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Senior - Geriatrics > 7 - Dementia > Flashcards

7 - Dementia Flashcards

1
Q

Dementia is aka?

A

Major neurocognitive disorder - per DSM-V

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2
Q

Dementia is the primary cause of?

A

Cognitive impairment among older patients and decline in mental ability sever enough to interfere w independence and daily life

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3
Q

What is mild cognitive impairment (MCI) in aging?

A

Difficulty recalling a person’s name

- compared to pts age and education

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4
Q

MCI may be?

A

Early alzheimer’s disease

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5
Q

Dementia presents as:

Memory impairment + _______

A

Memory impairment + one of the following?

  • aphasia
  • apraxia
  • agnosia
  • disturbed executive functioning
  • sig impairment (caused by cognitive deficits)
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6
Q

What is aphasia?

A

Loss of ability to use language

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7
Q

Examples of aphasia?

A

Wernicke’s aphasia: fluent

  • unable to understand written/spoken language
  • normal words that make no sense

Broca’s aphasia: non-fluent

  • expressive aphasia
  • able to read but limited in writing
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8
Q

What is apraxia?

A

Inability to perform previously learned motor acts in the presence of adequate motor strength
- difficulty making speech

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9
Q

What is agnosia?

A

Inability to recognize specific visual stimuli in the absence of visual impairment

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10
Q

What is disturbed executive functioning?

A

Complex thinking problems

- inability to plan and sequence events

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11
Q

Dementia prevalence?

A

Approx 50% of long-term care pts have some form of dementia

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12
Q

Presentation of dementia?

A

Gradual (months and years) stable cognitive decline

  • inattention is ascent
  • interferes w ADL/IADL
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13
Q

Is dementia reversible?

A

Rarely

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14
Q

MCC of dementia (there are 2)

A

Alzheimer’s disease

Stroke

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15
Q

Labs for dementia?

A 
RPR
LFT
TSH
Electrolytes
BUN/creat
CBC
B12
Folate
C
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16
Q

Radiology for dementia?

A

CT and MRI

  • used to detect stroke or other focal lesions
  • definitely order if s/s are acute
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17
Q

EEG may show?

A

Slowing after years of illness

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18
Q

What is pseudodementia?

A

Cognitive problems related to another issue besides dementia

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19
Q

Common disorders that can convert to pseudodementia-like presentation?

A 
Depression
Schizophrenia
Mania
Dissociative d/o
Conversion reaction
Side effects from psychoactive drugs
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20
Q

pseudodementia prognosis?

A

“Dementia” will be reversible w appropriate tx

- i.e. treating the depression etc

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21
Q

Types of early dementia?

A

Cortical

  • memory/amnesia
  • language
  • problem solving
  • reasoning

Subcortical

  • motivation
  • emotionality/depression
  • clumsiness
  • irritability
  • apathy
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22
Q

Examples of cortical dementia?

A

Alzheimer’s disease (#1 cause)
Stroke syndrome/vascular dementia
Lewy body dementia

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23
Q

Examples of sub cortical dementia?

A

Huntington’s disease

Tumors

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24
Q

Late stage dementia can cause?

A

Damage to both cortical and subcortical areas in the brain

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25
Q

Alzheimer’s disease is characterized by?

A

Prominent amnesia, aphasia, apraxia, agnosia

Fine motor movement and gait is preserved (until late)

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26
Q

Gate disturbance in alzheimer’s?

A

After 3-4 yrs pts may develop gate and muscle tone abnormalities
- eventually becoming unable to move

27
Q

How is alzheimer’s diagnosed?

A

Diagnosis of exclusion

- systemic and other CNS d/o can cause cognitive decline must be ruled out

28
Q

Alzheimer’s disease includes/causes?

Random factoid

A
  • significant deficits in social function
29
Q

Physical presentation of alzheimer’s?

A

Early - no abnormal motor

Mid/late - pathological reflexes appear

Late - myoclonus and seizures

30
Q

Meds types for alzheimer’s disease?

A

Mainstay drugs are Cholinesterase inhibitors (ChEI’s)

  • AChE (anticholinesterase)
  • BuChE (butyrocholinesterase)
31
Q

What effect do the alzheimer’s drugs have?

A

Decrease rate of cognitive decline

Slow progress of the disease

32
Q

Name so alzheimer’s disease drugs?

A

AChE inhibitor

  • Aricept (donepezil)
  • Reminyl (galantamine)

AChE and BuChE inhibitors
- exelon (rivastigmine)

33
Q

What is namenda (memantine)

A

Miscellaneous CNS agent
Sometimes added to CHEIs
Used in moderate-sever AD

34
Q

Alzheimer’s dz effect on the brain?

A

Cerebral cortex shrinks

Hippocampus shrinks

Ventricles enlarge

Its like weight loss for your brain

35
Q

Presentation of stroke syndrome/vascular dementia?

A

Sudden onset of cognitive dysfunction accompanied by physical findings consistent with a

  • stroke or
  • small recurrent strokes,
  • cognitive losses

occurring in small steps with stability between steps

36
Q

Stroke syndrome/vascular dementia commonly has?

A

Broca’s aphasia is prominent

37
Q

Presentation of lewy body dementia?

A

Changes in thinking and reasoning

Confusion and alertness that varies significantly from one time of day to another or from one day to the next

Parkinson’s symptoms

Visual hallucinations

Delusions

38
Q

Dementia with NO prominent aphasia, apraxia or agnosia?

A

Subcortical dementias

39
Q

Subcortical dementias can be caused by?

A

Tumors

40
Q

Presentation of subcortical dementia?

A 
Amnesia, 
slowness of thought
Apathy
Lack of initiative in all aspects of cognitive function
NO prominent aphasia, apraxia or agnosia
Early gait d/o
Depressed mood
41
Q

When does dementia present in parkinson’s?

A

Dementia occurs late in the disease

42
Q

Parkinson’s is a result of’?

A

Dopamine deficiency and shrinking of substantia nigra

43
Q

Though commonly considered a motor d/o ___ can also present with progressive dementia?

A

Huntington’s disease

44
Q

Dementia treatment of non-cognitive symptoms

A

Depression - SSRI (zoloft)

Psychosis and agitation (hallucinations/delusions) - neuroleptics or antipsychotics

45
Q

Non-cognitive dementia symptoms may respond to ___ (a non pharm tx)

A

Reassurance, distraction and structured schedule alone may be effective to control psychosis and agitation

46
Q

sleep disturbances can be caused by?

A

Depression
Hallucinations
Delusions
Behavioral d/o

47
Q

Dementia pts need to be reminded to:

A

Transfer financial management
Not drive
POA and last will

48
Q

Care facilities/families need to make sure they:

A

Structure daily schedule for pts (w activities etc)

Send pts to bathroom q 2-4 hrs

Arrange social support appropriate for pts

49
Q

Dementia treatments

A

Slid 30

WTF

50
Q

Dementia diagnosis is a

A

Sentinel event for planning end-of-life care

  • It takes yrs though and can be hard to determine when to send to hospice
51
Q

Warning signs that its time to send pts to hospice?

A

Illness features suggest very limited life expectancy such as:

  • inability to ambulate
  • inability to eat
  • inability to ambulate
  • inability to communicate w/o assistance
  • decubitus ulcer
  • recurrent pneumonia
52
Q

Delerium vs dementia

A

Slide 33

But i;ll make cards (fair warning its a lot)

53
Q

Delerium vs dementia

Onset

A

Delirium - sudden w definite beginning point

Dementia - slow and gradual w uncertain beginning point

54
Q

Delerium vs dementia

Duration

A

Delirium - days to weeks or longer

Dementia - permanent

55
Q

Delerium vs dementia

Cause

A

Delirium - almost always another condition
- infection, dehydration, withdrawal symptoms

Dementia - chronic brain d/o

56
Q

Delerium vs dementia

Course

A

Delirium - reversible

Dementia - slow progressive

57
Q

Delerium vs dementia

Effect at night

A

Delirium - always worse at night

Dementia - often worse at night

58
Q

Delerium vs dementia

Attention

A

Delirium - greatly impaired

Dementia - unimpaired until dementia is severe

59
Q

Delerium vs dementia

LOC

A

Delirium - variably impaired

Dementia - unimpaired until severe

60
Q

Delerium vs dementia

Orientation to time/place

A

Delirium - varies

Dementia - impaired

61
Q

Delerium vs dementia

Language

A

Delirium - slow, often incoherent and inappropriate

Dementia - difficulty finding word

62
Q

Delerium vs dementia

Memory

A

Delirium - varies

Dementia - lost, esp recent events

63
Q

Delerium vs dementia

Need for medical attention

A

Delirium - immediate

Dementia - meh, they need it when they can get it

64
Q

I’ve just been diagnosed as color blind

A

I know, it really came out of the purple!

Senior - Geriatrics (9 decks)

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