Dementia vs Delirium

Question 1

What are characteristics of “Normal state of consciousness”

Answer 1

• Wakefulness, awareness, alertness when not asleep
• Can be readily awakened
• Requires arousal & cognition

Question 2

What is arousal mediated by?

Answer 2

RAM

Question 3

Cognition is a function of what?

Answer 3

Properly working hemispheres

Question 4

Define: clouding of consciousness

Answer 4

• Very mild form of AMS

- Inattention & reduced wakefulness

Question 5

Define: confusional state

Answer 5

• More profound deficit

- Disorientation, bewilderment & difficulty following commands

Question 6

Define: lethargy

Answer 6

• Severe drowsiness

- Can be aroused by moderate stimuli, then drifts back to sleep

Question 7

Define: obtundation

Answer 7

• Similar to lethargy
• Lessoned interest in the environment
• Slowed responses to stimulation
• Sleeps more than normal w/ drowsiness btwn sleep states

Question 8

Define: stupor

Answer 8

• Only vigorous & repeated stimuli will arouse

- When left alone will immediately relapse

Question 9

Define: coma. What is it a complication of?

Answer 9

State of unarousable unresponsiveness

- Major complication of serious nervous system d/o

Question 10

What causes coma?

Answer 10

• seizure
• hypothermia
• metabolic disturbances
• structural lesions

Question 11

How do you tx all comatose patients?

Answer 11

Hospitalization & referral to neurologist or neurosurgeon

Question 12

What are the 3 phases used to evaluate an altered patient?

Answer 12

• Determine level of consciousness
• Search for cause of confusion/coma
• Look for presence or absence of focality of the d/o

Question 13

What are the components of the GCS?

Answer 13

15 point scale

• Eye opening response
• Verbal response
• Motor response

Question 14

What GCS is considered normal vs AMS vs coma?

Answer 14

• Normal = 15 pts
• AMS = greater than 3, but less than 15 pts
• Coma = 3 pts

Question 15

What medical conditions can cause AMS?

Answer 15

• DM
• HTN
• Endocrine dz
• Renal failure
• CA
• Dementia
• Seizure
• Psychiatric

Question 16

Describe dementia.

Answer 16

Progressive intellectual decline

Question 17

What are RFs of dementia?

Answer 17

• Age*
• Family hx
• Vascular dz
• DM
• Hx of head injury

Question 18

What population is most affected by dementia?

Answer 18

Females, after age 60

Question 19

What should you be concerned about in a pt w/ dementia?

Answer 19

• Vit D deficiency
• Chronic sleep deprivation
• Need to educate

Question 20

What is the MC form of dementia? How do you make the dx?

Answer 20

• Alzheimers

- Definitive dx = autopsy or brain biopsy

Question 21

Describe dementia w/ lewy bodies. What other conditions have lewy bodies?

Answer 21

Type of dementia caused by deposits that damage cells over time.
- Lewy bodies are also found in Alzheimers & Parkinsons

Question 22

What other microscopic findings are found in dementia?

Answer 22

• Plaques: deposits of protein “beta-amyloid”

- Tangles: twisted fibers of protein “tau”

Question 23

Describe vascular dementia. What causes it? When does it occur?

Answer 23

Multifocal ischemic change

• Cause: impaired blood flow
• Occurs after CVA

Question 24

What are RFs of vascular dementia?

Answer 24

• HTN
• Hyperlipidemia
• Smoking

Question 25

What are sx of vascular dementia?

Answer 25

- Memory loss - Difficulty planning/organizing - Confusion, apathy - Wandering - Poor judgement, reasoning - Difficulty w/ math, problem solving - Agitation, aggression, hallucinations, delusions - Mood/behavior changes - Inappropriate laughing/crying

Question 26

Define: Delirium

Answer 26

Acute, confused state that occurs in response to an identifiable trigger

Question 27

What are causes of delirium?

Answer 27

"I WATCH DEATH" - Infection - Withdrawal - Acute metabolic - Traumatic injury - CNS lesion - Hypoxia - Def of vitamins - Edocrine - Acute vascular - Toxins - Heavy metals

Question 28

What are differences btwn dementia & delirium?

Answer 28

Dementia: - Slow & insidious (mos-yrs) - Not reversible Delirium: - Acute (days-mos) - Potentially reversible

Question 29

How does dementia present?

Answer 29

- Short term memory loss - Word finding difficulty - Visuospatial dysfunction - Executive dysfunction - Apathy - Apraxia

Question 30

What is the workup for dementia?

Answer 30

- Neuropsychological assessment: MMSE - MRI preferred, PET scan - Labs: B12, T4, TSH, RPR, CBC, CMP, lipids, ApoE

Question 31

How do you tx dementia?

Answer 31

- Aerobic exercise (45mins) - Mental stimulation - Mood/behavior tx: SSRIs - Psychostimulants for apathy - Trazodone for insomnia - Those w/ lewy bodies: Memantine

Question 32

How do you tx Alzheimers?

Answer 32

- Cholinesterase inhibitors - Donepezil (for mild-mod) - Rivastigmine - Memantine (for mod-severe)

Question 33

What medication do you want to avoid in dementia?

Answer 33

Paroxetine *due to anticholinergic effect

Question 34

What is the most common cause of rapidly progressive dementia?

Answer 34

Jakob-Creutzfeldt disease (human form of mad cow disease) | - Check for PRNP gene mutation