Delerium/dementia

Front 1

Dementia definition?
signs?

Back 1

Syndrome consisting of impaired cognition functions interfere w/ ability to function
4A's (Can be involved)
1) Aphasia (language)
2) Amnesia (memory)
3) Apraxia (carry out motor activities)
4) Agnosia (recognize/identify)

Also: executive function (planning, organizing, sequencing, abstraction)
Irreversible (most of time)

Front 2

Pseudodementia

Back 2

reversible (DO NOT DIAGNOSE AS DEMENTIA)
- Get when depressed
- Give up easily (effort when testing)
- No "sundowning" (activity at night; will have diurnal mood variation)
- Crying spells, suicidal thoughts
- Will notice if have problems with memory (true dementia: don't think have memory problems)
- NO APRAXIA, AGNOSIA, APHASIA
(Note: Depression often before full onset of Alzheimer's)

Front 3

Delerium vs. Dementia

Back 3

- Dementia: Usually insidious but acute (ex: stroke), sensorium unimpaired (no clouded consciousness, normal level of arousal, progressive (usually irreversible)

- Delerium: usually rapid/acute, clouded consciousness, agitation or stupor, reversible

Front 4

Histopathology of AD

Back 4

1) Senile plaque/Beta Amyloid (extracellular)
2) Neurofibrillary tangles/Hyperphosphorylated Tau proteins (Intracellular)
3) Hirano Bodies (intracell - not specific: also see in Creutzfeld-Jakob)
4) Granulovacuolar degen (intracell)
5) Loss of Neurons in nucleus basalis of Meynert

Front 5

Delirium

Back 5

* decreased attention
*altered memory, orientation, language, mood, perception
*Rapid evolution several hours to days!
*suspect UTI, alcohol/sedative withdrawl, or Rx. toxicity (elderly)
*comes and goes (waxes and wanes) & loss of orientation
*Acute Brain Failure: treatable!

Front 6

Dementia

Back 6

*Slow evolution of multiple cognitive
deficits
*Impaired memory
*Personality Disturbance
*constant & have sense of orientation (NOTE: May not always how symptoms - can have Mini Mental Eval 29/30 and still have dementia)
*Alzheimer’s type: 40 < x <90 yo

Front 7

Frontal Lobe Release signs

Back 7

Delerium brings out reflexes have as a baby
- Palmar grasp
- Suck:
- Snout: touch above upper lip -> scrunch up against nose
- Rooting: touch mandibular ramus -> rotate head TOWARDS stimulus (as if trying to see it)
- Glabellar: tap btwn eyes -> nod/shake off head

Front 8

Treatment of delerium

Back 8

Light
Resynch sleep/wake
Ground pt
Treat underlying condition
Time
Phys/Chem restraints

Front 9

Diagnosing Dementia

Back 9

H&P, PET, SPECT, Labs
Mini Mental status (Can have 29/30 and still have dementia)
Focus on: Sensorium/Cognition:
- Level of Consciousness (clouded, stupor, etc)
- Orientation (name, place, time, situation)
- Concentration/attention (serial 7's, digit span)
- Read/Write (write sentence, read and follow instructions
- Verbal fluency (words start w/ F)
- Visual spatial (Draw clock/intersect pentagon)
- Memory

Front 10

Most common cause of degenerative dementia

Back 10

Alzheimers disease (50-60% of all cases)

Front 11

Alzheimer's Disease
Early vs late
Onset
MRI/CT
Phys Exam findings

Back 11

Early = 65 or younger
Late >65
Familial -> 5th decade (50 yo) onset
Insidious onset
MRI/CT show atrophy/enlarged ventricals
Babinski, frontal lobe release signs, hyperactive reflex
PET = best for diagnosis (i

Front 12

Treatment of Alzheimers Disease

Back 12

Cholinergic Therapies:
- Donepazil
- Galantamine
- Memantine
- Rivastigmine
- NOT TACTRINE (COGNEX)
(Note: No FDA drugs approved for controlling behavioral/agitation w/ Dementia - ALL off-label use of drugs)
"Forgot Me Gal Down the Riva"

Front 13

Concerns treating Dementia with drugs

Back 13

All are off-label use
Avoid Anti-ACh drugs (make worse; ex: benztropine/anti-PD drugs)
BBW: antipsychotics in pt w/ dementia -> increased rate of sudden death
Used:
- Antipsychotics
- Antidepressants
- Anticonvulsants
- Anxiolytics

Front 14

Lewy Body Dementia:
Prevalence
Signs/Symptoms
Histology
Concerns

Back 14

25% of dementias
Progressive, irreversible (MORE malignant than AD)
Visual hallucinations & Parkinsonian features (**Hallmark: hallucinations & movement disorders)
Lewy bodies: eosinophilic (red) inclusions in cortex/brainstem
Concern: VERY sensitive to psychotropics/antipsychotics

Front 15

Frontotemporal Dementia
Histology
Behavior
Other signs/symptoms

Back 15

Tau inclusions
Behavior: Either withdrawn OR disinhibited; repeat same action
Problems with speech
Memory last to go

Front 16

Vascular Dementia
Onset
History
Prevalence

Back 16

SUDDEN onset
hx HTN, vascular disease
#2 behind Alzheimers

Front 17

NPH
Signs
Etiology

Back 17

Normal Pressure Hydrocephalus:
Triad: Dementia, Gait disturbance, Urinary incontinent
1) Excess accum CSF
2) Dilated Ventricles
3) Normal CSF pressure
4) Flow obstructed/fluid collects in ventricles
(Can give Ventriculo-Peritoneal Shunt)

Front 18

Wernicke's Encephalopathy
Signs
Treatment

Back 18

1) Nystagmus
2) Gait disturbance
3) Confusion
Treat: Thiamine STAT (can lead to Korsakoff's dementia/psychosis)