Delirium/Dementia Disorders

Dementia
impairment of memory and other cognitive functions (no altered level of
consciousness)
Dx criteria:
1 multiple cognitive deficits - must include memory impairment + at least 1 of the
following:
a aphasia
b apraxia
c agnosia
d disturbance of executive functioning
2 deficits must cause significant impairment
3 cannot occur during a delirium (no altered level of consciousness, no loss of
attention or waxing and waning features)
***delusions, hallucinations, depression, and anxiety may be seen as part of presentation in
dementia

Alzheimers Disease
most common dementia (diffuse...not localized to any one lobe)
affects more women
genetic predisposition (APOe4, presenilin I, presenilin II, APP)
DECREASED ACh
typical 10 year progression from dx to death (gradual progressive decline)
Nearly all Trisomy 21 (Down Syndrome) patients get AD by 40
Senile AB amyloid plaques and neurofibrillary tangles (toxic to brain)
Dx criteria:
1 clinical dx of exclusion
2 definitive dx = autopsy/bx
Genetics:
homozygous APOe4 = significant increase in Alzheimers risk
most cases sporadic
Treatment:
AchE Inhibitors - slow decline for 6-12 mo (donepezil, rivastigmine, galantamine)
NMDA antag. (memantine)
Delirium
waxing and waning of level of consciousness and changes in cognition over a
short period of time
very common in hospital, especially post-op, ICU, elderly, etc.
Common causes:
***infection
***medications
***substance intox./withdrawal
electrolyte imbalance
Common Symptoms:

visual hallucinations
impaired attention
waxing and waning of symptoms
confusion, loss of orientation (often first symptom)

Dx criteria:
1
2
3

disturbed consciousness
change in cognition
develops over short period of time and tends to wax and wane

treat underlying cause

supportive care: hydration and nutrition
antipsychotics (haloperidol is most studied)
AVOID benzos unless secondary to alc. withdrawal

Tx:

Picks Disease
frontotemporal dementia (atrophy of frontal and temporal lobes)
profound ***personality changes***
rapid progression (4-6 yrs)
disinhibited
poor insight
- no good treatment (anticholinergics and antidepressants are sometimes used for behavioral
symptoms)

Dementia vs Delirium
Delirium: rapid onset, disturbance of consciousness, fluctuating course/wax and
wane, confusion, loss of orientation = first symptom
Dementia: gradual onset, clear consciousness, steady/gradual course, first
symptom = subjective loss of memory
Definitions:
aphasia - loss of ability to understand or express speech
agnosia - loss of ability to recognize objects
apraxia - inability to perform purposeful complex actions (cant tie shoes)
loss of exec functioning - inability to organize thoughts, make decisions, plan,
manage, etc (higher thinking)