39 Dementia and Delirium

  • both when people get confused
  • delirium: over course of hours

  • like EKG for heart
  • records nerve cell depolarization
  • Creutzfeldt-Jakob: spiked

Delirium

  • acute onset

  • withdrawal from alcohol/opioids
  • take dementia patient in unknown setting: they become delirius
  • PNA: pneumonia
  • AMS: altered mental status

  • hypoxic: fix O2

Haloperidol

  • haloperidol: give acutely

  • pyramidal = corticospinal tract

  • in order they occur
  • dystonia: acute effect, a few hours
  • tardive: after years
  • also NMS

  • benztropine: anti Ach

  • Falling "extra parking" cone: antimuscarinics treat extrapyramidal side effects caused by antipsychotics: e.g. dystonia, akathisia, parkinsonism (re-establish dopaminergiccholinergic balance)

  • see fever, rigid muscles, think haloperidol

Dementia

  • no change in level of consciousness, all cognition

  • Alzheimers
  • can't do daily job
  • urinate on themselves

  • small strokes that result in dementia

Alzheimer's

  • global loss of cognitive ability

  • APP normally found on neurons, alpha degradation no negative effect
  • beta builds up to AB sheets of amyloid

  • build up in extracellular space

  • sporadic: not mutated gene
  • risk groups get early disease

  • not type 1 diabetes
  • brain injury, LOC for >30 min more likely

  • classically brought by family

Drugs

  • nonspecific SE

  • Alzheimer's GALA: galantamine (acetylcholinesterase inhibitor used to treat Alzheimer's disease)
  • REVERSE the STIGMA: rivastigmine (acetylcholinesterase inhibitor used to treat Alzheimer's disease)
  • Done with brain puzzle: donepezil (acetylcholinesterase inhibitor used to treat Alzheimer's disease)
  • Brain puzzle: galantamine, rivastigmine, and donepezil penetrate the CNS

Infarct Dementia

  • pt do ok then have a sudden decrease, then do ok, then another sudden decrease (little strokes make them worse each time)

Lewy Body

  • parkinson symptoms first, then dementia: Parkinson
  • dementia symptoms first, then parkinson: dementia

Pick's Disease

  • similar in appearance to tangles but nice round

Creutzfeldt-Jakob

  • round vacuoles in brain
  • same thing that causes mad cow.

  • PrPc normal, everyone has them
  • PrPsc gets in body and link to normal one, convert it to abnormal

  • startle to minimal stimuli
  • know spike wave complexes