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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 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.. • More likely to experience patients with dementia, and to encounter delirium/ acute confusion in surgical patients.
DementiaDefinitions and Epidemiology • Dementia
DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition”
DementiaDefinitions and Epidemiology • Dementia: “acquired loss of cognitive function due to an abnormal brain condition” • Usually progressive • Includes functional decline
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!
DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8%
DementiaDefinitions and Epidemiology • Prevalence of all dementias in the >65 yr population is 6-8% • Prevalence in >85yr population is 30%
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
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
Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease
Types of Dementia • At least 50-60% of people with dementia have Alzheimer’s Disease • Commonest types of dementia include:
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)
Alzheimer’s Disease Neurodegenerative disease associated with:
Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits
Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss)
Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment
Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness*
Alzheimer’s Disease Neurodegenerative disease associated with: • Cognitive deficits (including memory loss) • Functional impairment • Clear consciousness* • Change from previous level (>6 months duration)
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
Alzheimer’s Disease is associated with specific changes in brain anatomy, chemistry and physiology
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*
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
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
Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question.
Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia
Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties
Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia
Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair
Alzheimer’s Disease Clinical Features: Cognitive • Amnesia • Misplace/ lose objects. Repeat same question. • Aphasia • Word-finding difficulties • Apraxia • Brush teeth, dress, comb hair • Agnosia
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
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
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)
Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms
Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations
Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems
Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes
Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes
Alzheimer’s Disease Clinical Features: Non-Cognitive • Psychotic symptoms • Delusions, hallucinations • Mood problems • Behavioural changes • Apathy • Overactivity/ agitation (wandering) • Aggression • Personality changes • Abnormal sleep
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
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
Management of Alzheimer’s Disease and Dementias • Biological
Management of Alzheimer’s Disease and Dementias • Biological • Social
Management of Alzheimer’s Disease and Dementias • Biological • Social • Psychological