7 - Dementia Flashcards
Dementia is aka?
Major neurocognitive disorder - per DSM-V
Dementia is the primary cause of?
Cognitive impairment among older patients and decline in mental ability sever enough to interfere w independence and daily life
What is mild cognitive impairment (MCI) in aging?
Difficulty recalling a person’s name
- compared to pts age and education
MCI may be?
Early alzheimer’s disease
Dementia presents as:
Memory impairment + _______
Memory impairment + one of the following?
- aphasia
- apraxia
- agnosia
- disturbed executive functioning
- sig impairment (caused by cognitive deficits)
What is aphasia?
Loss of ability to use language
Examples of aphasia?
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
What is apraxia?
Inability to perform previously learned motor acts in the presence of adequate motor strength
- difficulty making speech
What is agnosia?
Inability to recognize specific visual stimuli in the absence of visual impairment
What is disturbed executive functioning?
Complex thinking problems
- inability to plan and sequence events
Dementia prevalence?
Approx 50% of long-term care pts have some form of dementia
Presentation of dementia?
Gradual (months and years) stable cognitive decline
- inattention is ascent
- interferes w ADL/IADL
Is dementia reversible?
Rarely
MCC of dementia (there are 2)
Alzheimer’s disease
Stroke
Labs for dementia?
RPR LFT TSH Electrolytes BUN/creat CBC B12 Folate C
Radiology for dementia?
CT and MRI
- used to detect stroke or other focal lesions
- definitely order if s/s are acute
EEG may show?
Slowing after years of illness
What is pseudodementia?
Cognitive problems related to another issue besides dementia
Common disorders that can convert to pseudodementia-like presentation?
Depression Schizophrenia Mania Dissociative d/o Conversion reaction Side effects from psychoactive drugs
pseudodementia prognosis?
“Dementia” will be reversible w appropriate tx
- i.e. treating the depression etc
Types of early dementia?
Cortical
- memory/amnesia
- language
- problem solving
- reasoning
Subcortical
- motivation
- emotionality/depression
- clumsiness
- irritability
- apathy
Examples of cortical dementia?
Alzheimer’s disease (#1 cause)
Stroke syndrome/vascular dementia
Lewy body dementia
Examples of sub cortical dementia?
Huntington’s disease
Tumors
Late stage dementia can cause?
Damage to both cortical and subcortical areas in the brain
Alzheimer’s disease is characterized by?
Prominent amnesia, aphasia, apraxia, agnosia
Fine motor movement and gait is preserved (until late)
Gate disturbance in alzheimer’s?
After 3-4 yrs pts may develop gate and muscle tone abnormalities
- eventually becoming unable to move
How is alzheimer’s diagnosed?
Diagnosis of exclusion
- systemic and other CNS d/o can cause cognitive decline must be ruled out
Alzheimer’s disease includes/causes?
Random factoid
- significant deficits in social function
Physical presentation of alzheimer’s?
Early - no abnormal motor
Mid/late - pathological reflexes appear
Late - myoclonus and seizures
Meds types for alzheimer’s disease?
Mainstay drugs are Cholinesterase inhibitors (ChEI’s)
- AChE (anticholinesterase)
- BuChE (butyrocholinesterase)
What effect do the alzheimer’s drugs have?
Decrease rate of cognitive decline
Slow progress of the disease
Name so alzheimer’s disease drugs?
AChE inhibitor
- Aricept (donepezil)
- Reminyl (galantamine)
AChE and BuChE inhibitors
- exelon (rivastigmine)
What is namenda (memantine)
Miscellaneous CNS agent
Sometimes added to CHEIs
Used in moderate-sever AD
Alzheimer’s dz effect on the brain?
Cerebral cortex shrinks
Hippocampus shrinks
Ventricles enlarge
Its like weight loss for your brain
Presentation of stroke syndrome/vascular dementia?
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
Stroke syndrome/vascular dementia commonly has?
Broca’s aphasia is prominent
Presentation of lewy body dementia?
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
Dementia with NO prominent aphasia, apraxia or agnosia?
Subcortical dementias
Subcortical dementias can be caused by?
Tumors
Presentation of subcortical dementia?
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
When does dementia present in parkinson’s?
Dementia occurs late in the disease
Parkinson’s is a result of’?
Dopamine deficiency and shrinking of substantia nigra
Though commonly considered a motor d/o ___ can also present with progressive dementia?
Huntington’s disease
Dementia treatment of non-cognitive symptoms
Depression - SSRI (zoloft)
Psychosis and agitation (hallucinations/delusions) - neuroleptics or antipsychotics
Non-cognitive dementia symptoms may respond to ___ (a non pharm tx)
Reassurance, distraction and structured schedule alone may be effective to control psychosis and agitation
sleep disturbances can be caused by?
Depression
Hallucinations
Delusions
Behavioral d/o
Dementia pts need to be reminded to:
Transfer financial management
Not drive
POA and last will
Care facilities/families need to make sure they:
Structure daily schedule for pts (w activities etc)
Send pts to bathroom q 2-4 hrs
Arrange social support appropriate for pts
Dementia treatments
Slid 30
WTF
Dementia diagnosis is a
Sentinel event for planning end-of-life care
- It takes yrs though and can be hard to determine when to send to hospice
Warning signs that its time to send pts to hospice?
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
Delerium vs dementia
Slide 33
But i;ll make cards (fair warning its a lot)
Delerium vs dementia
Onset
Delirium - sudden w definite beginning point
Dementia - slow and gradual w uncertain beginning point
Delerium vs dementia
Duration
Delirium - days to weeks or longer
Dementia - permanent
Delerium vs dementia
Cause
Delirium - almost always another condition
- infection, dehydration, withdrawal symptoms
Dementia - chronic brain d/o
Delerium vs dementia
Course
Delirium - reversible
Dementia - slow progressive
Delerium vs dementia
Effect at night
Delirium - always worse at night
Dementia - often worse at night
Delerium vs dementia
Attention
Delirium - greatly impaired
Dementia - unimpaired until dementia is severe
Delerium vs dementia
LOC
Delirium - variably impaired
Dementia - unimpaired until severe
Delerium vs dementia
Orientation to time/place
Delirium - varies
Dementia - impaired
Delerium vs dementia
Language
Delirium - slow, often incoherent and inappropriate
Dementia - difficulty finding word
Delerium vs dementia
Memory
Delirium - varies
Dementia - lost, esp recent events
Delerium vs dementia
Need for medical attention
Delirium - immediate
Dementia - meh, they need it when they can get it
I’ve just been diagnosed as color blind
I know, it really came out of the purple!
