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Dementia & Delirium in Surgical Patients

Dementia & Delirium in Surgical Patients. Damian Harding Department of Geriatric Medicine February 2008. Introduction. Surgical patient population has changed. Introduction. Surgical patient population has changed.. More older patients Patients have more co-morbidities..

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Dementia & Delirium in Surgical Patients

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  1. Dementia & Delirium in Surgical Patients Damian Harding Department of Geriatric Medicine February 2008

  2. Introduction Surgical patient population has changed..

  3. Introduction Surgical patient population has changed.. • More older patients • Patients have more co-morbidities.. • More likely to experience patients with dementia, and to encounter delirium/ acute confusion in surgical patients.

  4. DementiaDefinitions and Epidemiology • Dementia

  5. DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition”

  6. DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition” • Usually progressive • Includes functional decline

  7. DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition” • Usually progressive • Includes functional decline • Memory loss and cognitive impairment are NOT features of normal aging!

  8. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8%

  9. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30%

  10. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30% • Estimated annual cost reaches US$100 billion (2001) • Direct care to individual • Lost wages by caregivers

  11. DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30% • Estimated annual cost reaches US$100 billion (2001) • Direct care to individual • Lost wages by caregivers • Significant emotional and personal costs

  12. Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease

  13. Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease • Commonest types of dementia include:

  14. Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease • Commonest types of dementia include: • Alzheimer’s Disease • Vascular (multi-infarct) dementia • Lewy body Dementia • Alcoholic dementia • (depression and pseudo-dementia)

  15. Alzheimer’s Disease Neurodegenerative disease associated with:

  16. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits

  17. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss)

  18. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment

  19. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness*

  20. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness* • Change from previous level (>6 months duration)

  21. Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness* • Change from previous level (>6 months duration) • Median survival from diagnosis: 5-6 years

  22. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology

  23. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology • Neurofibrillary tangles* • Amyloid plaques • Loss of cortical choline acetyltransferase activity and of cholinergic projection neurons in Nucleus basalis of Meynert*

  24. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology • Neurofibrillary tangles* • Amyloid plaques • Loss of cortical choline acetyltransferase activity and of cholinergic projection neurons in Nucleus basalis of Meynert* • Multifactorial genetic component

  25. Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology • Neurofibrillary tangles* • Amyloid plaques • Loss of cortical choline acetyltransferase activity and of cholinergic projection neurons in Nucleus basalis of Meynert* • Multifactorial genetic component CT/MRI may be normal or show generalized atrophy/ focal atrophy in medial temporal lobe *correlates with disease severity

  26. Alzheimer’s Disease Clinical Features:

  27. Alzheimer’s Disease Clinical Features: Cognitive

  28. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia

  29. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question.

  30. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia

  31. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties

  32. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia

  33. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair

  34. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia

  35. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia • Failure to recognise objects/ familiar faces

  36. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia • Failure to recognise objects/ familiar faces • Frontal executive dysfunction

  37. Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia • Failure to recognise objects/ familiar faces • Frontal executive dysfunction • (Capacity to consent for treatment)

  38. Alzheimer’s Disease Clinical Features: Non-Cognitive

  39. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms

  40. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations

  41. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems

  42. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes

  43. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes

  44. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep

  45. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep • Reduced appetite

  46. Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep • Reduced appetite • Incontinence

  47. Management of Alzheimer’s Disease and Dementias

  48. Management of Alzheimer’s Disease and Dementias • Biological

  49. Management of Alzheimer’s Disease and Dementias • Biological • Social

  50. Management of Alzheimer’s Disease and Dementias • Biological • Social • Psychological

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