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This Concept Map, created with IHMC CmapTools, has information related to: Dementia, Delirium, Dementia & Delirium DELIRIUM Dx: Hx, MMSEs (baseline), vitals, medication inventory, labs/studies: -chem, CBC, CXR, EKG, pulse ox, ABG, UA, C&S, urine tox screen, serum drug levels, TFTs, RPR Consider psychiatric causes LAST, Dementia & Delirium DEMENTIA Stable decline in mult areas of cognition, Dementia & Delirium DEMENTIA Types: Alzheimer - 50-75% Vascular DAT-vascular Lewy Body Other (Rx, B12, etc) 3-4% reversible -medication, ALZHEIMER'S -40-90yo onset (65 peak) -neuronal, synaptic loss -Amyloid plaques -neurofibrillary tangles -esp in TEMPOROPARIETAL CORTEX (early), hippocampus -risk fx: APOE-4 allele on chrom 19 -late-onset more common than fam Pathogenesis: -abnl beta-amyloid deposition ->nn. death -abnl proteolytic cleavage of APP -disrupted ACh, glutamate action Clinical A.Increasing forgetfulness -usually first Sx -10-12%->AD B.Personality changes -disengagement, dec'd spontaneity, low frustration tolerance C.Mood changes-depressive, lability, catastrophic rxns D. other-aphasia, apraxia (motor), agnosia (recognize objects) E. Disturbed abstract thinking, judgment, orientation F. Later->disrupted sleep/wake -wandering, agitation, psychosis, globally confused, can't attend personal needs wheelchair->bed G. Terminal stage-can't walk, speak, personal needs H. 2-20 yr course-mean 8-10 yr, Dementia & Delirium DELIRIUM Critical Medical Causes: -act sometime today -I WATCH DEATH Infx Withdrawal Acute metabolism Trauma CNS pathology H Deficiencies (electrolyte) Endocrinopathies Acute vascular Toxins Heavy metals, Dementia & Delirium DELIRIUM Syndrome of cog, emo, beh Sx -acute or subacute medical cause NOT a stable decline Sign of impending death in 20-40% pts Prevalence: Up to 80% term. ill or struc brain dz 10-50% post-op pts 30-40% AIDS pts, Dementia & Delirium DELIRIUM Tx: TREAT UNDERLYING CONDITION -restore sleep -calm environment -reorientation, teaching -avoid physical restraint -Haldol if agitated, ALZHEIMER'S -40-90yo onset (65 peak) -neuronal, synaptic loss -Amyloid plaques -neurofibrillary tangles -esp in TEMPOROPARIETAL CORTEX (early), hippocampus -risk fx: APOE-4 allele on chrom 19 -late-onset more common than fam Pathogenesis: -abnl beta-amyloid deposition ->nn. death -abnl proteolytic cleavage of APP -disrupted ACh, glutamate action Clinical Tx: -reduce AChE activity ->modest ADL improvement -DONEPEZIL (Aricept) -Rivastigmine (Exelon) -Galantamine (Raminyl) NEWEST: -Memantine (Namenda)-mod-severe -NMDA antagonist -decrease glutamate excitatory effects, Dementia & Delirium DELIRIUM DSM-IV 1. disturbance of consciousness, reduced ability to focus, sustain, shift attn -no sustained sleep, excessive sleepy -irritable, agitated, slowing 2. cognition change or perceptual disturbance (need to find baseline) -disoriented, no clock-face/pentagons -no sequencing, organizing, abstraction, judgment/insight -disorganized thought, irrelevance -language-aphasia/paraphasic, dysnomia 3. short period of time, fluctuates over day (GMC changed) 4. caused by general medical condition, Dementia & Delirium DELIRIUM Emergency Medical Causes (act fast): WWHHHHIMP Wernicke's/Withdrawal Hypoxia/HTN/Hypoglycemia/Hypoperf Intracranial bleed Meningitis Poisons, Dementia & Delirium DELIRIUM Other Sx: Perceptual-like psychosis -illusions, halls, delusions Affective lability Neuro abnormalities -primitive reflexes, hyperreflexia -tremor, asterixis, myoclonus -CBLR signs, nystagmus EEG-diffuse slowing (hyperactivity in AW), Dementia & Delirium DEMENTIA ALZHEIMER'S -40-90yo onset (65 peak) -neuronal, synaptic loss -Amyloid plaques -neurofibrillary tangles -esp in TEMPOROPARIETAL CORTEX (early), hippocampus -risk fx: APOE-4 allele on chrom 19 -late-onset more common than fam Pathogenesis: -abnl beta-amyloid deposition ->nn. death -abnl proteolytic cleavage of APP -disrupted ACh, glutamate action