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
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