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618 Quiz 2 > Alzheimers Disease & Dementia > Flashcards

Alzheimers Disease & Dementia Flashcards

1
Q

Prevalence

A

“Graying” population
-by 2030, there may be 70 million elderly in the US

Current prevalence rates of dementia

  • 6-8% if older than 65
  • 30% if older than 80
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2
Q

Dementia

A

an acquired syndrome consisting of a decline in memory and other cognitive functions

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3
Q

Diagnosis of Dementia

A

Memory impairment & one of the following

  • Aphasia, APraxia (noted in transfers, tool use) or impaired executive functioning ($ management, driving)
  • Deficits cause significant impairment in social or occupational functioning
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4
Q

Aphasia

A

Characterized initally by a fluent aphasia

  • able to initiate & maintain a conversation
  • impaired comprehension
  • intact grammar and syntax - but speech is vague, tangential
  • Later language can be severely impaired w/ mutism, echolalia
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5
Q

Aphasia During Tx

A

Be aware of their ability to follow directions
(provide repatition & teach back by the pt.)
If they use nonspecific phrases (“The thing”) fill in the word

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6
Q

Apraxia

A

Inability to carry out motor activities despite intact motor function
Contributes to loss of ADLS

May be a progressive decline

  • keep envt. unclutered
  • keep routine consistent
  • keep room set up the same
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7
Q

Agnosia

A

The inability to recognize or identify objects despite intact sensory function
Typically occurs later in the course of illness
Can be visual or tactile

Envt. simplification
Hand over hand A
Picture of objects

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8
Q

Impaired Executive Function

A

Difficulty w/ planning, initiating, sequencing, monitoring or stopping complex behaviors

  • occurs early to midcourse
  • contributes to loss of IADL’s

Ressist A d/t parinoa & lack of awareness of decline

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9
Q

Dementia Subtypes : Early onset

A

Before 60

  • less then 5% of all cases
  • strong genetic link
  • tends to progress more rapidly
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10
Q

Dementia Subtypes: Late onset

A

After 60

Represents a majority of cases

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11
Q

Features Associated w/ Dementia

A

Agitation, Aggression, Sleep disturbances
Apathy, Depression or Anxiety, Personality changes
Behavioral disinhibition, impaired insight, hallucinations
Delusions

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12
Q

Medical Assessment of Dementia

A 
History 
Physical & Neurological Exam 
Cognitive screening test 
Rule out reversible causes 
Neuroimaging 
Consider the etiology 
Tx or referral
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13
Q

Potentially Reversible Dementia

A 
Drug toxicity 
Metabolic disturbance 
Hydrocephalus 
Mass lesion
Infectious Process 
Endrocine Disorder 
Nutritional Disease 
Other (COPD, CHF, Liver, Apnea

Fewer then 13% are reversible
Tx may not return pt. to baseline

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14
Q

Assessments for Reversible Dementia

A

Labwork

Neuroimaging

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15
Q

Alzheimer’s Disease (AD) : Overview

A

Insidious onset and gradual progression
Presentation usually related to primary deficits in recent memory
Incidence age-related 8% per year by 85
1/2-2/3 the cause of dementia is AD
Ultimate Dx based on pathology of plaques & tangles

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16
Q

Genetics of AD

A

In minority of cases there is an autosomal dominant inheritance linked to chromosome 1, 14, or 21.

This is associated w/ Early Onset

The presence of AD in a 1st degree relative is associated w/ a fourfold increased risk of AD

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17
Q

Course of AD

A

Insidious onset & progressive course w/ typical loss of 3 point on MMSE each year and death occuring 8-12 years after diagnosis

18
Q

Course of AD : Mild

A

MMSE 20-24
Usually the first 2-3 years after diagnosis
Primarily memory and visual-spatial deficits
Mild difficulty w/ executive functioning

19
Q

Course of AD : Moderate

A

MMSE 11-20
3-6 years following diagnosis
Apashia and apraxia become more pronounces
Loss of IADL and increased A w/ ADL’s
Beginning to exhibit some neuropsych Sx particularly paranoia

20
Q

Course of AD : Severe

A

Usually 6-10 years following diagnosis
Severe language disturbances
Pronounced neuropsych manifestations including agitation, aggression
Very late in the course can see muscle ridgity, gait disturbances, incontinence, dysphagia

More bed bound pt.s, seen for positioning, transfers

21
Q

Vascular Dementia : Dementia Syndromes

A

Second most common form of dementia after AD
One or more strokes, two or more cognitive functions affected
Abrupt onset of stepwise course - different from AD

Aka “binswanger’s disease”, “lacunar state” or “multi-infact dementia

-Difficulty w/ name recall dates, increased difficulty w/ speech, decreased endurance

22
Q

Vascular Dementia : Prevelance

A

Increase risk population
should be reserved for pt.’s w/ evidence of stroke or imaging or physical examination
10-40% of all dementia cases
10-15% of AD cases are “mixed”

23
Q

Vascular Dementia : Tx

A

Tx focused on risj factors

  • smoking
  • atrial fibrillation
  • diabetes
  • HTN
24
Q

Dementia w/ Lewy Bodies

A 
Lewy body = abnormal protein
High incidence 7-26% 
Memory impairment may come after 
visual hallucinations, delirium, parkinsonism 
Sensitive to neuroleptics 
Decline faster than AD
25
Q

Lewy Body vs Parkinson’s

A

In DLB, lewy bodies are cortical
in (idiopathic) parkinsons disease
Lewy bodies in substantia nigra
In PD motor sx precede dementia for years
In LBD the motor sx more closely linked to the memory problems

26
Q

Frontotemporal

A

Pick’s disease is type of frontotemporal dementia

  • Personality changes, disinhibition, executive dysfunction
  • memory impairment
27
Q

Frontotemporal Dementia : Picks Disease

A

Presenile in onset 50-60
More progressive and rapidly deteriorating than AD
Final diagnosis also autopsy-based

28
Q

Behavioral Tx : Overview

A

Should be tried 1st before medication
Generally consists of reassurance, distraction, redirection, structure
-dont argue makes things worse
-provide a safe place where dysfunctional behavior can occur w/o causing harm

29
Q

Behavioral Treatment : Ed/ Sites

A 
Refer to adult day care 
Respite/adult family homes 
Caregiver support groups 
psycho-ed 
despression in caregiver 
SNF before crisis
30
Q

Pharmacologic Tx For

A

Agitation, depression, delusions, aggression, improvements are modest

31
Q

BADLS

A

Look at safety, balance, transfers
Dressing adaptive equipment when needed (pull over vs snaps)
Toileting
Continence: loose urine @ night, frequently run to the bathroom (structure toileting schedule)

32
Q

IADL’s

A

Telephone, travel, shopping, meals
housework (clutered)
Medicine, money

33
Q

Screening Assessment : MMSE

A 
Mini-mental state examination 
-orientation (10 pts) 
-Registration (3 pts) 
-Attention & Calculation (5 pts) 
-Recall (3pts) 
-Language (8pts) 
-Visuospatial (1 pt.) 
Total = 30, if less than 25, consider dementia
34
Q

MMSE Pros

A

Widely used and therfore can track cognition overtime

5-10 min

35
Q

MMSE Cons

A

False positives : little education
False negatives: high premorbid intellectual functioning
Psychologically stressful - makes people angry & defensive

36
Q

Screening assessment : Clock Drawing Test (CDT)

A 
Draw a large circle on the blank page 
Put number on the circle 
Place hands to show 10 past 11 
-test planning, visuospatial abilities, but not memory 
-less stressful & less culture bound
37
Q

Screening Assessment : Mini Cog

A

Clock-drawing & three item memory test
-more sensative than CDT
Same advantages as CDT
-not as commonly used as MMSE but fast
-involved visospatial, executive planning, and memory functions.
“positive” 2 word recall/and or abnormal clock

38
Q

Screening Assessment : Time & Change Test

A

Telling time task:
Pt. asked to tell what time when presented w/ a clock face set at 11:10, two trials allowed w/n 60 seconds

Making change task:
Present pt. w/ 3 quarters, 7 dimes, 7 nickles, and ask them to give 1$ worth of change: 2 tries w/in 120 seconds

39
Q

OT Assessment

A

ADL , motor, sensory (safety) cognitive & environmental
Determine AE or DME needs considering the learning abilities of the pt.

Short orientation memory concentration (SOMC)
Physical self-maintenance scale (score 6 areas of ADL”s and has an 8 item IADL scale
Geriatric depression scale

40
Q

OT Intervention

A 
Memory clinic 
Reminisance therapy 
Snoezelen 
Environmental strategies 
Caregiver teaching 
Animal assisted tx 
Music therapy 
Creative art therapy 
Movement therapy (yoga) 
Cognitive stim (talk about family play games) 
Distraction & diversion

618 Quiz 2 (5 decks)

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