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N2270 > 10 - Cognitive Health & Aging > Flashcards

10 - Cognitive Health & Aging Flashcards

1
Q

5 Different Functions of the Brain

A

1) Cognitive health: thinking, learning, remembering

2) Motor function: ability to control movements and balance

3) Emotional function: ability to interpret and respond to emotions

4) Tactile function: ability to feel and respond to touch (pressure, pain, temperature)

5) Sensory function: ability to use the other sense (sight, hearing, taste, smell)

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2
Q

The 3 D’s Of Cognitive Impairment

A
  • not a normal part of the aging process
  • the incidence of the 3 D’s increases with age
  • all lead to cognitive and behavioural changes
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3
Q

What is Depression?

A
  • known as major depression, major depressive disorder, or clinical depression
  • Common mood disorder
  • affects how a person feels, thinks, and handles daily activities, such as sleeping, eating, or working

Type of Depression
- Major depression: loss of interest in activities or depressed mood most of the time over the last 2 weeks, to the extent that symptoms impair everyday activities

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4
Q

Depression in Older Adults

A
  • <20% of older adults in Canada have depression
  • almost 1/2 ofolder adults living in residential care facilities had a diagnosis and/or symptoms of depression
  • The symptoms of depression impacted residents’:
    • physical Health (e.g. Unstable health conditions)
      • Socialization (e.g. Conflict/ withdrawal)
      • Functional Health (e.g. Decline in self-sufficiency)
      • Quality of Life (e.g. Pain or serious health challenges)
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5
Q

What are the Causes of Depression?

A
  • no singular cause

Predisposing Factors
- Brain chemistry
- Genetics
- Certain medical conditions (e.g. thyroid dysfunction)
- Certain medications
- Social Isolation
- History of depression
- Widowed/divorced

Precipitating Factors
- Recent bereavement
- Stressful life events
- Chronic stress
- Persistent sleep challenges

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6
Q

S & S of Depression in the Older Adult

A
  • Does not get dressed
  • Loss of interest in previously enjoyed activities
  • Expresses consistent feelings of sadness
  • Sleep dysfunction (too little or too much)
  • Eats more or less than typical
  • Difficulty concentrating
  • Lacks energy
  • Difficulty remembering things
  • Isolates oneself
  • Talks about self-harm or suicide
  • Somatic symptoms (insomnia, loss of appetite, persistent pain)
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7
Q

How to Diagnose Depression

A

A comprehensive assessment
1) Patient interview
2) Medical history
3) Physical & cognitive assessment
4) Medication review
5) Family/caregiver review, if possible
6) Depression screening tool e.g.
7) Geriatric Depression Scale Short Form (GDS-SF)

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8
Q

How to treat Depression?

A

Common treatments include:
- Psychotherapy
- Medications

Other actions that improve symptoms of depression include:
- Regular physical activity
- Eating a nutritious diet
- Avoiding alcohol
- Social interaction with friends and family
- Proper sleep hygiene

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9
Q

Consequence’s of Depression

A
  • Functional decline
  • Delayed recovery from an illness
  • Malnutrition
  • Decreased quality of life
  • Increased risk of substance use
  • Increased risk of suicide
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10
Q

Prevalence of Dementia

A
  • Prevalence of dementia increases with age, doubling approx. every 5 years for ppl between ages of 60- 95 years
  • prevalence is 25% for those older than 85 years
  • Stroke doubles the chances of developing dementia
  • Mitigating stroke risk is the most immediate and effective strategy to reduce the rates of both stroke and dementia
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11
Q

Who is most likely to have dementia?

A
  • Women are more likely than men
  • prevalence of dementia is higher among racial minorities
  • prevalence of dementia and a younger age of onset is higher among Indigenous peoples
  • Indigenous men are more likely than women
  • These differences are caused by the increased vulnerability associated with: ______________________(need this answer)
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12
Q

Early Signs of Dementia

A
  • Memory loss
  • Misplacing items often
  • Forgetting names of familiar things
  • Repeating themselves without noticing
  • Hesitating to try new things
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13
Q

Typical VS. Untypical Signs of Dementia

A

Typical
- Forgetting which word to use
- Making a bad decision
- Poor judgments/decisions a lot of the time
- Problems taking care of the monthly bills
- Losing track of the date/time of year
- Trouble having a conversation
- Misplacing things often/unable to find them

Untypical
- Losing things from time to time
- Missing a monthly payment
- Forgetting which day it is (remembering later)

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14
Q

Modifiable Risk Factors

A
  • LDL cholesterol
  • Health weight/treat obesity
  • High alcohol consumption
  • Treatment of vision loss
  • Quality education
  • Hearing aids
  • Use of helmets
  • Exercise
  • Cigarette smoking
  • Hypertension ???
  • Social isolation ???
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15
Q

What is Dementia

A
  • the correct term is Neurocognitive Disorder
  • it is a disorder on neuro-cognition
  • thinking, remembering, and reasoning will be disorganized
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16
Q

What are the 4 Types of Dementia

A

1) Alzheimer’s disease
2) Vascular dementia
3) Lewy body dementia
4) Frontotemporal dementia

17
Q

What is Alzheimers?

A
  • Can take a long time to recognize as something other than normal aging
  • Apathy & depression may be the first/earliest signs of AD (up to 3 yrs b/f dx)
  • Early symptoms: memory loss, may include word-finding problems, vision or spatial issues, and impaired reasoning or judgement
  • Common to take up to 4 yrs from the first symptom to seeking help
  • Stigma associated with dementia contributes to the delay in seeking help
18
Q

What is Vascular Dementia?

A
  • known as multi-infarct dementia, post-stroke dementia, or vascular cognitive impairment
  • Consists of a group of heterogeneous disorders arising from cerebrovascular insufficiency or ischemic or hemorrhagic brain damage
19
Q

What is Lewy Body Dementia?

A
  • Characterized by a combination of cognitive impairment, psychosis, and features of parkinson
  • Memory loss might not be evident at first
  • Hallucinations are common and occur often through out the day
  • Movement problems and altered gait
  • Sleep disorders
  • Dysregulation or autonomic body functions: changes in blood pressure or incontinence
  • Less common/widely underdiagnosed condition
  • Many are diagnosed as having other types of dementia (most commonly AD or PD) if they present with movement problems
  • Memory impairment is milder, and impaired executive function is common
  • includes severe sensitivity to neuroleptics
20
Q

Why is it important to diagnose LBD early?

A
  • Early and accurate diagnosis is essential, as neuroleptics can cause a severe worsening of movement and a fatal condition known as neuroleptic malignant syndrome (severe fever and muscle rigidity, can lead to kidney failure)
21
Q

What is Frontal-Temporal Dementia?

A
  • Shrinkage of the frontal and temporal anterior lobes of the brain
  • linked to several chromosomal mutations: 30 - 40% have family members with a neurodegenerative disease
  • Mean age onset between 52 and 56 yrs
  • Rapid disease progression, poor prognosis
  • Often not accurately diagnosed
  • Early symptoms are often related to changes in personality and inappropriate social behaviour (different from AD)
  • There are no approved medications that slow the progress of FTD
22
Q

Symptoms of FTD

A
  • Behavioural changes/challenges…
  • Inappropriate actions
  • Lack of empathy
  • Poor judgment
  • Apathy
  • Aphasia
  • Poor Hygiene
  • Impulsive
  • Movement disorder
  • Speech and language problems
23
Q

Nursing Interventions for Dementia Care?

A
  • Create meaningful moments and activities
  • Structure daily living to maximize remaining abilities
  • Monitor the general health and impact of dementia acute and chronic medical conditions, paying attention to the person’s experience of pain and mental health
  • Create opportunities for social engagement, freedom of choice, self-expression, spirituality, and creativity
  • Support advance care planning
  • Educate caregivers in the areas of problem solving, long-range planning, emotional support, and accessing resources and respite
24
Q

Nursing Implications: Caring for a Client with Dementia

A

Person-Centered Care
- Foster client’s abilities & control
- Ensure client’s safety
- Maximize quality of life
- Prevent avoidable disability
- Support proper nutrition
- Create opportunities for meaningful interaction
- Developing therapeutic relationships

Minimize Stressors
- Pain
- Depression
- Loss of control/restraints
- Communication difficulties
- Hunger, thirst, need to use the washroom
- Loneliness
- Fatigue
- Depersonalized care

25
Q

What are the 7 A’s

A

1) Anosognosia

2) Aphasia

3) Amnesia

4) Agnosia

5) Apraxia

6) Altered perception

7) Apathy

26
Q

What is Sundowning?

A
  • Agitated at night, no sleep, climbing out of bed, pacing, wandering

What risks does this present?
Does the hospital environment help/hinder?
How to minimize? Restraints?

27
Q

What is Delirium?

A
  • a complex neuropsychiatric syndrome marked by an acute onset, fluctuating course, altered level of consciousness, inattention, and disorganized thinking
  • It is acute and typically lasts for hours to days, though it may persist for weeks or even months
  • Symptoms fluctuate throughout the day
    Can often be prevented
28
Q

Clinical Features of Depression

A

Onset
- variable; can appear abruptly
- coincides with life changes

Course
- diurnal effects; worse in the morning

Duration
- S&S present for at least 2 weeks (many persist)

Alertness
- normal

Attention
- minimal impairment
- distractible
- poor concentration

Orientation
- selectively intact (“I dont know”)

Memory
- selective or patchy impairments

Thinking
- intact
- themes of helplessness, hopelessness, guilt
- rumination

Perception
- rarely impaired
- hallucinations absent except in severe cases (psychosis)

29
Q

Clinical Features of Dementia

A

Onset
- chronic, progressive decline

Course
- long, progressive, stable loss over time

Duration
- chronic (months - years)

Alertness
- normal until late stage

Attention
- generally normal
- can decline with disease progression

Orientation
- increasing impairment overtime

Memory
- recent memory impaired
- remote memory is increasingly impaired with disease progression

Thinking
- difficulty with abstract thinking
- poor judgement

Perception
- can be longstanding (dementia w/ lewy bodies)
- can occur at late state of illness (alzheimers)

30
Q

Clinical Features of Delirium

A

Onset
- acute

Course
- short, fluctuating and worse at night

Duration
- typically short (hours to < 1 month)
- can be persistent

Alertness
- lethargic or hyper-alert; fluctuates

Attention
- inattention, unfocused, distracted; fluctuates

Orientation
- may be impaired; fluctuates in severity

Memory
- recent memory impaired

Thinking
- disorganized; disconnected; tangential; rambling; incoherent

Perception
- acute onset hallucinations
- delusions and illusions are common

31
Q

Incidence and prevalence of delirium

A
  • Approximately 50% of hospitalized adults may experience delirium
  • Over 40% of residents in long-term care facilities experience delirium at some point
  • Within acute care and LTC, delirium is unrecognized in many individuals
32
Q

Consequences of Delirium

A
  • Distress for the individual and their family/friends

Delirium during hospitalization is associated with:
- high morbidity and mortality
- functional decline
- increased postoperative complications
- increased length of hospital stay and hospital readmissions
- increased services after discharge
- long-term cognitive decline
- high rates of institutionalization

  • although delirium is considered a reversible cause of altered mental status, many elderly with delirium never return to their baseline cognitive status, especially in the presence of pre-existing dementia
33
Q

Subtypes of Delirium

A

1) Hyperactive delirium: - characterized by heightened arousal, restlessness, agitation, delusions, and/or aggressive behaviour

2) Hypoactive delirium: - characterized by sleepiness, quieting of symptoms, and/or disinterested behaviour
Most common type of delirium in older adults

3) Mixed delirium:
- characterized by alternating hyperactive and hypoactive states

34
Q

How to Prevent Delerium

A

Assessment (assess risk factors)
- Planning (tailored, non-pharma prevention)
- Implementation
- Ongoing assessment at least daily

35
Q

Risk factors for Delirium

A

Predisposing Risk Factors
- age 65 and older
- male
- visual/hearing impairment
- reduced mobility and history of falls
- dehydration
- malnutrition
- certain meds (polypharmacy and psychoactive)
- co-existing medication conditions

Precipitating Risk Factors
- emotional stress
- pain
- surgery
- severe illness
- prolonged sleep deprivation
- neurological infections (ie. stroke)
- infections
- admission to ICU and/or use of restraints

36
Q

Risk Factors for Delirium Severity in Long-Term Care Homes

A

Absence Of
- Adequate nutrition
- Aids to orientation
- Family member
- Glass of water
- Reading eyeglasses

Presence Of
- Antipsychotic prescription
- Bed rails and other restraints
- Dementia
- Depression
- Hearing impairment
- Pain

37
Q

Preventative Interventions for Delirium

A

1) Cognitive Impairment, Dementia, Disorientation
Intervention
- use clear communication
- implement environmental aids (sufficient lighting, signage, clocks, calendars)

2) Sensory Deprivation
Intervention
- implement cognitively simulating activities

3) Sleep deprivation and disturbance
Interventions:
- avoid medical intervention during sleeping hours
- use non-pharmacalogical methods to promote sleep
- reduce noise/light during sleeping hours

N2270 (12 decks)

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