Dementia Delirium

DELIRIUM & DEMENTIA
Department of Psychiatry
V S Hospital
DELIRIUM
• Definition-Acute onset of fluctuating cognitive impairment and a disturbance
in consciousness.
• Delirium by other Names-
-Intensive care unit psychosis
-Acute confusional state
-Acute brain failure
-Encephalitis
-Encephalopathy
-Toxic metabolic state
-Central nervous system toxicity
-Paraneoplastic limbic encephalitis
-Sundowning
-Cerebral insufficiency
-Organic brain syndrome
COMMON CAUSES OF DELIRIUM
• MEDICAL CAUSES
• Seizures
• Malnutrition
• Dehydration
• Electrolyte imbalance
• Anaemia
• Hypoxia
• Hypercapnoea
• Hypoglycemia
• Endocrine disorders (Diabetes Mallitus)
• Infection
– CNS infections
– Substance withdrawal, esp. alcohol, benzodiazepines
• Surgical causes
– Pain
– Iatrogenic event, esp. post-operative,
mechanical ventilation in ICU
– Chronic/terminal illness, esp. cancer
– Post-traumatic event, e.g. fall, fracture
– Immobilisation/restraint
– Traumatic head injury
• Medication
– Anticholinergics(Atropin), dopaminergics, opioids, steroids,
antihypertensives
DEMENTIA
• Definition-Progressive impairment of cognitive functions
occuring in clear consciousness.
CAUSES OF DEMENTIA
• (1) Alzheimer's disease(most common);

• (2) vascular dementia
• (3) mixed vascular and Alzheimer's dementia.
• (4)Other illnesses that account for approximately 10 percent include-
– Lewy body dementia;
– Pick's disease;
– Frontotemporal dementias;
– Normal pressure hydrocephalus (NPH);
– Alcoholic dementia;
– Infectious dementia-HIV or syphilis; and
– Parkinson's disease
– Metabolic abnormalities (e.g., hypothyroidism), nutritional deficiencies (e.g., vitamin B 12 or folate deficiencies)
– Drugs and toxins
Alcohol
Heavy metals
Irradiation
Pseudodementia due to medications (e.g., anticholinergics)
Carbon monoxide
Cortical vs Subcortical Dementia
CHARACTERISTIC CORTICAL SUBCORTICAL
Language aphasia early no aphasia
Memory recall/recognition recall impaired;
impaired recognition normal
or better preserved
than recall
Visuospatial impaired impaired
Calculations impaired preserved until late
Frontal systems consistently disproportionately
impaired affected
Speed of Cognition normal until late in slowed early
course
Personality unconcerned apathetic, inert
Mood euthymic depressed
Speech normal articulation dysarthric
until late
Posture upright bowed or extended
Dementia vs Pseudodementia
Alzheimer’s disease
• cognitive deficits
– profound memory loss (anterograde/retrograde)
– language - anomic, empty, circumlocutory
– visuospatial disturbance
• behavioral deficits
– no significant early changes in personality
– unawareness or denial of illness
– psychosis
• no sensory or motor deficits
Dementia with Lewy bodies (DLB)
• One of the most common types of progressive dementia.
• Core features
- Fluctuating levels of attention and alertness
- Recurrent visual hallucinations
- Parkinsonian features (cog wheeling, bradykinesia, and resting
tremor)
Supporting features
- Repeated falls
- Syncope
- Sensitivity to neuroleptics
- Systematized delusions
- Hallucinations in other modalities (e.g. auditory, tactile)
Huntington’s Chorea
• Subcortical functions are affected first and dominate
throughout; subcortical involvement is manifested by
slowness of thinking or movement and personality
alteration with apathy or depression.
• There are involuntary choreiform movements, typically of

the face, hands, or shoulders, or in the gait.
• Comments
In addition to involuntary choreiform movements, there
may be development of extrapyramidal rigidity or of
spasticity with pyramidal signs.
Frontotemporal dementia (Pick's disease)
• This progressive condition accounts for 5% of all dementias.

• Usually sporadic, it more commonly affect women between 40 and
60 years.
• Personality and behaviour are initially more affected than memory.
• Frontal lobe dysfunction predominates with apathy, lack of initiative
and personality changes.
• CT or MRI scans show frontal (and/or temporal) atrophy, often
asymmetrical.
• The disorder is characterized pathologically by argyrophylic
inclusion bodies within the cytoplasm of cells of the frontotemporal
cortex.
• There is no treatment, death occuring within 2-3 years of the onset.
PERSONALITY CHANGES IN DEMENTIA
• Has become self-centered
• Has become more irritable
• Has become more passive and easier to deal with
• Curses and uses foul language
• Complains and criticizes more
• Is less motivated
• Becomes easily tearful or upset
• Is stingy or overly worried about wastefulness
• Says or does things they never would have said or done before,
decreased inhibition
• Is always anxious or worried
• Is less talkative
• Becomes scared or frightened easily
THANK YOU

Dementia Delirium

Uploaded by

Copyright:

Available Formats

Dementia Delirium

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dementia Delirium

Uploaded by

Copyright:

Available Formats

DELIRIUM & DEMENTIA

• (1) Alzheimer's disease(most common);

• There are involuntary choreiform movements, typically of

• This progressive condition accounts for 5% of all dementias.

You might also like