Discussion Response to Professor- Dementia and Delirium

Discussion Response to Professor- Dementia and Delirium

Assessing dementia and delirium involves a targeted neuro-physical exam encompassing specific cognitive and motor functions. Pertinent elements include assessing mental status, cranial nerves, motor strength, coordination, reflexes, and sensory perception (Srinivas, 2018). Additionally, for delirium assessment, attention, arousal level, and fluctuating cognition are crucial aspects.

Determining the need for advanced imaging depends on clinical evaluation. Advanced imaging, such as CT or MRI, is considered when neurological signs or symptoms suggest underlying structural issues or in cases of suspected trauma or intracranial pathology. CT scans are quicker and more suitable for emergent situations like suspected hemorrhage, while MRI provides higher resolution for soft tissue evaluation, making it more suitable for detailed examinations.

Medication dosing for dementia and delirium varies. For dementia, acetylcholinesterase inhibitors like donepezil may be prescribed. Typical dosing starts at 5 mg daily and can increase to 10 mg daily. NMDA receptor antagonists like memantine usually commence at 5 mg and may increase to 20 mg daily. Delirium treatment focuses on identifying and managing underlying causes, with medication use for severe cases of agitation. Specific dosing varies based on the cause and patient factors, often using antipsychotics or benzodiazepines cautiously.

The selection between acetylcholinesterase inhibitors and NMDA receptor antagonists in dementia treatment depends on various factors like the stage of the disease and individual patient response. Generally, acetylcholinesterase inhibitors are preferred for mild to moderate cases, while NMDA receptor antagonists may be considered in moderate to severe cases or in combination therapy.

Subsequently, different types of dementia may require tailored approaches. While Alzheimer’s, a common type of dementia, primarily utilizes medications like Brexpiprazole and Donepezil (How is Alzheimer’s disease treated? n.d), vascular dementia may focus on managing risk factors like hypertension. On the other hand, frontotemporal dementia may necessitate more behavioral interventions due to its unique symptomatology.

Genetic tests exist to assess dementia risk, like APOE genotyping for Alzheimer’s risk. Genetic markers like APOE4 can indicate increased susceptibility to Alzheimer’s. However, they aren’t definitive indicators. Consistently, lifestyle modifications, cognitive activities, and maintaining cardiovascular health may reduce dementia risk. Regular physical activity, a balanced diet, mental stimulation, and social engagement potentially contribute to prevention. Additionally, managing cardiovascular risk factors like diabetes and hypertension may lower the risk of vascular dementia. Conclusively, assessing neurology requires a multifaceted approach, considering individualized treatment and prevention strategies based on the type and stage of dementia. Advanced imaging, medication dosing, and lifestyle modifications play crucial roles in managing and potentially preventing dementia

Reference

Srinivas, H. (2018). Neurological examination. Clinical Neurology Made Easy, 11–11. https://doi.org/10.5005/jp/books/14202_4

U.S. Department of Health and Human Services. (n.d.). How is Alzheimer’s disease treated? National Institute on Aging. https://www.nia.nih.gov/health/alzheimers-treatment/how-alzheimers-disease-treated

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DISCUSSION RESPONSE TO MY PROFESSOR REGARDING JAQUELINE POST YOU DID EARLIER

Hi Jacqueline

Thanks for your compare and contrast of dementia and delirium.

What specific parts of the neurophysical exam would be relevant to assess?

Discussion Response to Professor- Dementia and Delirium

When would you consider advanced imaging? How would you determine if a CT vs. MRI would be most appropriate?

Can you provide specifics with dosing for the medication you could consider prescribing for each condition?

Under what conditions would you consider an acetylcholinesterase inhibitor vs an NMDA receptor antagonist for dementia?

Are all types of dementia treated in the same way?

Are there any genetic tests available to assess the risk of developing dementia?

Additionally, can dementia be prevented? if so, what are some suggestions you might provide?