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37 Cards in this Set
- Front
- Back
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Decline in memory, with impairment of at least one other domain of cognitive functioning
Must represent a CHANGE from baseline and must interfere significantly with social or occupational dysfunction Clear consciousness |
dementia
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what are impairments of domains of cognitive function?
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Aphasia
Apraxia (impaired ability to perform motor tasks despite intact motor functioning) Agnosia (impaired object recognition) Executive dysfunction (poor planning, organizing, sequencing, or abstracting) Must represent a CHANGE from baseline and must interfere significantly with social or occupational dysfunction Clear consciousness |
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What is the rate of missed diagnosis of dementia?
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75% of patients with moderate dementia
97% of patients with mild dementia |
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What are the current challenges of dementia diagnosis?
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Primary Care Physicians
Missed diagnosis Underrecognition of dementia leads to increased: Hospitalization rates Medication errors ER visits Mortality Motor vehicle accidents |
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only 40% of PCPs knew ___________ was most common cause of late-life memory loss (vs. 97% of experts)
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Alzheimer’s
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The prevalence of Alzheimer's inceases with age and peaks at ______ % at age 85
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32%
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You can classify dementia into to major categories
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cortical and subcortical
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Which is classical Alzheimer's?
cortical or subcortical |
cortical
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What features are associated with cortical dementia?
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Loss of core ability to do cognition
Amensia Apraxia Agnosia Aphasia Can’t recall Repeats questions Doesn’t ‘know’ things |
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What features are associated with subcortical dementia?
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Loss of ability to coordinate cognition
Dysmnesia Dysexecutive Delay Depletion Benefits from cues to remember Trouble planning/executing Slowed thinking |
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What is the most important aspect in making the diagnosis of dementia?
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history
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Medications are implicated in up to _____ % of cases of dementia
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30%
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What kinds of medications cause dementia?
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Anticholinergic drugs
Benadryl is highly anticholinergic and is not good to use in the elderly – there are lots of safer and better choices |
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What is the cut off point for significant cognitive impairment in the mini-mental state exam?
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24
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What is the Folstein mini-mental state exam?
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30 point scale assesses key elements: orientation, memory, concentration, language, praxis and visual-construction skills
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What is the new screening test for dementia?
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Mini Cog
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What are the two components of the mini cog?
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three item recall
clock drawing test |
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What labratory tests would you order if dementia is suspected?
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Electrolytes
Glucose BUN/creatinine LFT’s CBC TSH B12 RPR CT head |
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What medications are used to treat Alzheimer's Disease?
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Cholinesterase inhibitors
Donepezil Galantamine Rivastigmine Tacrine NMDA receptor antagonist Memantine |
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Studies shows improvement in cognition on this medication, but it was not a cure because it went back to placebo levels when taken off:
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Donepezil
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With this drug, patients were able to stay out of nursing homes a year longer:
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Tacrine
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Frontaltemporal dementia causes:
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behavioral problems
Loss of personal awareness Loss of social awareness Disinhibition of sexuality, aggression Hyperorality Stereotypies, perserveration |
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Lewy Body dememtia causes:
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Memory problems that overlap with Alzheimer’s
Excessive Daytime drowsiness Visual hallucinations Cognitive symptoms fluctuate May have Parkinson like features |
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People with dementia also can have other features like
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aggression
apathy depression psychosis psychomotor agitation aggression |
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Delusional thought content (e.g., paranoia) is common (studies suggest 34% to 50% incidence) in this disease
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Alzheimer's
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What is a powerful and cheap medication for dementia?
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counciling and education
Counseling, education inexpensive and prolong caregivers ability to keep family at home |
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Disturbance of consciousness with reduced ability to focus, sustain, or shift attention
A change in cognition or the development of a perceptual disturbance that is not better accounted for The disturbance develops over a short period of time and FLUCTUATES |
delirium
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what are the differences in delirium and dementia?
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delirium:
Marked psychomotor changes (hyperactive or hypoactive) Altered and changing level of consciousness Strikingly short attention span dementia: Psychomotor changes occur late in the illness unless depression or apathy develops Consciousness not clouded until terminal stage Attention span not characteristically reduced |
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What are some major risk factors for delirium?
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Extremes of age, pre-existing brain damage, history of delirium, alcohol dependence, diabetes impairment, sensory impairment (glasses, hearing aids), malnutrition
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It is important to distinguish between psychosis and delirium because
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psychosis is never fatal whereas delirium is often fatal
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Delirium is most common in what types of patients?
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Hospitalized medically ill patients 10-30%
Hospitalized elderly patients 10-40% Cancer patients 25% Patients with AIDS 30-40% Post operative patients 10-51% Terminally ill patients up to 80% Patients with coexistent structural brain disease up to 81% |
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Is delirium a medical emergency?
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yes
25-33% within first three months 40-50% within 1 year |
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The causes of delirium in a mneumonic
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I WATCH DEATH
Infection, Withdraw, Acute metabolic, Trauma, CNS pathology, Hypoxia, Deficiencies, Endocrinopathy, Acute Vascular, Toxins, Heavy Metal WHHHHIMP Wernicke’s encephalopathy / Withdrawal Hypoxemia Hypertensive encepholathy Hypoglycemia Hypoperfusion Intracranial bleeding / infection Meningitis / encephalitis Poisons / medications |
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What is the final common pathway to delirium?
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deficiency in cholinergic and excess in dopaminergic
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What lab workup would you do in a suspected case of delirium?
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CBC
Chem-20 Serum drug levels Arterial blood gas Urinalysis and culture Urine drug screen EKG Chest X-ray Syphilis (RPR) Vitamin B12 HIV Thyroid Function Tests Lumbar Puncture CT/MRI EEG |
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How do you treat delirium
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treat the underlying cause!
High potency antipsychotics good (Haldol) to help with agitation with minimal sedation |
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What drugs worsen delirium
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benzodiazepines (paradoxical reaction)
Avoid anticholinergics |
