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Delirium and Dementia, Dementia, Delirium - Coggle Diagram
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Dementia
Classification
Chronic slow changes for long peroids of time. Progressive symptoms at a slow rate lasting for months to years.
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Diagnosis
ADAS-Cog assessment: specifically for alzheimers disease ranging from 0-70 (higher = worse) and changes in > 4 is significant
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Signs and Symptoms
Alzheimers: Memory impairment, aphasia cognitive problems at a continous pattern
Fronttotemporal lobar degeneration: Compulsive behaviours, apathy and language problems and speech disorders
Vascular dementia: Abrupt and stepwise deterioration. Risk factors include: diabetes, HTN and Hx of stroke.
Lewy Body Dementia: cognitive disturbances and halluncinations along with parkinsonism with hallucination and delusions
Cognitive Treatment
Cholinesterase inhibitors: mild congitive improvements and improvements in MMSE. It does not treat the cause, only to maximum current functions
Donepezil (most tolerable GI effects), Galantamine and Rivastigimine transdermal are 1st line
Rivastigmine oral is 2nd line
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Non-drug techniques
Education: explaining to carers and family for better management and care
Self care skills: dressing, eating and toileting training and practice.
Physical activity: simple excerises with groups
Social intervention: regular social activitys and support groups
Delirium
Classification
Acute confusion in the elderly with rapid changes, starts aburptly and lasting for hours to 1 month
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Signs and Symptoms
Acute onset and fluctuation of inattention, disorganised thinking or altered level of consciousness
Causes
Medical
Infections, electrolyte imbalance, hypoxia or urinary retention
(which can also be drug induced)
Cerebrovas event, endocrine causes such as diabetes, thyroid dysfunction, head trauma, seizure, heaptic encephalopathy
Medications
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Steroids, opioids, benzos, H2 blocks and metoclopramide are some others
Psychosocial
Depression, vision/hearing impairment, pain, mania, unfamiliar environment
Treatment
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Drug use
Haloperidol, Olanzapine or Risperidone oral are 1st line single dose to sedate patient to identify underlying cause
Haloperidol or Olanzapine IV can be used if oral administration is not possible and is absolutely necessary