retrograde amnesia (loss of memory befor trauma, anterograde amnesia( loss of memory after the trauma), confabulation, only 20% recover Head Injust (TBI)- delirium, dementia, mood problems, alteratioisnin personlity, memory loss |
