Delirium and Alzheimer's Overview

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Questions and Answers

What is a primary characteristic of delirium?

Permanent cognitive decline

Gradual onset over months

Memory loss due to aging

Disturbed level of consciousness (correct)

Which of the following can cause delirium?

Opiate withdrawal (correct)

Do not disturb syndrome

Chronic depression

Age-related cognitive decline

How does delirium differ from dementia?

Delirium develops slowly over years

Delirium is caused by a medical condition (correct)

Dementia presents with rapid onset

Dementia is reversible in short term

What is a critical step in recognizing delirium in patients?

Taking a detailed history from family or caregivers Signup and view all the answers

What is a common setting for the occurrence of delirium?

Among hospitalized elderly patients Signup and view all the answers

What initial tests are recommended to assess the causes of delirium?

CT or MRI, CBC, and a urine drug screen Signup and view all the answers

Which assessment is commonly used as a bedside screening test for neurocognitive disorders?

Montreal Cognitive Assessment (MoCA) Signup and view all the answers

Which finding is indicative of a neurocognitive disorder in a patient without delirium?

Presence of multiple cognitive deficits Signup and view all the answers

When history and bedside testing do not provide conclusive results, what should be conducted?

Neuropsychologic testing supervised by a neuropsychologist Signup and view all the answers

What is a necessary component of supportive care in patients with delirium?

Sedation when necessary Signup and view all the answers

What is the role of neuroimaging in patients with dementia?

It should be considered in the initial evaluation of all patients. Signup and view all the answers

Which class of medications may improve cognitive function in Alzheimer's disease?

Cholinesterase inhibitors Signup and view all the answers

What is the effect of memantine in dementia treatment?

It may help slow cognitive decline in moderate to severe dementia. Signup and view all the answers

What should be avoided in the treatment of patients with dementia experiencing depression?

Antidepressants with anticholinergic effects Signup and view all the answers

Which of the following measures can help ensure safety for patients with dementia?

Providing appropriate stimulation and cues Signup and view all the answers

Study Notes

Delirium

Delirium is an acute syndrome caused by a medical condition, substance, intoxication, or withdrawal, altering mental status temporarily.
Examples include sepsis, sundowning, ETOH withdrawal, opiate withdrawal, and stroke.
Common in hospitalized elderly patients, often caused by drugs, dehydration, infections (e.g., UTI), or other factors.
Delirium is rapid in onset, short-term, and reversible.
Criteria for diagnosis include:
- Disturbed level of consciousness (decreased attention span, lack of awareness).
- Cognitive changes (memory deficit, disorientation, language disturbance, possible visual illusions/hallucinations).
- Rapid onset within hours or days, with a fluctuating course.
- Evidence of a causal physical condition.
Delirium is distinct from dementia, which is a long-term memory impairment, such as in Alzheimer's disease.

Alzheimer's Disease

Alzheimer's disease is a progressive, neurodegenerative disease characterized by memory loss, language deterioration, impaired visuospatial skills, poor judgment, but preserved motor function.
Begins after age 65.
The most common cause of dementia.
Acetylcholine is severely diminished in the brains of people with Alzheimer's, crucial for learning and memory.
Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) are established treatments, which aim to improve memory.
Amyloid plaques (protein deposits) are a hallmark of Alzheimer's disease, found outside nerve cells.
Avoiding haldol and anticholinergic drugs is important as these may worsen dementia.

Diagnosing/Evaluating Delirium/Alzheimer's

History from family, caregivers, and friends along with mental status examination are critical to recognizing delirium.
Thorough assessment for neurological and systemic causes/triggers.
Testing may include CT/MRI, tests for infections (e.g., CBC, blood cultures, chest x-ray, urinalysis), electrolyte, BUN, creatinine, plasma glucose, drug levels, and urine drug screen (if indicated).
Treat the underlying cause and provide supportive care, including sedation if needed.
Mini-Mental Status Examination (MMSE) or Montreal Cognitive Assessment (MoCA) are screening tools, but neuropsychological testing may be necessary if history/bedside testing is inconclusive.
Screen for depression, B12 deficiency, and hypothyroidism.
Lumbar puncture considered if a chronic infection or neurosyphilis is suspected.
Neuroimaging (MRI or CT) should be considered in the initial evaluation of all patients with dementia.

Managing Alzheimer's Disease

Eliminate drugs with sedating or anticholinergic effects.
Cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) can improve cognitive function.
Memantine (NMDA antagonist) may slow cognitive decline in moderate-to-severe cases.
Antipsychotics may be needed for behavior disorders, though nonanticholinergic antidepressants are preferred for depression.
Maintaining safety is crucial, including measures to prevent falls and provide stimulating activities.
Assist caregivers and make arrangements for end-of-life care.

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Description

This quiz explores the key concepts surrounding delirium and Alzheimer's disease, including their definitions, symptoms, and diagnostic criteria. Learn the differences between delirium, a temporary condition, and Alzheimer's, a progressive disease. Perfect for students in health sciences or those interested in neurological disorders.