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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
Alzheimer’s disease is characterized by?
Prominent amnesia, aphasia, apraxia, agnosia Fine motor movement and gait is preserved (until late)
26
Gate disturbance in alzheimer’s?
After 3-4 yrs pts may develop gate and muscle tone abnormalities - eventually becoming unable to move
27
How is alzheimer’s diagnosed?
Diagnosis of exclusion | - systemic and other CNS d/o can cause cognitive decline must be ruled out
28
Alzheimer’s disease includes/causes? | Random factoid
- significant deficits in social function
29
Physical presentation of alzheimer’s?
Early - no abnormal motor Mid/late - pathological reflexes appear Late - myoclonus and seizures
30
Meds types for alzheimer’s disease?
Mainstay drugs are Cholinesterase inhibitors (ChEI’s) - AChE (anticholinesterase) - BuChE (butyrocholinesterase)
31
What effect do the alzheimer’s drugs have?
Decrease rate of cognitive decline | Slow progress of the disease
32
Name so alzheimer’s disease drugs?
AChE inhibitor - Aricept (donepezil) - Reminyl (galantamine) AChE and BuChE inhibitors - exelon (rivastigmine)
33
What is namenda (memantine)
Miscellaneous CNS agent Sometimes added to CHEIs Used in moderate-sever AD
34
Alzheimer’s dz effect on the brain?
Cerebral cortex shrinks Hippocampus shrinks Ventricles enlarge Its like weight loss for your brain
35
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
36
Stroke syndrome/vascular dementia commonly has?
Broca’s aphasia is prominent
37
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
38
Dementia with NO prominent aphasia, apraxia or agnosia?
Subcortical dementias
39
Subcortical dementias can be caused by?
Tumors
40
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 ```
41
When does dementia present in parkinson’s?
Dementia occurs late in the disease
42
Parkinson’s is a result of’?
Dopamine deficiency and shrinking of substantia nigra
43
Though commonly considered a motor d/o ___ can also present with progressive dementia?
Huntington’s disease
44
Dementia treatment of non-cognitive symptoms
Depression - SSRI (zoloft) Psychosis and agitation (hallucinations/delusions) - neuroleptics or antipsychotics
45
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
46
sleep disturbances can be caused by?
Depression Hallucinations Delusions Behavioral d/o
47
Dementia pts need to be reminded to:
Transfer financial management Not drive POA and last will
48
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
49
Dementia treatments
Slid 30 WTF
50
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
51
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
52
Delerium vs dementia
Slide 33 But i;ll make cards (fair warning its a lot)
53
Delerium vs dementia | Onset
Delirium - sudden w definite beginning point Dementia - slow and gradual w uncertain beginning point
54
Delerium vs dementia | Duration
Delirium - days to weeks or longer Dementia - permanent
55
Delerium vs dementia | Cause
Delirium - almost always another condition - infection, dehydration, withdrawal symptoms Dementia - chronic brain d/o
56
Delerium vs dementia | Course
Delirium - reversible Dementia - slow progressive
57
Delerium vs dementia | Effect at night
Delirium - always worse at night Dementia - often worse at night
58
Delerium vs dementia | Attention
Delirium - greatly impaired Dementia - unimpaired until dementia is severe
59
Delerium vs dementia | LOC
Delirium - variably impaired Dementia - unimpaired until severe
60
Delerium vs dementia | Orientation to time/place
Delirium - varies Dementia - impaired
61
Delerium vs dementia | Language
Delirium - slow, often incoherent and inappropriate Dementia - difficulty finding word
62
Delerium vs dementia | Memory
Delirium - varies Dementia - lost, esp recent events
63
Delerium vs dementia | Need for medical attention
Delirium - immediate Dementia - meh, they need it when they can get it
64
I’ve just been diagnosed as color blind
I know, it really came out of the purple!

Senior - Geriatrics (9 decks)

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