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

• acute onset

• withdrawal from alcohol/opioids
• take dementia patient in unknown setting: they become delirius
• PNA: pneumonia
• AMS: altered mental status

• hypoxic: fix O2

Haloperidol

• haloperidol: give acutely

• pyramidal = corticospinal tract

• in order they occur
• dystonia: acute effect, a few hours
• tardive: after years
• also NMS

• benztropine: anti Ach

• 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

• nonspecific SE

• 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