Alzheimer-Dementia

Question 1

What is Dementia?

Answer 1

Characterized by loss of function in multiple cognitive domains
Has 1 or more of the following clinical manifestations
-General decrease in cognition
-Behavioral Disturbance
-Interference with daily function/independence

Question 2

What is the prevalence of Dementia?

Answer 2

5% under 65

35-50% over 85%

Question 3

What else comes with dementia?

Answer 3

Aphasia-A language disorder that affects a person’s ability to communicate
Apraxia- difficulty with motor planning
Agnosia- inability to process sensory information
Disturbance of executive functions

Question 4

What are some things pt with dementia will have?

Answer 4

Difficulty learning & retaining new info (remembering events)
Handling complex tasks (balancing a checkbook)
Reasoning (unable to cope with unexpected events)
Spatial ability and orientation (Getting lost in familiar places)
Language
Behavior

Question 5

What are some different versions of dementia?

Answer 5

Alzheimers-60-80%
Vascular (multi-infarct)-10-20%
Parkinsons disease and related demtias - 5%
Frontal Lobe dementia
Reversible dementia's

Question 6

What is delirium?

Answer 6

Disturbance of consciousness
-reduced clarity of awareness of environment
-w/ reduce ability to focus, sustain or shift attention
Change in cognition
-memor deficit, disorientation, language disturbance

Question 7

How does delirium work?

Answer 7

The disturbance develops over short period of time and fluctuates during the course of the day.
Differentiated by etiology (due to general medical condition, substance induced, multiple etiology, not otherwise specified)

Question 8

What is the prevalence of Delirium?

Answer 8

10-30% in hospitalized medically ill
10-40% of hospitalized elderly
Up to 51% of post-operative patients

Question 9

How can you differentiate between delirium and dementia?

Answer 9

Delirium fluctuates with time of day, differentiated by variations in alertness/orientation.
Dementia residents usually are alert, and mental status does not change during the day

Question 10

How many pt with delirium fully recover?

Answer 10

40%

Question 11

What’s the most common form of dementia?

Answer 11

Alzheimers-60-70%

Question 12

What is Alzheimers?

Answer 12

Acquired syndrome of decline in memory and at least one other cognitive domain sufficient to interfere with social or occupational functioning in an alert person

Question 13

What are some risk factors for Alzheimers?

Answer 13

Age
History of depression
Femaile
Low education level
Family history
Diabetes
Hypercholesterolemia
Blood Pressure
Genetics

Question 14

How can Alzheimers disease be diagnosed

Answer 14

only at an autopsy

Question 15

What are some signs and symptoms of Alzheimers?

Answer 15

memory loss
personality change
global cognitive dysfunction, 
functional impairments
Loss of short term memory

Question 16

What is the 1st Stage of Alzheimers?

Answer 16

Stage 1-Mild
-Defective memory difficulty learning new info, language and visuospacial skills decline
-Personality changes occur, but motor abilities remain intact
First 1-3 years

Question 17

What is the 2nd stage of Alzheimers?

Answer 17

Moderate

• recent and remote memory severely impaired, recall of previously learned info difficult
• language, visuospatial skills and personality changes worsen
• Psychiatric features and acalculia are noted
• Neuroimaging and EEG changes begin
• Lasts 2-10 years

Question 18

What is the 3rd stage of Alzheimers?

Answer 18

Severe

• Intellectual function markedly worsens
• Echolalia, palilalia, aphasia, loss of motor function, falls, loss of sphincter control, personality changes
• Bedridden
• Neuroimaging studies demonstrate atrophy
• EEG shows diffuse slowing
• Lasts 1-3 years

Question 19

What is Vascular dementia?

Answer 19

Clinical presentation varies with location of infarcts.

• Lacunar Dementia-no stroke history; progressive dementia, focal deficits, frontal lobe-like syndrome
• Binswanger’s disease-Apathy, agitation, bilateral corticospinal or bulbar signs

Question 20

What is Post-stroke Dementia?

Answer 20

New dementia at 3 months after acute stroke

6-32% prevalence

Question 21

What’s mixed dementia?

Answer 21

Features vascular (lacunar) and Alzheimer

Question 22

What are some examples of reversible dementias?

Answer 22

Medication-induced
Alcohol-related (Withdrawal, intoxication)
Metabolic disorders
Depression

Question 23

What is the 1-minute mental status exam?

Answer 23

Category fluency-name as many animals as they can
Phonemic fluency test-Name as many words as possible in a minute
Test of recall-3 unrelated objects and see if the pt can remember

Question 24

What is sundowning?

Answer 24

Occurs late in day, and extends into the night
Etiology unknown
May be aggravated by
-fatigue
-low lighting
-increased shadows
-disruption of internal clock
Sleep disturbance

Question 25

What are some treatment tips with these disorders?

Answer 25

Speak slowly
limit distractions
don't argue
comfort and assurance
Encourage nonverbal communication (point/gesture)

Question 26

What are the 7 modifiable factors that help prevent these disorders?

Answer 26

Diabetes
High BP
Obesity
Smoking
Depression
Cognitive inactivity
Physical inactivity

Question 27

What are some other interventions with these disorders?

Answer 27

low lighting levels, music, simulated nature sounds
Walking and other forms of light exercise
Simulated presence therapy (videotaped family)
Massage, pet therapy, bright light, cognitive remediation

Question 28

Why do driving skills deteriorate?

Answer 28

Decreased sensory response
Reaction times
Visual Acuity changes
ROM decreased

Question 29

What are some signs of unsafe driving?

Answer 29

Difficulty locating familiar places
Failure to observe traffic signals
Slow or poor decision making
Driving inappropriate speeds
Become angry or confused when driving

Question 30

What kind of scores on the Clinical Dementia Rating (CDR) implicate unsafe driving conditions?

Answer 30

As low as .5, and should not be driving with a score of 1 or higher.
Need to reassess every 6 months of .5