Delerium and Dementia

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  1. Diagnosis of Alzheimers requires:Development of multiple cognitive deficits manifested by both:
    • memory impairment 
    • one of the following cognitive disturbances: aphasia, apraxia, agnosia, disturbance in executive functio
  2. Neurotransmitter changes in alzheimers:
    • decreased level of acetylcholine (Ach)-disruption of cholinergic mechanisms damages memory
    • norepinephrine decreased in the cortex by 50%
    • loss of serotonin -- alteration in sleep patterns
    • glutamate -  too much causes neuronal degeneration
  3. Stage 1 Alzheimers:
    Mild cognitive decline
  4. Stage 2 Alzheimers:
    Moderate cognitive decline with obvious memory impairment
  5. Stage 3 Alzheimers:
    Motor and gait disturbance leading to immobility, loss of verbal abilities, does not recognize familiar people/events
  6. Pharmacological interventions for alzheimers:
    • Cholinesterase inhibitors
    • NMDA antagonist
  7. Examples of NMDA antagonists:
    Memantine (namenda)
  8. Examples of cholinesterase inhibitors:
    • Donepezil (Aricept)
    • Galantamine (razadyne)
    • Rivastigmine (Exelon)
  9. What medication must be used carefully with cholinesterase inhibitors?
    NSAIDS – increase risk of ulcers
  10. Rapid onset of variable and fluctuating changes in mental status caused by physiologic consequences of a medical disturbance.
  11. Consciousness that is accompanied by a change in cognition that cannot be better accounted for by a preexisting or evolving dementia.
  12. Two forms of delirium.
    • Hyperactive (restless, agitated, violent)
    • Hypoactive (lethargic, obtunded)
  13. Delirium vs. Dementia : ONSET
    • Delirium = acute
    • Dementia = insidious
  14. Delirium vs. Dementia : COURSE
    • Delirium = fluctuating
    • Dementia = progressive
  15. Delirium vs. Dementia : DURATION
    • Delirium = days to weeks
    • Dementia = months to years
  16. Delirium vs. Dementia :  CONSCIOUSNESS
    • Delirium = altered
    • Dementia = clear
  17. Delirium vs. Dementia : ATTENTION
    • Delirium = impaired
    • Dementia = normal, except for severe dementia
  18. Delirium vs. Dementia : PSYCHOMOTOR CHANGES
    • Delirium = increase/decreased
    • Dementia = Often normal
  19. Delirium vs. Dementia :  REVERSIBILITY
    • Delirium = usually
    • Dementia = rarely
  20. I in I WATCH DEATH:
  21. W in I WATCH DEATH:
  22. A in I WATCH DEATH:
    Acute metabolic change
  23. T in I WATCH DEATH:
  24. C in I WATCH DEATH:
    CNS pathology (seizure, stroke, tumor…)
  25. H in I WATCH DEATH:
  26. D in I WATCH DEATH:
    Deficiencies (B12, folate, niacin, thiamine)
  27. E in I WATCH DEATH:
    Endocrinopathies  (hyperglycemia, hyperparathyroid)
  28. A in I WATCH DEATH:
    Acute vascular
  29. T in I WATCH DEATH:
    Toxins (narcotics, etc…)
  30. H in I WATCH DEATH:
    Heavy metals (lead, mercury…)
  31. Four major risk factors for delirium:
    • Elderly
    • Pre-existing dementia
    • Polypharmacy
    • Poor hearing/low vision
  32. Gold standard for pharmacological treatment of delirium:
  33. Adverse effect of haldol:
    Extrapyramidal (parkinsonian)
  34. Atypical antipsychotics for delirium:
    • Seroquel
    • Risperdal
    • Zyprexa
  35. Rarely used as monotherapy for delirium, except when delirium is caused by withdrawal:
  36. Benzos used for delirium:
    • Ativan
    • Klonopin
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Delerium and Dementia
Delirium and dementia
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