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
- withdrawal from alcohol/opioids
- take dementia patient in unknown setting: they become delirius
- PNA: pneumonia
- AMS: altered mental status
Haloperidol
- haloperidol: give acutely
- pyramidal = corticospinal tract
- in order they occur
- dystonia: acute effect, a few hours
- tardive: after years
- also NMS
- Falling "extra parking" cone: antimuscarinics treat extrapyramidal side effects caused by antipsychotics: e.g. dystonia, akathisia, parkinsonism (re-establish dopaminergic- cholinergic 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
- 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
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