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Questions and Answers
What is a defining characteristic of dementia?
What is a defining characteristic of dementia?
Which of the following is a common cause of dementia?
Which of the following is a common cause of dementia?
What finding is associated with Alzheimer's disease?
What finding is associated with Alzheimer's disease?
Which group has the highest prevalence of dementia?
Which group has the highest prevalence of dementia?
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What is a significant downside to the traditional model of diagnosing Alzheimer's disease?
What is a significant downside to the traditional model of diagnosing Alzheimer's disease?
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Which statement best describes the prognosis of vascular dementia?
Which statement best describes the prognosis of vascular dementia?
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Which cognitive domain is NOT required for a dementia diagnosis?
Which cognitive domain is NOT required for a dementia diagnosis?
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What is a potential risk factor for developing delirium?
What is a potential risk factor for developing delirium?
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What is a key non-pharmacological strategy for managing patients?
What is a key non-pharmacological strategy for managing patients?
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Which of the following is a significant complication associated with delirium?
Which of the following is a significant complication associated with delirium?
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What is the recommended approach for administering pharmacological treatment in patients with delirium?
What is the recommended approach for administering pharmacological treatment in patients with delirium?
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What distinguishes delirium from dementia?
What distinguishes delirium from dementia?
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Which of these is not a potential long-term consequence of delirium?
Which of these is not a potential long-term consequence of delirium?
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Why should sedation be avoided unless absolutely necessary in delirious patients?
Why should sedation be avoided unless absolutely necessary in delirious patients?
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What is the typical duration of delirium symptoms?
What is the typical duration of delirium symptoms?
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What is the prognosis for patients experiencing hypoactive delirium?
What is the prognosis for patients experiencing hypoactive delirium?
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What is the primary focus of the FINGER Study conducted in 2015?
What is the primary focus of the FINGER Study conducted in 2015?
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Which approach is emphasized for managing dementia according to the content?
Which approach is emphasized for managing dementia according to the content?
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What lifestyle changes can help prevent damage to the brain and reduce dementia risk?
What lifestyle changes can help prevent damage to the brain and reduce dementia risk?
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Which of the following medications is considered a cholinesterase inhibitor used in dementia treatment?
Which of the following medications is considered a cholinesterase inhibitor used in dementia treatment?
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For preventing vascular dementia, which intervention is notably recommended for middle-aged and older adults?
For preventing vascular dementia, which intervention is notably recommended for middle-aged and older adults?
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What is an important aspect to consider in non-pharmacological management of dementia?
What is an important aspect to consider in non-pharmacological management of dementia?
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Which of the following options is not advised for managing dementia symptoms?
Which of the following options is not advised for managing dementia symptoms?
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In the case of the 80-year-old male with mild-moderate dementia, which medication would be the most appropriate for him?
In the case of the 80-year-old male with mild-moderate dementia, which medication would be the most appropriate for him?
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What primarily causes vascular dementia?
What primarily causes vascular dementia?
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Which of the following symptoms is commonly associated with frontotemporal dementia?
Which of the following symptoms is commonly associated with frontotemporal dementia?
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Which combination of symptoms defines Lewy body dementia?
Which combination of symptoms defines Lewy body dementia?
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What is a common sign of delirium in a patient?
What is a common sign of delirium in a patient?
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Which of the following is NOT a risk factor for developing delirium?
Which of the following is NOT a risk factor for developing delirium?
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What does apraxia refer to in the context of dementia symptoms?
What does apraxia refer to in the context of dementia symptoms?
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Which type of delirium involves heightened arousal and agitation?
Which type of delirium involves heightened arousal and agitation?
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What is a key aspect of diagnosing dementia during assessment?
What is a key aspect of diagnosing dementia during assessment?
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Which substance is most likely to cause or worsen delirium?
Which substance is most likely to cause or worsen delirium?
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Which of the following is a possible underlying cause of delirium?
Which of the following is a possible underlying cause of delirium?
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What cognitive assessment tool is commonly used to measure cognition in potential dementia patients?
What cognitive assessment tool is commonly used to measure cognition in potential dementia patients?
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Which condition is NOT typically included in the differential diagnosis for dementia?
Which condition is NOT typically included in the differential diagnosis for dementia?
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What is the relationship between frontotemporal dementia and genetics?
What is the relationship between frontotemporal dementia and genetics?
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Which of the following symptoms is indicative of delirium?
Which of the following symptoms is indicative of delirium?
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What is the first line treatment for mild to moderate dementia?
What is the first line treatment for mild to moderate dementia?
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Which type of dementia currently has no specific treatment available?
Which type of dementia currently has no specific treatment available?
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What is a significant risk associated with the new disease-modifying treatments for Alzheimer’s disease?
What is a significant risk associated with the new disease-modifying treatments for Alzheimer’s disease?
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Which of the following is a contraindication for the new disease-modifying treatments?
Which of the following is a contraindication for the new disease-modifying treatments?
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What investigation is considered the leading cause of delirium?
What investigation is considered the leading cause of delirium?
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Which cognitive assessment tool is used to evaluate alertness, awareness, attention, and behavior changes?
Which cognitive assessment tool is used to evaluate alertness, awareness, attention, and behavior changes?
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Which type of biomarker is expected to become available for dementia diagnosis in the next 2-5 years?
Which type of biomarker is expected to become available for dementia diagnosis in the next 2-5 years?
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What is the primary management strategy for delirium?
What is the primary management strategy for delirium?
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What characteristic is essential in defining dementia?
What characteristic is essential in defining dementia?
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Which of the following is associated with Alzheimer’s disease pathology?
Which of the following is associated with Alzheimer’s disease pathology?
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Identifying dementia involves which investigative approach?
Identifying dementia involves which investigative approach?
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Which type of dementia is associated with the shortest life expectancy post-diagnosis?
Which type of dementia is associated with the shortest life expectancy post-diagnosis?
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What factor significantly complicates the diagnosis of Alzheimer’s disease?
What factor significantly complicates the diagnosis of Alzheimer’s disease?
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Which of the following types of dementia is linked with a genetic predisposition?
Which of the following types of dementia is linked with a genetic predisposition?
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What aspect of dementia significantly impacts its prevalence among older adults?
What aspect of dementia significantly impacts its prevalence among older adults?
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Which condition is frequently excluded when diagnosing different types of dementia?
Which condition is frequently excluded when diagnosing different types of dementia?
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What is a crucial element in the non-pharmacological management of delirium?
What is a crucial element in the non-pharmacological management of delirium?
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Which of the following pharmacological treatments should be avoided in patients with Parkinson's disease?
Which of the following pharmacological treatments should be avoided in patients with Parkinson's disease?
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What is the expected prognosis for patients experiencing hypoactive delirium compared to other forms?
What is the expected prognosis for patients experiencing hypoactive delirium compared to other forms?
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What complication is most specifically associated with prolonged delirium in older patients?
What complication is most specifically associated with prolonged delirium in older patients?
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In the context of delirium management, what is the most appropriate approach to the use of sedatives?
In the context of delirium management, what is the most appropriate approach to the use of sedatives?
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What is an important factor to monitor in patients with delirium to prevent complications?
What is an important factor to monitor in patients with delirium to prevent complications?
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How does the onset of delirium typically differ from that of dementia?
How does the onset of delirium typically differ from that of dementia?
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What is a significant long-term consequence of experiencing delirium in older adults?
What is a significant long-term consequence of experiencing delirium in older adults?
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What is the potential impact of maintaining a cognitively enriching environment in adulthood on dementia risk?
What is the potential impact of maintaining a cognitively enriching environment in adulthood on dementia risk?
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Which pharmacological treatment would be the most suitable for an elderly patient experiencing mild-moderate dementia?
Which pharmacological treatment would be the most suitable for an elderly patient experiencing mild-moderate dementia?
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In the context of preventing vascular dementia, which method is emphasized as effective for middle-aged and older adults?
In the context of preventing vascular dementia, which method is emphasized as effective for middle-aged and older adults?
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Which statement best describes a significant recommendation made for non-pharmacological management of dementia?
Which statement best describes a significant recommendation made for non-pharmacological management of dementia?
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Which of the following is NOT recommended as a part of management strategies for dementia?
Which of the following is NOT recommended as a part of management strategies for dementia?
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What role does the FINGER Study highlight in reducing cognitive decline?
What role does the FINGER Study highlight in reducing cognitive decline?
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What common misconception about dementia management is highlighted in the document?
What common misconception about dementia management is highlighted in the document?
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Why is monitoring carer stress considered important in dementia management?
Why is monitoring carer stress considered important in dementia management?
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What is the primary characteristic of drugs like Aducanemab and Lecanemab in the treatment of Alzheimer's disease?
What is the primary characteristic of drugs like Aducanemab and Lecanemab in the treatment of Alzheimer's disease?
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What is a potential drawback of new disease-modifying treatments such as Aducanemab?
What is a potential drawback of new disease-modifying treatments such as Aducanemab?
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Which imaging technique is noted to be most effective for diagnosing dementia?
Which imaging technique is noted to be most effective for diagnosing dementia?
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What factor is considered a relative contraindication for the new disease-modifying treatments in Alzheimer's disease?
What factor is considered a relative contraindication for the new disease-modifying treatments in Alzheimer's disease?
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Which medication is commonly utilized to manage agitation in patients with frontotemporal dementia?
Which medication is commonly utilized to manage agitation in patients with frontotemporal dementia?
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What is the main purpose for performing a lumbar puncture in the context of delirium suspected due to infection?
What is the main purpose for performing a lumbar puncture in the context of delirium suspected due to infection?
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What is a significant development expected in dementia treatment that involves biomarkers?
What is a significant development expected in dementia treatment that involves biomarkers?
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Which cognitive assessment tool evaluates multiple domains associated with alertness, awareness, attention, and behavior change?
Which cognitive assessment tool evaluates multiple domains associated with alertness, awareness, attention, and behavior change?
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What characterizes the progression of vascular dementia?
What characterizes the progression of vascular dementia?
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Which symptom is most closely associated with frontotemporal dementia?
Which symptom is most closely associated with frontotemporal dementia?
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Which of the following describes Lewy body dementia?
Which of the following describes Lewy body dementia?
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Which of the following conditions could be included in the differential diagnosis for dementia?
Which of the following conditions could be included in the differential diagnosis for dementia?
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What are common symptoms of delirium?
What are common symptoms of delirium?
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What type of cognitive assessment is the MMSE classified as?
What type of cognitive assessment is the MMSE classified as?
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Which of the following is a common risk factor that can increase the likelihood of developing delirium?
Which of the following is a common risk factor that can increase the likelihood of developing delirium?
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Which variant of frontotemporal dementia involves language disturbances?
Which variant of frontotemporal dementia involves language disturbances?
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Which of the following is NOT a common symptom of dementia?
Which of the following is NOT a common symptom of dementia?
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What is a significant expected outcome when using PET imaging in dementia diagnosis?
What is a significant expected outcome when using PET imaging in dementia diagnosis?
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Which cause is related to the development of delirium as indicated by the acronym 'DELIRIUM'?
Which cause is related to the development of delirium as indicated by the acronym 'DELIRIUM'?
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Which of the following statements is true about memory impairment in dementia?
Which of the following statements is true about memory impairment in dementia?
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Which of the following is a potential effect of delirium concerning patient behavior?
Which of the following is a potential effect of delirium concerning patient behavior?
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Study Notes
Dementia and Delirium Overview
- Dementia is a progressive neurodegenerative condition causing cognitive decline, including memory loss and at least one other cognitive domain impairment (language, executive, perceptual, social cognition).
- Dementia impacts daily function and independence significantly.
- Dementia is age-related, with prevalence increasing with age (4% over 65, 20% over 80, 50% over 90).
- Dementia is common and often unrecognized in earlier stages.
- Alzheimer's disease is the most common type (50-75%).
- Vascular dementia accounts for 20-30% of cases.
- Lewy body dementia accounts for 10-25% of cases.
- Frontotemporal dementia makes up 10-15%.
- Mixed dementia is also possible.
Learning Outcomes
- Learning Outcome 1: Define Dementia.
- Learning Outcome 2: List the causes/types of dementia.
- Learning Outcome 3: Describe how each cause leads to the development of dementia.
- Learning Outcome 4: Outline the common symptoms and signs of dementia.
- Learning Outcome 5: Develop a differential diagnosis for Dementia - Consider other conditions which may cause similar symptoms.
- Learning Outcome 6: Define Delirium.
- Learning Outcome 7: List the causes/risk factors to develop Delirium.
- Learning Outcome 8: Outline the common symptoms and signs in Delirium.
- Learning Outcome 9: Outline the overarching principles of investigation and management of Dementia and Delirium.
Alzheimer's Disease (AD)
- AD is the most frequent type of dementia characterized by cholinergic neuron loss, amyloid plaques, neurofibrillary tangles, and brain atrophy, especially in the hippocampus, with ventricular enlargement.
- The APOE4 gene increases risk but only by 7%.
- Progression is typically linear, declining over months to years.
- AD is significant due to high prevalence and rising care costs - comparable to other serious illnesses.
- Traditional diagnosis relies on informant history, normal neuro-imaging and excluding dementia mimics.
- Formal diagnosis is using NINDS-ADRDA criteria.
Other Types of Dementia
- Dementia associated with Parkinson's disease
- Huntington's disease
- Alcohol-related dementia
- Progressive supranuclear palsy
- Multiple systems atrophy
- Creutzfeldt-Jakob disease
- HIV-related cognitive impairment
- Mixed dementia
Dementia Prognosis
- Dementia is a progressive condition associated with morbidity and mortality.
- Alzheimer's disease typically lasts 10 years.
- Vascular dementia averages 5 years.
- Lewy body dementia lasts approximately 2-8 years.
Dementia Symptoms
- Forgetfulness, losing objects, forgetting appointments
- Inability to follow movies/TV, inability to read books (amnesia)
- Word-finding difficulties (aphasia/dysphasia)
- Difficulty remembering familiar faces/items (agnosia)
- Inability to complete motor tasks (apraxia)
- Disorientation in time and place
- Changes in sleep patterns
- Withdrawal and apathy
- Behavioral changes/personality changes/agitation and emotional lability
- Loss of independence
Alzheimer's: DSM-IV Criteria
- Development of multiple cognitive deficits demonstrating both memory impairment and one or more of the following: aphasia, apraxia (inability to perform learned purposeful movements), agnosia, and disturbance in executive function.
- These deficits cause significant social or occupational impairments and represent a decline.
- Onset is gradual.
Dementia Signs - General Inspection
- Disorientation in time and place.
- Sloppy dress and apathetic behavior
- Visual hallucinations
- Repetitive physical or behavioral disturbances
- Tremor
- Poor eye contact/affect incongruent with situation
Dementia Signs - Clinical Exam
- Visual field deficits
- Swallowing difficulty
- Slurred speech and paucity of speech
- Slow shuffling gait
- Balance issues
- Hemiparesis/spasticity with increased tone
- Asymmetrical deep tendon reflexes
- Changes in sensation
Prognostic Markers for Dementia
- Weight loss
- Functional loss/personal care dependence
- UTI/LRTI if dependent or in a nursing home (NH) resident
- Swallow impairment
Delirium
- An acute, fluctuating change in mental status.
- Associated symptoms include disorientation in time and place, impaired short-term memory, and altered level of consciousness.
- Types: hyperactive (heightened arousal, restlessness, agitation, hallucinations), hypoactive (lethargy, lack of interest, reduced motor activity), and mixed (combination of both).
Causes of Delirium
- Drugs (withdrawal, discomfort)
- Electrolyte abnormalities
- Environmental factors
- Elimination problems
- Lung problems (hypoxia)
- Infection (iatrogenic events and or infarcions)
- Renal failure
- Restricted mobility
- Injury or post-operative events
- Impaired hearing/vision
- Intoxication
- UTIs
- Unfamiliar environment
- Metabolic abnormalities (e.g., glucose/thyroid)
Drugs Causing or Worsening Delirium
- Analgesics (especially opioids)
- Alcohol
- Anxiolytics
- Anticholinergics
- Antiepileptics
- Psychotropics
- Antihistamines
- Steroids
Risk Factors for Delirium
- Increased age
- Physical frailty
- Existing dementia, stroke, Parkinson's disease
- Disturbed sleep
- Infection
- Trauma
- Visual or hearing impairment
- Immobility
- Previous history of delirium)
- Polypharmacy, new medication, withdrawal, or toxicity
Delirium Symptoms
- Acute onset
- Disorientation in time and place
- Disordered thinking
- Sharply fluctuating course
- Agitated and restless (increased wandering)
- Decreased awareness and activity of surroundings
- Decreased activity and speech
- Behavioral disturbances and emotional lability
- Symptoms suggestive of underlying aetiology
Delirium Signs
- Possible disorientation in time and place
- Sloppy dress or apathetic behavior
- Altered consciousness/loss of awareness
- Repetitive physical or behavioral disturbances
- Poor eye contact/affect
- Inattention
- Slurred speech
- Slow or absent speech
Dementia Diagnosis
- History (collateral/informant history)
- Examination/Neuro-imaging.
- Bedside cognitive assessments
- Exclude any dementia mimics.
Key Historical Questions for First Assessment (Dementia)
- Instrumental activities become impaired (appointments, finances, travel, mobile phone, etc.)
- Repetitive/rapid forgetting
- Circumlocution/word finding difficulties
- Safety issues (becoming lost, falls, kitchen accidents)
- Withdrawal from social activity
- Apathy
- Weight loss/reduced dietary intake
- Driving difficulty
- Personality changes including delusions
Measuring Cognition
- MMSE
- MOCA
- RUDAS
- Addenbrookes' Cognitive Examination (ACE III)
Dementia Investigations
- Neuroimaging (CT and MRI brain) - check for atrophy or structural issues
- B12/folate, TFTs, routine bloods
- SPECT/FDG/PET CT imaging (if diagnosis is unclear)
- Lumbar puncture (not routinely done, can be helpful for younger patients)
New Diagnostic Tools
- PET 18 FDG & PET amyloid scanning
- PET Tau (research tool)
- Tau serum biomarkers (being used in clinical trials, but lacking FDA approval)
Dementia Management - Non-Pharmacological
- Multidisciplinary team approach
- Caregiver and family support/education
- Driving assessment
- Discuss advance care directives (power of attorney)
- Home supports as needed
- Monitor caregiver stress
Dementia Management – Multidisciplinary
- Occupational therapy (OT)
- Medical social work
- Pharmacist
- Physiotherapist
- Dietitian
- Nursing
- Neuropsychology (mental capacity)
Dementia Management - Pharmacological
- Remove or minimize agents that impair cognition (anticholinergic Rx).
- Cholinesterase inhibitors (Donepezil, rivastigmine, galantamine)
- NMDA receptor antagonist (Memantine)
- Manage hypertension
- Avoid alcohol
Dementia Complications
- Increased risk of falls and fractures
- Immobility
- Prolonged hospital stay
- Pressure sores (hypoactive delirium)
- Aspiration pneumonia and other infections.
- Over sedation
- Dehydration and malnutrition
- Incontinence
- Long-term cognitive impairment or functional decline (possible "new baseline")
Delirium Prognosis
- Hypoactive delirium has a worse prognosis (often diagnosis is delayed) and response to treatment is typically slower.
- Delirium can last for weeks or even months.
- Delirium significantly impacts the health of older individuals.
- Delirium increases risk of longer hospital stays.
- Delirium increases the likelihood of long-term or permanent cognitive impairment, such as "new baseline" cognitive ability.
- Delirium increases risk of institutionalization.
- Delirium increases mortality risk (up to 22% mortality in six months).
Delirium Investigations
- Cognitive assessments (4AT)
- Bloods, blood gases, cultures, toxicology
- Infection-related causes (e.g., CXR, urine dip)
- Structural issues (e.g., CT brain)
- MI or other precipitants (e.g., ECG)
- CNS infection (e.g., lumbar puncture (LP))
Delirium Management - Non-Pharmacological
- Avoid triggering factors; monitor risk factors
- Treat underlying causes
- Patient-centered care:
- Nurse in well-lit, familiar rooms (ideally with same staff)
- Educate families, caregivers.
- Re-orient the patient.
- Normalize sleep patterns (consider moving to side room).
- Encourage mobility and self-care.
- Avoid physical restraints; avoid urinary catheters/IVCs.
- Monitor for dehydration, constipation, and pain.
Delirium Management - Pharmacological
- Avoid sedatives (if possible)
- Medications should be used cautiously in patients with agitation and aggression.
- Start low and titrate slowly (begin with low-dose and adjust as required).
- Antipsychotics (Risperidone or Olanzapine) – avoid in patients with Parkinson's Disease.
- Short-acting benzodiazepines (e.g., Lorazepam)
New Disease-Modifying Treatments for Dementia
- Aducanumab (Aduhelm)
- Lecanemab (Leqembi) - reduced adverse reactions and faster amyloid clearance
- Donanemab (not yet licensed)
- Biological agents (humanized IgG monoclonal antibodies)
- Targeting soluble and insoluble oligomers
- Donanemab targeting pyroglutamate modification of A beta amyloid in plaques
Disease-Modifying Treatments for Alzheimer's (DMARDS)
- Infusion therapies have shown benefits.
- Significant Benefits may be offset by risks, including ARIAs (Amyloid-Related Imaging Abnormalities), Cerebral edema, and Cerebral hemorrhage.
- FDA now specifies contraindications, such as anticoagulation and pre-existing microhemorrhages in certain patient populations (with positive APOE-E4 genotype or pre-existing microhemorrhages).
Dementia vs. Delirium
Provides a comparison table that differentiates the diagnoses of dementia and delirium.
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Description
This quiz explores the key concepts surrounding dementia and its various types, including Alzheimer's and vascular dementia. It covers definitions, causes, symptoms, and the impact of dementia on daily life. Test your knowledge and understanding of this important public health issue.
