2.9 Neurological and Sensory Motor DEMENTIA/ALZHEIMER'S Flashcards
What is dementia?
Cognitive decline caused by any disorder that permanently damages areas of the brain necessary for memory & learning
Progressive impairment of cognitive function, personality & behavior
Umbrella term for disorders that result in neuron death &/or loss of communication between cells
Increasing numbers as our population ages (8.8% of all over 65yo)
Risk factors: age, family history, smoking/ETOH use, ethnicity, diseases: high cholesterol, atherosclerosis, DM, Down’s syndrome, TBI (traumatic brain injury)
Various types of dementia
Alzheimer’s disease Vascular dementia Lewy body dementia Fronto-temporal dementia Mixed dementia
Alzheimer’s Disease
Pathophysiology
Pathophysiology
Cause unknown –interaction of multiple factors
Brain changes: loss of nerve cells & vascular supply causing brain atrophy neuritic plaques- group of degenerated cells that clump around amyloid core begin in areas for cognition & memory, disrupt transmission of nerve impulses tangles–twisted fibers of tau protein that build up in cytoplasm of affected neurons
Progressive –more areas of brain over time = loss of neurons/neurotransmitters
with enlargement of ventricles (hydrocephalus) & structural changes
https://www.youtube.com/watch?v=zTd0-A5yDZI&t=199s
Alzheimer’s Disease
Manifestations
Dementia often categorized as mild- moderate- severe
Alzheimer’s Association 7-stage classification system (based on S/S)
Alzheimer’s Disease
Manifestations
Stages 1-3
KNOW THIS ONE!!
Stages 1-3 Mild: trouble finding words, ↓memory & planning, lose objects, social & work problems, stage 3 may become noticeable to others & measurable in exams
Alzheimer’s Disease
Manifestations
Stages 4 & 5
Stages 4&5 Moderate: short term memory loss, loss of mental functions, can’t perform complex tasks, become withdrawn, may need ADL assist, poor recall, disorientation to place, time, context
Alzheimer’s Disease
Manifestations
Stages 6 & 7
Stages 6 & 7 Severe: worsening memory, personality change, lose context, need supervision, sleep-wake cycle disruptions, wandering, personality changes (delusions, suspicious, compulsive behaviors). In final stage lose ability to respond to environment, speech, & purposeful movement. ↓ reflexes, muscle rigidity, swallowing impairments, vision loss, malnutrition & aspiration are frequent complications.
Alzheimer’s Disease
Diagnosis
No single, specific test have to R/O things that mimic AD
Medical & medication history
Unintentional weight loss?
History of behavior patterns over time – include info from family
Lab work
Physical exam
- Neuro exams, mood evaluation
- Cognitive testing:
- -Montreal Cognitive Assessment (demo: https://www.youtube.com/watch?v=JcmUWpmtH74 )
- -Mini Mental State Exam (https://www.youtube.com/watch?v=jejkdRotqrc )
Brain scans: CT, MRIs (often see hippocampus deterioration
Common causes of dementia-like symptoms
Common causes of dementia-like symptoms are depression, untreated sleep apnea, delirium, side effects of medications, thyroid problems, certain vitamin deficiencies and excessive alcohol consumption. Unlike Alzheimer’s and other dementias, these conditions often may be reversed with treatment.
The Montreal Cognitive Assessment
The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation
Alzheimer’s Disease
Treatment - meds
Meds for memory- slow progression
- Acetylcholinesterase inhibitors – donepezil prevents breakdown of Acetylcholinesterase = enhanced neuron activity
- NMDA receptor antagonist –memantine reduces glutamate & blocks excessive Ca entry into cells= prevent cell death
Meds for behavior – antidepressants, anxiolytics, antipsychotics
Meds for sleep changes
Alzheimer’s Disease
Treatment: non-med strategies
Reminiscence
Validation therapy
Cueing
Reality orientation
Manage aggression
Space
Low stimuli environment
Distraction
Alternative activities
Touch – caution!
Alzheimer’s Disease
Nursing Care
Risk for Injury/Safety - more than just fall prevention Nutrition Self care deficit Confusion/disturbed thought patterns Anxiety Grief/hopelessness/ social isolation Caregiver role strain/Coping Care planning & Relocation stress Disturbed sleep pattern Disturbed sensory perception Impaired communication Impaired mobility
Differentiating confusion, delirium, dementia
DEMENTIA
DEMENTIA
group of cognitive disorders
Could have problems with memory, judgement, using and understanding language and motor function
Result in death of neurons
Gradual onset, slow decline
No cure
Differentiating confusion, delirium, dementia
DELIRIUM
DELIRIUM
Caused by underlying medical problem (infection, dehydration, drug toxicity, sensory overload etc)
Occurs abruptly
Symptoms fluctuate throughout day
More profound states of confusion, delusions and agitation
Once medical problem is identified and treated, symptoms subside and person returns to previous level of functioning
