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Marked by short-term confusion and changes in cognition
A.K.A. acute confusional state, acute brain syndrome, metabolic encephalopathy, toxic psychosis, & acute brain failure
syndrome, not a dse
characterized by a disturbance of consciousness & a change in cognition that develop over a short time.
Hallmark symptom : impairment of consciousness
Delirium - Clinical Manifestations
Tremor
Fluctuating levels of consciousness
Clouding of consciousness
Disorientation
Illusions
Hallucinations
Dysphasia
Dysarthria
Delirium - Causes
Gen. Medical Condition-e.g. infection
Substance Induced- e.g. cocaine
Multiple Causes- e.g. head trauma, kidney dse.
not otherwise specified-e.g. sleep deprivation
marked by severe impairment in memory, judgement, orientation & cognition.
Subcategories of Dementia
Dementia of Alzheimer’s Type
manifested by progressive intellectual disorientation, dementia, delusions, or depressions.
Vascular Dementia
vessel thrombus hemorrhage
Other Medical Conditions
HIV dse, trauma
Substance Induced - Toxin/Meds
Multiple Etiologies and Others not Specified
Marked by memory impairment and forgetfulness
AMNESTIC DISORDER - CAUSES
by medical condition (hypoxia)
by toxin/meds- marijuana
others not specified (trauma)
DIFFERENTIAL DIAGNOSIS
Onset:
Delirium - sudden onset
Dementia – insidious (slowly)
with dementia- usually alert
with delirium- has episodes of dec. consciousness
Beclouded dementia- delirium occurs to pt. with dementia
Primary Goal: Treat the underlying cause
Provide physical, sensory, environmental support
Pharmacotherapy
2 major symptoms: psychosis & insomnia
e.g. haloperidol- antipsychotic drug
Benzodiazepine- insomnia
DEMENTIA
a diminution in cognition in the setting of a stable level of consciousness.
"characterized by multiple cognitive defects that include impairment in memory" (DSM-IV-TR)
may be progressive or static, permanent or reversible
Memory impairment- prominent feature in dementia
DEMENTIA OF THE ALZHEIMER’S TYPE
Genetic Factors - 40%
Neuropathology - diffuse atrophy with flattened cortical sulci and enlarged cerebral ventricles.
Neurotransmitters - acetylcholine & norepinephrine
Other Causes
carried on chromosome 17
short term memory problems; difficulty maintaining balance & walking
protein build up kills brain cells
VASCULAR DEMENTIA
affects small & medium cerebral vessels
Most common - men with Htn, cardiovascular problem
BINWANGER’S DISEASE
a.k.a. subcortical arteriosclerotic encephalopathy (clotting)
presence of many small infections of the white matter that spare the cortical region.
PICK’S DISEASE
atrophy in the frontotemporal regions
5% of all irreversible dementia
early stage: characterized by personality & behavioral changes, with preservation of other cognitive functions.
e.g. Kluver-bucy syndrome-more common in pick's
LEWY BODY DISEASE
often characterized by hallucinations, parkinsonian features, and extrapyramidal signs.
HUNTINGTON’S DISEASE
associated with the dev't of dementia
characterized by more motor abnormalities and fewer language abnormalities
PARKINSON'S DISEASE
20-30 % of patients
bradyphrenia-slow thinking and movement
Unintended or uncontrollable movements, such as shaking, stiffness and difficulty with balance and coordination.
HIV-Related Dementia
14% annually
other infectious dementia are caused by cryptococcus & treponema pallidum
Head Trauma -Related Dementia
punch-drunk syndrome (dementia pugilistica) - occurs in boxers
Chronic traumatic encephalopathy
characterized by emotional lability, dysarthria, & impulsivity.
DIFFERENTIAL DIAGNOSIS - DEMENTIA
symptoms of psychosis & thought d/o: schizophrenia>dementia
Normal Aging- minor memory deficit- benign senescent forgetfulness
Other disorders
MR- no memory impairment
Amnestic d/o- characterized by circumscribed loss of memory and no deterioration
Onset- 50s-60s with gradual deterioration over 5-10 yrs
Survival expectation
Alzheimer's type: ≈8 yrs
TREATMENT - DEMENTIA
verification of the diagnosis
Preventive measures
Provide supportive medical care, emotional support, pharmacological treatment for specific symptoms
AMNESTIC DISORDER
feature is the acquired impaired ability to learn & recall new information, or inability to recall previously learned knowledge or past events
AMNESTIC DISORDER - ETIOLOGY
diencephalic structures involvement & usually bilateral damage
systemic medical condition (Korsakoff's syndrome); hypoglycemia; primary brain conditions (seizures, head trauma); substance-related causes (alcohol use d/o)
AMNESTIC DISORDER - CLINICAL FEATURES
central symptom- dev't of memory d/o
short term/recent memory are usually impaired
sudden onset of symptoms
can be short or long duration
SUBTYPES - AMNESTIC DISORDER
CVD
MS
KORSAKOFF’S SYNDROME
ALCOHOLIC BLACKOUTS
ELETROCONVOLSIVE THERAPY
HEAD INJURY
TRANSIENT GLOBAL AMNESIA
CVD
often involve the occipital or parietal lobes
affecting bilateral medial thalamus (ant. portions) assoc. with sx. of amnestic d/o
MS
plaques occur in temporal lobe & diencephalic regions
memory impairment- 46-60 %
KORSAKOFF’S SYNDROME
Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Korsakoff syndrome is most commonly caused by alcohol misuse
Develops in about 80% of people with untreated Wernicke encephalopathy
often assoc. with Wernicke's encephalopathy-confusion, ataxia, and ophthalmoplegia (paralysis or weakness of the eye muscles)
Acute confusional state
onset may be gradual
Prominent symptoms- confabulation, apathy, & passivity
ALCOHOLIC BLACKOUTS
person's awake in the morning with a conscious awareness of being unable to remember a period the night before which they were intoxicated
ELECTROCONVOLSIVE THERAPY
usually assoc. with retrograde amnesia for a period of several minutes and anterograde amnesia after the treatment (within 5 hours).
1-2 months mild memory deficits after the course of Tx, but sx completely resolved 6-9 months
HEAD INJURY
retrograde amnesia - improvement during the 1st week of gain consciousness
TRANSIENT GLOBAL AMNESIA
Dementia- memory impairment with other cognitive deficits
Delirium- memory impairment occurs in the setting of impaired attention and consciousness
Normal aging- minor impairment in memory
Dissociative d/o- lost orientation to self and may have more selective memory deficits
experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity.
Factitious d/o - mimicking an amnestic d/o
is a serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury.
inconsistent results on memory test & no evidence of an identifiable cause