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Neurology pro +1060 > Dementia and Delirium > Flashcards

Dementia and Delirium Flashcards

1
Q

Dementia is a term used to describe a cluster of symptoms including:
6

A
  1. Forgetfulness (progressive)
  2. Difficulty doing familiar tasks
  3. Confusion
  4. Poor judgment
  5. Decline in intellectual functioning
  6. Dementia is not a part of normal aging
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2
Q

Diagnostic Criteria for Dementia (DSM-5)
Significant cognitive impairment in at least one of the following cognitive domains.
6

A
  1. Learning and memory
  2. Language
  3. Executive function
  4. Complex attention
  5. Perceptual-motor function
  6. Social cognition
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3
Q

Diagnostic Criteria for Dementia (DSM-5):

  1. The impairment must be _______ and represent a significant _______ from a previous level of functioning
  2. The cognitive deficits must interfere with what?
  3. The cognitive deficits result in what? 2
  4. The cognitive deficits do not occur exclusively solely during a what?
  5. WHat is it not due to?
A
  1. acquired
    decline
  2. independence in everyday activities
  3. functional impairment (social/occupational)
  4. delirium
  5. NOT due to other medical or psychiatric conditions
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4
Q

Causes of Dementia

8

A
  1. Alzheimer’s disease (approximately 70%)
  2. Vascular dementia – (Strokes and TIA’s)
  3. Parkinson’s disease
  4. Frontotemporal dementia (FTD)
  5. Normal-Pressure hydrocephalus (NPH)
  6. Dementia with Lewy Bodies
  7. Delirium/Depression
  8. Other, less common causes
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5
Q

“Modifiable” Causes of Dementia

6

A
  1. Medications (anticholinergics)
    Studies suggest evidence of a link between long-term use of otc anticholinergics like diphenhydramine and dementia
  2. Alcohol
  3. Metabolic (B12, thyroid, hyponatremia, hypercalcemia, hepatic and renal dysfunction)
  4. Depression - severe
  5. CNS neoplasms, chronic subdural hematoma
  6. NPH
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6
Q
  1. What is alzheimer’s disease?

2. What sign is most prominant early?

A
  1. Progressive neurologic disorder that results in memory loss, personality changes, global cognitive dysfunction, and functional impairments.
  2. Loss of short-term memory is most prominent early.
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7
Q

Alzheimer’s Diagnosis is a dignosis of what?

A

exclusion

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8
Q

Alzheimer’s Diagnosis
symptoms and behaviors?
8

A
  1. Short-term memory loss (early)‏
  2. Long-term memory loss preserved until late
  3. Poor judgment and indecisiveness (early)‏
  4. Disorientation/inability to adapt new environments
  5. Personality change and disinhibition
  6. Communication disorders: comprehension and expression
  7. Demanding and repetitive behaviors (early to mid)‏
  8. Behavior changes w/ aggression, delusions, hallucinations
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9
Q

AD Diagnosis 8

A
  1. Thorough detailed History
  2. mental status evaluation
  3. a depression screen
  4. physical examination, including 5. vision and hearing screen
  5. limited laboratory testing
  6. neuroimaging
  7. more extensive neuropsychological testing
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10
Q

AD MRI findings?

The laboratory testing includes what? 4

A
  1. An MRI finding of bilateral hippocampal atrophy suggests AD, but is not specific or sensitive.
  2. CBC,
  3. CMP,
  4. serum B12
  5. TSH
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11
Q

MMSE
What are the four ranges in scores?

What are the results affected by? 5

A
  1. 20-26: mild functional dependence
  2. 10-20: moderate, more immediate dependence
  3. Score below 10: severe, total dependence

Results affected by educational level, low SES, language skills, illiteracy, impaired vision/hearing.

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12
Q

Pathology of AD. There are 3 consistent neuropathological hallmarks. What are they?

How do the pathological problems relate on the timeline with clinical symptoms?

A
  1. Amyloid-rich senile plaques
  2. Neurofibrillary tangles
  3. Neuronal degeneration

These changes eventually lead to clinical symptoms, but they begin years before the onset of symptoms.

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13
Q

What are the four diagnosises of AD?

A
  1. Definite AD
  2. Probably AD
  3. Possible AD
  4. Unlikely AD
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14
Q

Describe each of the following:

  1. Definite AD 2
  2. Probably AD 2
  3. Possible AD 2
  4. Unlikely AD 3
A
    • Histopathological evidence (requires autopsy)
    • Course and examination characteristic of AD
  2. Deficits in 2 or more areas of cognition
    - Onset 40-90 (usually > 65); progressive course
    - Other causes excluded
    • Deficit in only 1 area of cognition
      - Atypical course
      - Other dementia causes present
    • Sudden onset
    • Focal signs
    • Seizures or gait disturbance early in course
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15
Q

Describe Stage 1 of AD?

A
  1. Stage 1: Normal
    Patient may potentially be free of objective or subjective symptoms of cognition and functional decline and also free of associated behavioral and mood changes.

The pathology has already begun

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16
Q

Describe stage 2 of AD?

3

A

Stage 2: Normal aged forgetfulness

  1. Half or more of the population of persons over the age of 65 experience subjective complaints of cognitive and/or functional difficulties. The nature of these subjective complaints is characteristic.
  2. Elderly persons with these symptoms believe they can no longer recall names as well as they could 5 or 10 years previously.
  3. They also intermittently experience difficulties in concentration and in finding the correct word when speaking.
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17
Q

Stage 3 of AD?

A

Stage 3: Mild cognitive impairment

Persons at this stage manifest deficits which are subtle, but which are noted by persons who are in close contact.

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18
Q

Stage 3. The subtle deficits may manifest in diverse ways, such as: 4

A
  1. Repeated questions
  2. Showing compromise in their ability to perform executive functions.
  3. For persons who are still working, job performance may decline.
  4. For those who must master new job skills, decrements in these capacities may become evident
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19
Q

Describe stage 4 AD?

A

Stage 4: Mild Alzheimer’s disease
The diagnosis of probable Alzheimer’s disease can be made with considerable accuracy in this stage. The most common functioning deficit in these patients is a decreased ability to manage instrumental (complex) activities of daily life.

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20
Q

Describe stage 5 of AD?

A

Stage 5: Moderate Alzheimer’s disease

In this stage, deficits are of sufficient magnitude as to prevent catastrophe-free, independent community survival.

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21
Q

Stage 5: The characteristic functional change in this stage is what?
3

A
  1. deficits in basic activities of daily life such as the inability to choose proper clothing to wear for the weather conditions and/or for the daily circumstances
  2. cannot recall such major events and aspects of their current lives as the name of the current president, the weather conditions of the day, or their correct current address.
  3. may not recall the names of some of the schools which they attended for many years
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22
Q

Describe stage 6 AD? 2

The total duration of the stage of moderately severe AD is approximately what?

A

Stage 6: Moderately severe Alzheimer’s disease
1. Ability to perform basic activities of daily life becomes compromised. Functionally, in addition to having lost the ability to choose their clothing without assistance, they begin to require assistance in putting on their clothing properly.

  1. Cognitive deficits are of sufficient magnitude as to interfere with the ability to carry out basic activities of daily life. Without assistance they will not be able to maintain living at home.
  2. 5 years.
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23
Q

Describe Stage 7 AD? 2

  1. How long does this stage last?
  2. It is followed in survivors, by a final stage, in which AD patients additionally lose the ability to
A
  1. Speech ability is limited to only a few words. Later, all intelligible speech is essentially lost.
  2. Subsequently, ambulatory ability is lost and the patient requires assistance in walking.
  3. This end stage lasts approximately 1 year.
  4. hold up their head independently.
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24
Q

Stage 7: Physical rigidity occurs due to immobility. Neurological reflex changes also become evident. Particularly notable is the emergence of so-called what?

A

‘infantile‘ or ‘primitive‘ reflexes which are present in the infant but which disappear in the toddler (Babinski).

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25
Q

What is the most common cause of death in AD?

Some other causes of mortality in AD? 4

A

The most frequent cause of death is aspiration pneumonia.

  1. infected decubital ulcerations
  2. stroke,
  3. heart disease
  4. cancer
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26
Q

Medical treatment:
Cholinesterase Inhibitors
MOA?

Which ones are they? 3

What part of dementia are these used to treat?

A

Cholinesterase inhibitors curb the breakdown of acetylcholine.

Help increase the levels of acetylcholine in the brain. Which may slow the progression of symptoms for about half of people taking them for a limited time, on average 6 to 12 months.

  1. Donepezil (Aricept)
  2. Rivastigmine (Exelon)
  3. Galantamine (Reminyl)

Cognitive impairment

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27
Q
  1. What is the only treatment approved by the FDA in all stages?
  2. What can it improve?
A
  1. Donepezil (Aricept) – 5mg po qday at bedtime (Cholinesterase Inhibitors)
  2. neuropsychiatric symtpoms
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28
Q
  1. Rivastigmine (Exelon)‏ - 4.6mg/24hrs (max 9.5)
    is approved for what kind of AD?

(Cholinesterase inhibitors)

  1. Galantamine (Reminyl),‏ Razadyne (formerly Reminy) 8mg po qday (max 16-24mg)
    is approved for what?
  2. Contraindications?
  3. Common side effects? 5
A
  1. Approved for use in mild to moderate Alzheimer’s dementia and is available as a skin patch, capsules, and liquid form.
  2. Also approved for mild to moderate Alzheimer’s dementia
    • severe renal
    • hepatic impairment
    • Diarrhea,
    • vomiting/nausea,
    • fatigue/insomnia,
    • loss of appetite
    • weight loss.
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29
Q
  1. NMDA (n-methyl-D-aspartate) receptor antagonists approved for what?
  2. Thought to play a protective role in the brain by regulating the activity of what?
  3. SE? 3
  4. What is this used to treat in AD?
A
  1. Approved to treat moderate-to-severe Alzheimer’s disease.
  2. Glutamate– also plays a role in learning and memory.
    • dizziness
    • confusion
    • hallucinations
  4. cognitive impairment
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30
Q
  1. Brain cells in people with Alzheimer’s disease release too much what?
A
  1. glutamate

Namenda helps regulate glutamate activity.

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31
Q

Why would we say to use vit D in AD pts?

A

has antioxidant properties

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32
Q

Antidepressants: SSRI’s recommended are?

3

A
  1. Sertraline (Zoloft)‏ 50mg po qday – max 200mg
  2. Paroxetine (Paxil)‏ 20mg po qday – max 50mg
  3. Citalopram (Celexa)‏ 20mg po qday – max 40mg
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33
Q

Antipsychotic medications for hallucinations, delusions, aggression, hostility and uncooperativeness.

A

Newer “atypical” agents such as aripiprazole (Abilify); olanzapine (Zyprexa); quetiapine (Seroquel); risperidone (Risperdal); and ziprasidone (Geodon)

These are atypical antipsychotics and have shown an increased risk of sudden death; they should only be used after discussion with the patient’s internist or neurologist.

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34
Q

What drugs should we avoid with AD? 3

Why?

A
  1. Benzodiazepines
  2. Antihistamines
  3. Anticholinergics

All have limited value in patients with dementia. They are not recommended for the management of neuropsychiatric symptoms of dementia, and can actually worsen symptoms

35
Q

AD behavioral intervention: Steps to managingbehaviors include?3

A

(1) identifying the behavior
(2) understanding its cause
(3) adapting the patient’s environment to remedy the situation

36
Q

AD behavioral intervention:
Correctly identifying what has triggered symptoms can often help in selecting the best approach. Often the trigger is some sort of change in the person’s environment such as?
5

A
  1. change in caregiver/living arrangements
  2. travel
  3. hospitalization
  4. presence of houseguests
  5. being asked to change clothing
37
Q

Behavioral intervention: A key principle of intervention is redirecting theperson’sattention, rather than arguing, disagreeing, or being confrontational. Additional strategies include the following?
8

A
  1. simplify the environment
  2. simplify tasks and routines
  3. allow adequate rest between stimulating events
  4. use labels to cue or remind the person
  5. equip doors and gates with safety locks
  6. remove guns /sharp objects
  7. reduce risk of fires with extra smoke alarms and control access to the stove
  8. use lighting to reduce confusion and restlessness at night
38
Q
  1. What is vascular dementia?
  2. What will the onset by like?
  3. Findings on neurologic examination consistent with what?
  4. What will you see on cerebral imaging?
A
  1. The onset of cognitive deficits associated with a CVA.
  2. Abrupt onset of symptoms followed by stepwise deterioration.
  3. prior stroke(s).
  4. Infarcts on cerebral imaging.
39
Q

Criteria for Vascular Dementia

3

A
  1. Cerebrovascular disease evident on history, examination and/or imaging.
    Along with:
  2. Onset of dementia within 3 months or
  3. Abrupt, fluctuating or stepwise progression in dementia
40
Q
  1. Most patients previously categorized as either Alzheimer’s type or vascular type dementias probably have?
A
  1. BOTH
41
Q
  1. FRONTOTEMPORAL DEMENTIA is chracterized by what?
  2. What is the first subtype of FTD and
  3. What is that characterized by?
A
  1. Characterized by focal atrophy of the frontal and temporal lobes in the absence of Alzheimer pathology.
  2. Pick’s disease (a subtype) was the first recognized subtype of FTD.
  3. Characterized pathologically by the presence of Pick bodies (silver staining intracytoplasmic inclusions) in the neocortex and hippocampus.
42
Q

FRONTOTEMPORAL DEMENTIA occurs at what ages?

Gene association?

A

Occurs between the ages of 35 and 75 years, and only rarely after age 75; the mean age of onset is the sixth decade.

chromosome 17

43
Q

Core features of Frontotemporal Lobe Dementia 5

A
  1. Insidious onset and gradual progression•
  2. Early decline in social/interpersonal conduct•
  3. Early impairment in personal conduct•
  4. Early loss of insight•
  5. Early emotional blunting
44
Q

Supportive features of Frontotemporal Lobe Dementia

3

A
  1. Behavior disorder – hygiene, grooming, mental rigidity, dietary changes, perseverative behavior
  2. Speech and language – perseveration, mutism, economy of speech
  3. Physical signs – akinesis, restlessness, rigidity, tremor, labile BP
45
Q
  1. Normal-Pressure Hydrocephalus is what?
  2. Triad of Normal-Pressure Hydrocephalus?
  3. How can this be reversed or treated?
A
  1. A condition of pathologically enlarged ventricular size with normal opening pressures on lumbar puncture.
  2. Triad of: dementia, gait disturbance, and urinary incontinence.
    Wacky
    Wobbly
    Wet
  3. Reversible by the placement of a ventriculoperitoneal shunt.
46
Q

Normal Pressure Hydrocephalus: Diagnosis?

2

A
  1. initially on neuroimaging. MRI>CT

2. Miller Fisher test: objective gait assessment before and after removal of 30 cc CSF.

47
Q
  1. The most common dementia syndrome associated with Parkinsonism is what?
  2. Characterized by dementia accompanied by what? 3
  3. Other common symptoms?
    4
A
  1. Dementia with Lewy Bodies
    • delirium,
    • visual hallucinations, and
    • parkinsonism.

Other common symptoms include

  • syncope,
  • falls,
  • sleep disorders
  • depression.
48
Q
  1. Central Core Feature For Clinical Diagnosis Of DLB?
  2. Two of the following core features are essential for a diagnosis of probable DLB, and one is essential for possible DLB? 3
A
  1. progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function.
    • Fluctuating cognition with pronounced variations in attention and alertness.
    • Recurrent visual hallucinations that are typically well formed and detailed.
    • Spontaneous motor features of parkinsonism
49
Q

Supportive Features For Clinical Diagnosis Of DLB

6

A
  1. repeated falls
  2. syncope
  3. transient loss of consciousness
  4. neuroleptic sensitivity
  5. systematized delusions
  6. hallucinations in other modalities
50
Q

Cardinal motor features of parkinson’s disease?

Dementia typically occurs in the ____ half of the clinical course of PD, whereas it is often one of the presenting features of DLB.

A
  1. Brady- and akinesia
  2. Rigidity
  3. Resting tremor
  4. Postural instability

last

51
Q

Risk Factors:
Dementia with Parkinson’s? 4

What may be exercerbated by treatment?

A
  1. Age over 70
  2. Depression
  3. Confusion/psychosis on levodopa
  4. Facial masking upon presentation

Hallucinations and delusions

52
Q
  1. Progressive supranuclear palsy is also called what?
  2. What can it mimic?
  3. Characteristic features of PSP 2
  4. Pts with PSP have posture how? (how does this differ from parkinson?)
A
  1. AKA Steele Richardson Olszewski syndrome.
  2. A rare syndrome that can mimic PD in its early phase.
  3. Characteristic features of PSP
    - Restricted up-and-down eye movement (vertical gaze palsy) is a hallmark of this disease.
    - Postural instability with unexplained falls.
  4. Patients with PSP usually stand straight or occasionally even tilt their heads backward (and tend to fall backward),

while those with Parkinson’s disease usually bend forward.

53
Q
  1. Creutzfeldt-Jacob Disease is also called what?
  2. Caused by what?
  3. How is it contracted?
  4. Characterized by what? 3
A
  1. AKA “Mad cow disease”
    Progressive and fatal
  2. Caused by a type of protein called a prion.
  3. Humans can contract the disease by consuming material from animals infected with the bovine form of the disease.
  4. Characterized by:
    -Dementia with rapid onset and deterioration
    -Motor deficits
    -Seizures
54
Q

What is neurosyphillis?

A

Neurosyphilis is a slow progressive, destructive infection of the brain and the spinal cord.
Tertiary syphilis

55
Q
  1. What is HIV dementia?

2. When is it often seen in AIDS?

A
  1. It is a metabolic encephalopathy which typically occurs after years of HIV infection.
  2. It is sometimes seen as the first sign of the onset of AIDS.
56
Q
  1. What is delirium?

2. Disturbance of consciousness with reduced ability to do what?

A

A sudden and significant decline in mental functioning not better accounted for by a preexisting or evolving dementia

  1. Disturbance of consciousness with reduced ability to
    - focus,
    - sustain, and
    - shift attention
57
Q

4 major causes of delirium?

A
  1. Underlying medical condition
  2. Substance intoxication
  3. Substance withdrawal
  4. Combination of any or all of these
58
Q

Patients at highest risk for delirium?

5

A
  1. Elderly
    - >80 years
    - History of dementia
    - Polypharmacy
  2. Post-cardiac surgery
  3. Burns
  4. Drug withdrawal
  5. AIDS
59
Q

Clinical features of delirium?

8

A
  1. Prodrome
  2. Fluctuating course
  3. Attention deficits
  4. Arousal /psychomotor disturbance
  5. Impaired cognition
  6. Sleep-wake disturbance
  7. Altered perceptions
  8. Affective disturbances
60
Q

Prodrome signs of delirium? 3

A
  1. Restlessness
  2. Anxiety
  3. Sleep disturbance
61
Q

The course in fluctuating and develops over a short period of time. Symptoms fluctuate during the course of the day with changes in?

You may also see occurences of? 2

A
  1. Levels of consciousness
  2. Orientation
  3. Short-term memory

Or occurrences of:

  1. Agitation
  2. Hallucinations
62
Q

You may also get Attention Deficits with delirium. How will this manifest?
2

A
  1. Easily distracted by the environment.

2. May be able to focus initially, but will not be able to sustain or shift attention.

63
Q

Delirium:
Arousal/psychomotor disturbance.
Could manifest how? 3

A
  1. Hyperactive (agitated, hyperalert)
  2. Hypoactive (lethargic, hypoalert)
  3. Mixed
64
Q

Delirium: Impaired Cognition. How will this manifest?

4

A
  1. Memory Deficits
  2. Language Disturbance
  3. Disorganized thinking
  4. Disorientation
65
Q

Delirium: Sleep-wake disturbance. How will this manifest?

A
  1. Fragmented throughout 24-hour period

2. Reversal of normal cycle

66
Q

Delirium: Altered Perceptions. How will this manifest?

3

A
  1. Illusions
  2. Hallucinations
    • Visual (most common)
    • Auditory
    • Tactile, Olfactory
  3. Delusions
67
Q

Delirium: Affective disturbance. How will this manifest? 6

A
  1. Anxiety / fear
  2. Depression
  3. Irritability
  4. Apathy
  5. Euphoria
  6. Lability
68
Q
  1. Delirium: typically symptoms resolve in how many days?
    - May last how long?
  2. What is this dependant on?
A
  1. Typically, symptoms resolve in 10-12 days.
    • may last up to 2 months
  2. Dependent on underlying problem and management.
69
Q

Delirium - Causes: “I WATCH DEATH”

A 
I nfections
W ithdrawal
A cute metabolic
T rauma
C NS pathology
H ypoxia
D eficiencies
E ndocrinopathies
A cute vascular
T oxins or drugs
H eavy metals
70
Q
  1. What are some common infections that cause delirium? 4
  2. What are the withdrawls that cause delirium? 3
  3. What are the acute metabolic problems that cause delirium? 4
  4. Trauma? 2
A
  1. Infections:
    - encephalitis,
    - meningitis,
    - sepsis,
    - urosepsis
  2. Withdrawal:
    - ETOH,
    - sedative-hypnotics,
    - barbiturates
  3. Acute metabolic:
    - acid-base,
    - electrolytes,
    - liver or
    - renal failure
  4. Trauma:
    - brain injury,
    - burns
71
Q
  1. What are some CNS causes of delirium? 4
  2. Diseases that cause hypoxia that cause delirium? 4
  3. Deficiencies? 3
  4. Endocrinopathies? 2
A
  1. CNS pathology:
    - hemorrhage,
    - seizures,
    - stroke,
    - tumor (don’t forget metastases)
  2. Hypoxia:
    - CO poisoning,
    - pulmonary or
    - cardiac failure,
    - severe anemia
  3. Deficiencies:
    - thiamine,
    - niacin,
    - B12
  4. Endocrinopathies:
    - hyper- or hypo- adrenocortisolism,
    - hyper- or hypoglycemia
72
Q
  1. Acute vascular causes of delirium? 3
  2. Toxins or drugs that could cause delirium? 4
  3. Heavy metals? 3
A
  1. Acute vascular:
    - hypertensive encephalopathy
    - shock,
    - MI
  2. Toxins or drugs:
    - pesticides,
    - solvents,
    - medications,
    - (many!) drugs of abuse
    - —-anticholinergics, narcotic analgesics, sedatives
  3. Heavy metals:
    - lead,
    - manganese,
    - mercury

44% estimated to have 2 or more etiologies

73
Q

Drugs of abuse that could cause delirium?

10

A
  1. Alcohol
  2. Amphetamines
  3. Cannabis
  4. Cocaine
  5. Hallucinogens
  6. Inhalants
  7. Opiates
  8. Phencyclidine (PCP)
  9. Sedatives
  10. Hypnotics
74
Q

Workup for delirium?

5

A
  1. History
  2. Interview- also with family, if available
  3. Physical, cognitive, and neurological exam
  4. Vital signs, fluid status
  5. Review of medical record
    Anesthesia and medication record review
75
Q

Mini-mental status exam: Delirium
1. What are the tests involved? 5

  1. Whats a perfect score?
  2. What score is suggestive of a problem?
  3. When is it not helpful?
A
  1. Tests
    - orientation,
    - short-term memory,
    - attention,
    - concentration,
    - constructional ability
  2. 30 points is perfect score
  3. less than 24 points suggestive of problem
  4. Not helpful without knowing baseline
76
Q

Delirium Workup: Labs and Imaging?

9

A
  1. Electrolytes
  2. CBC
  3. EKG
  4. CXR
  5. Arterial blood gas or oxygen saturation
  6. Urinalysis +/- Culture and sensitivity
  7. Urine drug screen
  8. Blood alcohol
  9. Serum drug levels (digoxin, theophylline, phenobarbital, cyclosporin, lithium, etc)
77
Q

Management of delirium

3

A
  1. Identify and treat the underlying etiology.
  2. Increase observation and monitoring – vital signs, fluid intake and output, oxygenation, safety.
  3. Discontinue or minimize dosing of nonessential medications.
  4. Monitor and assure safety of patient and staff
  5. Assess individual and family psychosocial characteristics.
  6. Educate the family – temporary and part of a medical condition – not “crazy”.
  7. Provide post-delirium education and processing for patient.
78
Q

Pharmacologic management of agitation/delirium.

3

A
  1. Low doses of high potency neuroleptics (i.e. haloperidol) – PO, IM or IV
    • Atypical antipsychotics (risperidone)
    • Inapsine (more sedating with more rapid onset than haloperidol – IM or iIV only – monitor for hypotension)
79
Q

Haloperidol and inapsine have been associated with WHAT? and WHAT?;

avoid or monitor by telemetry if corrected QT interval is what? 2

A
    • torsade de pointes
    • sudden death by lengthening the QT interval
  2. greater than 450 msec or greater than 25% from a previous EKG.
80
Q

Treatment of choice for delirium due to benzodiazepine or alcohol withdrawal is what?

Contraindicated in who?

A

Benzodiazepines

hepatic failure pts

81
Q

What could this progress to? 3

Increased risk for postoperative complications, longer postoperative recuperation, longer hospital stays, long-term disability.

A

May progress to

  1. stupor, coma,
  2. seizures or
  3. death, particularly if untreated.
82
Q

Take home points
Dementia Vs. Delirium
DEMENTIA CHARACTERISTICS?
7

A
  1. Slow, gradual onset.
  2. Time of onset unclear, typically note changes over several months.
  3. Due to chronic disorders, such as Alzheimer’s, etc.
  4. Progressive process.
  5. Attention not impaired until late stages.
  6. No effect on consciousness until late stages.
  7. Loss of memory esp. for recent events.
83
Q

Take home points
Dementia Vs. Delirium
DELIRIUM CHARACTERISTICS?
6

A
  1. Acute onset.
  2. Cause is usually treatable such as: infection, medications, pain, MI.
  3. Usually reversible.
  4. Attention impaired.
  5. Consciousness ranges from lethargic to hyperalert.
  6. Effect on memory varies.

Neurology pro +1060 (18 decks)

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