Disturbances of Consciousness in Delirium

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Questions and Answers

What is the primary neurotransmitter involved in the development of delirium?

Acetylcholine (correct)

Norepinephrine

Serotonin

Dopamine

A patient who is a tailor by profession starts asking for clothes and scissors while lying on the hospital bed. What is this behavior known as?

Floccillations

Carphologia

Sundowning

Occupational delirium (correct)

What is the term used to describe the diurnal variation of symptoms in delirium, with worsening of symptoms in the evening?

Carphologia

Clouding of consciousness

Floccillations

Sundowning (correct)

What is the percentage prevalence of delirium in terminally ill patients?

80% Signup and view all the answers

What is the primary difference between delirium and dementia in terms of symptoms?

Delirium has a sudden onset and fluctuating symptoms, while dementia has a slow onset and stable symptoms Signup and view all the answers

What is the term used to describe the EEG finding in patients with delirium caused by alcohol or sedative-hypnotic withdrawal?

Low voltage fast activity Signup and view all the answers

What is the term used to describe a patient with dementia who develops superimposed delirium?

Beclouded dementia Signup and view all the answers

What is the neuroanatomical area involved in delirium?

Reticular formation Signup and view all the answers

What is the primary location of Hirano bodies in Alzheimer's disease?

Hippocampal neurons Signup and view all the answers

Which of the following neurotransmitters is NOT implicated in Alzheimer's disease?

Dopamine Signup and view all the answers

Which chromosome is associated with the gene for APP (amyloid precursor protein)?

Chromosome 21 Signup and view all the answers

What is the most important risk factor for Alzheimer's disease?

Age Signup and view all the answers

What is the characteristic pattern of symptom deterioration in Vascular Dementia or Multi-infarct Dementia?

Stepladder pattern Signup and view all the answers

What is the usual comorbidity in patients with Vascular Dementia or Multi-infarct Dementia?

Hypertension Signup and view all the answers

What is the primary treatment approach for Vascular Dementia or Multi-infarct Dementia?

Cholinesterase inhibitors Signup and view all the answers

Which of the following is a protective factor against Alzheimer's disease?

High education levels and physical activity Signup and view all the answers

What is the primarygross neuroanatomical finding in Alzheimer's disease?

Diffuse atrophy with flattened cortical sulci and enlarged cerebral ventricles Signup and view all the answers

What is the source of the Ab protein found in senile plaques?

Amyloid precursor protein (APP) Signup and view all the answers

What is the function of tau protein in normal brain function?

To bind and stabilize microtubules Signup and view all the answers

What is cerebral amyloid angiopathy (CAA)?

Deposits of Ab in the vessel walls Signup and view all the answers

Which structure is always spared in Alzheimer's disease?

Cerebellum Signup and view all the answers

What is the primary difference between Alzheimer's disease and elderly individuals without dementia?

Extensive and widespread distribution of senile plaques and neurofibrillary tangles Signup and view all the answers

What is the initial phase of Alzheimer's disease characterized by?

Memory disturbances, apraxia, agnosia, aphasia, and acalculia Signup and view all the answers

What is the name of the protein found in neurofibrillary tangles?

Tau protein Signup and view all the answers

Which type of dementia is characterized by fluctuating levels of attention and alertness, recurrent visual hallucinations, and parkinsonian features?

Lewy Body Dementia Signup and view all the answers

Which of the following diseases is associated with the development of subcortical dementia?

Huntington's Disease, Parkinson's Disease, and Wilson's Disease Signup and view all the answers

What is the primary underlying cause of dementia?

Reversible or permanent damage to the brain Signup and view all the answers

What is the most common initial symptom of apraxia in dementia patients?

Inability to perform learned motor functions Signup and view all the answers

What is the characteristic feature of Pick's disease?

Presence of Pick's bodies Signup and view all the answers

What is the primary feature of Frontal variant FTD?

Loss of frontal lobe function Signup and view all the answers

What is the prevalence of dementia in individuals older than 85 years?

20-40% Signup and view all the answers

What is the primary treatment for delirium?

Treat the underlying cause Signup and view all the answers

What is the characteristic feature of Semantic dementia?

Loss of temporal lobe function Signup and view all the answers

Which type of dementia is associated with the development of dementia pugilistica?

Head Trauma Related Dementia Signup and view all the answers

What is the primary characteristic of delirium?

Disturbances of consciousness Signup and view all the answers

What is the primary feature of HIV Related Dementia?

Cognitive deficits and presence of motor abnormalities Signup and view all the answers

What is the primary use of benzodiazepines in delirium treatment?

Treatment of alcohol withdrawal delirium Signup and view all the answers

What is the primary characteristic of amnesia in dementia patients?

Loss of recent memory Signup and view all the answers

What is the characteristic age of onset for Frontotemporal Dementia?

45-65 years Signup and view all the answers

What is the primary difference between epilepsy and delirium?

Epilepsy is a disturbance of consciousness, while delirium is a disturbance of consciousness and cognitive impairment Signup and view all the answers

Study Notes

Delirium

Delirium is a state of consciousness characterized by a patient being totally unarousable and remaining with their eyes closed.
Other terms used to describe delirium include "confusional state", "clouding of consciousness", and "altered sensorium".
Sundowning refers to a diurnal variation of symptoms with worsening of symptoms in the evening.
Floccillations (or carphologia) refer to aimless picking behavior, where a patient appears to be picking at their clothes or bed.
Occupational delirium occurs when a patient behaves as if they are still on their job, despite being in a hospital.
The neurotransmitter involved in delirium is acetylcholine, and the neuroanatomical area involved is the reticular formation.
The prevalence of delirium in hospitals is 10-30% in ill patients, 10-40% in elderly patients, and 80% in terminally ill patients.
Delirium is diagnosed clinically based on symptoms, with sudden onset and fluctuations in symptoms being important pointers towards the diagnosis.
Bedside examinations such as the mini mental status examination (MMSE) and mental status examination (MSE) are used to provide a measure of cognitive impairment.
Generalized slowing on EEG is a common finding in patients with delirium.

Delirium vs Dementia

Delirium is characterized by an acute presentation and fluctuations in symptoms.
Dementia develops slowly and usually has stable symptoms over time.
Delirium is associated with disturbances of consciousness, whereas dementia is not.
A patient with dementia may develop superimposed delirium, a condition called "beclouded dementia".

Causes of Delirium

Physical/psychological stress (e.g. pain, post-operative, mechanical ventilation in ICU, chronic/terminal illness, post-traumatic event)
Surgery (e.g. cardiac operations, thoracic operations, orthopedic operations)
Other causes (e.g. substance withdrawal, substance intoxication, traumatic head injury)

Treatment of Delirium

Treat the underlying cause
Antipsychotics can be used for management of delusions, hallucinations, and agitation
Benzodiazepines are used for insomnia and are the drugs of choice in alcohol withdrawal delirium (delirium tremens)

Dementia

Defined as a progressive impairment of cognitive functions in the absence of any disturbances of consciousness
Prevalence increases with age, with a prevalence of around 5% in older than 65 years and 20-40% in older than 85 years
Underlying causes of dementia can be permanent or reversible

Symptoms of Dementia

Cognitive impairment characterized by 4 A's: Amnesia, Aphasia, Apraxia, and Agnosia
Memory impairment: loss of recent memory followed by immediate memory and lastly remote memory
Disturbances of language function (aphasia): word finding difficulties progressing to more severe abnormalities
Inability to perform learned motor functions (apraxia)
Loss of insight (awareness of illness) relatively early in the course of illness
Symptoms include memory disturbances, apraxia, agnosia, aphasia, and acalculia, with executive functions being lost in later stages
Neurological disabilities like tremors, rigidity, and spasticity may develop in later stages

Pathophysiology of Alzheimer's Disease

Gross neuroanatomical findings: diffuse atrophy with flattened cortical sulci and enlarged cerebral ventricles
Microscopic findings: neurotic (senile) plaques and neurofibrillary tangles
Neurotic plaques are composed of a particular protein Ab, derived from amyloid precursor protein (APP) by the action of b- and g-secretase enzymes
Neurofibrillary tangles are intraneuronal aggregates of tau protein, with abnormal functioning
Hirano bodies (eosinophilic inclusions) are abnormalities seen in the cytoplasm of hippocampal neurons in patients with Alzheimer's disease

Neurochemistry of Alzheimer's Disease

Predominantly a disorder of cholinergic neurons, with loss of cholinergic neurons being a consistent finding
Apart from acetylcholine, serotonin and norepinephrine have also been implicated in some cases

Risk Factors for Alzheimer's Disease

Age is the most important risk factor
Other risk factors include head injury, hypertension, insulin resistance, and depression
High education levels and remaining physically and mentally active till late in life are protective factors against Alzheimer's disease

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Description

This quiz covers various terms related to disturbances of consciousness, including coma, confusional state, and altered sensorium. It also explores sundowning and floccillations, common symptoms of delirium.