Altered mental status pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D., Pratik Bahekar, MBBS [2]

Overview

Altered mental status is a state of a variety of diseases. Although the neural science behind alertness, wakefulness, and arousal are not fully understood, it is known that the reticular formation plays an important role in these.

Pathogenesis

Dementia

Alzheimer's disease

While the pathogenesis of AD remains unclear, It is thought that dementia is the result of:

• Overproduction and/or decreased clearance of amyloid beta peptides.
• Accumulation of tau proteins.
• Accumulation of neurofibrillary tangles.
• Production of oxygen radicals and nitric oxide, and inflammatory processes.
• Decreased levels of cholinergic neurotransmission.

• Over-excitation of the glutamate neurotransmitter system via N-methyl-D-aspartate

Parkinson's disease

The pathogenesis of Parkinson's disease is a depletion of dopamine due to the following mechanisms:

Protein misfolding with decreased function and plasticity.

Defective proteolysis with aggregation of this protein and neuronal death.

Mitochondrial dysfunction with the following cell damage.

Oxidative stress

Iron metabolism

Immunologic and inflammatory mechanisms

Pathogenesis is the mechanism by which a certain factor causes disease (pathos = disease, genesis = development). The term can also be used to describe the development of the disease, whether it is acute, chronic, or recurrent. It can also be used to describe whether the disease causes inflammation, malignancy, necrosis etc.

Template Sentences[edit | edit source]

IF the pathogenesis of the disease is unclear:

• The exact pathogenesis of [disease name] is not fully understood.
• It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

IF the disease is infectious…

• …and the route of transmission is known:
  • [Pathogen name] is usually transmitted via the [transmission route] route to the human host.
  • Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

IF the disease has a known genetic component:

• [Disease name] is transmitted in [mode of genetic transmission] pattern.
• Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].

IF certain pathology findings are characteristic of the disease:

• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Other relevant information may include the action of the pathogen on a molecular level, the body’s response, whether or not mutations play a role in the disease development, whether the pathophysiology of the disease is different among subgroups of the disease, etc. Additional template sentences are listed below. Due to the highly variable nature of pathophysiology among various diseases, this list is not comprehensive.

• [Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
• The development of [disease name] is the result of multiple genetic mutations.
• The progression to [disease name] usually involves the [molecular pathway].
• The pathophysiology of [disease/malignancy] depends on the histological subtype.

• For an example of a pathogenesis section within a pathophysiology page, click here

Genetics[edit | edit source]

• Some diseases are genetic, and have particular inheritance patterns, and express different phenotypes.
• The effect that genetics may have on the pathophysiology of a disease can be described in this section.

Template sentences[edit | edit source]

• [Disease name] is transmitted in [mode of genetic transmission] pattern.
• Genes involved in the pathogenesis of [disease name] include [gene1], [gene2], and [gene3].

Associated Conditions[edit | edit source]

• Conditions associated with the disease can be detailed in this section.

Template sentences[edit | edit source]

• The most important conditions/diseases associated with [disease name] include:
  • Condition 1: A brief explanation of the condition and its association with the disease
  • Condition 2: A brief explanation of the condition and its association with the disease

For an example of an associated conditions sub-section of pathophysiology, click here.

Gross Pathology[edit | edit source]

• Gross pathology refers to macroscopic or larger scale manifestations of disease in organs, tissues and body cavities. The term is commonly used by pathologist to refer to diagnostically useful findings made during the gross examination portion of surgical specimen processing or an autopsy.

Template Sentences[edit | edit source]

• Template Sentences 1: On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• Template Sentence 2: The most important characteristics of [disease name] on gross pathology are:
  • Organ 1: List of characteristics + image
  • Organ 2: List of characteristics + image
  • Organ 3: List of characteristics + image
• This section is a good place to include pictures. Search for copyleft images on The Pathology Wiki [3] and Ask Dr. Wiki [4].
• For an example of this section, click here.

Microscopic Pathology[edit | edit source]

• Microscopic pathology is the disease process as it occurs at the microscopic level.
• Template Sentence 1: On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• Template Sentence 2: The most important histopathological characteristics of [disease name] are summarized in the table below:

Organs	Light microscope	Electron microscope	Images
Organ 1	Characteristic 1a	Characterstic 1b	Image 1
Organ 2	Characteristic 2a	Characterstic 2b	Image 2
Organ 3	Characterstic 3a	Characterstic 3b	Image 3

• This section is a good place to include pictures. Search for copyleft images on The Pathology Wiki [5] and Ask Dr. Wiki [6].
• For an example of this section, click here.

Pathophysiology

Dementia is a symptom

Although the neural science behind alertness, wakefulness, and arousal are not fully known, the reticular formation is known to play a role in these. The ascending reticular activating system is a postulated group of neural connections that receives sensory input and projects to the cerebral cortex through the midbrain and thalamus from the retucular formation. Since this system is thought to modulate wakefulness and sleep, interference with it, such as injury, illness, or metabolic disturbances, could alter the level of consciousness.

Normally, stupor and coma are produced by interference with the brain stem, such as can be caused by a lesion or indirect effects, such as brain herniation. Mass lesions in the brain stem normally cause coma due to their effects on the reticular formation. Mass lesions that occur above the tentorium cerebelli (pictured) normally do not significantly alter the level of consciousness unless they are very large or affect both cerebral hemispheres.