B2.020 Big Case Mr. D Flashcards
what are the 3 d’s in differential diagnosis for ‘confusion’
delirium, dementia, depression
what are the domains of normal aging?
attention, executive function, memory, language, visuospatial, psychomotor
what is executive function?
tasks/judgements with complex sequences
i.e. finances, cooking a famous roast
what does BADLs stand for?
basic activities of daily living
what are the BADLs?
dressing, eating, ambulating, transferring, toileting, hygeine
what does IADL stand for?
instrumental activities of daily living
what are the IADLs?
shopping, housekeeping, accounting, food preparation/medications, transportation, telephone
define delirium
acute disorder of attention and global cognitive function
what percentage of delirium is estimated to go unrecognized?
70%
where is delirium most commonly seen?
ICUs, inpatient units, nursing facilities
what is the 1 year mortality after hospitalization that includes delirium?
35-40%
what are the 4 features of the CAM criteria?
1: acute onset and fluctuating course
2: inattention
3: disorganized thinking
4: altered conciousness
what are the 3 types of delirium?
hypoactive, hyperactive, mixed
what is the primary etiology of delirium?
dysfunction of multiple brain regions and neurotransmitter systems
what makes older adults more vulnerable to delirium?
age related changes in central neurotransmission, stress management, hormonal regulation, immune response
what are some predisposing factors for delirium?
severe dementia, severe illness, major depression, sensory impairment, advanced age, history of delirium, depression, functional impairment
what are precipitating factors for delirium?
major surgery, ICU stay, physical restraints, multiple psychoactive meds, metabolic derangement or infection, prolonged sleep deprivation, sleep meds
what are some nonpharmacologic strategies for delirium treatment?
reorientation, family involvement, eyeglasses/hearing aides, sleep protocol, avoid physical restraints and immobilizations, ensure hydration
is delirium reversible?
yes; can take several weeks
define dementia
a progressive disease with cognitive or behavioral symptoms that interfere with function/ represent a decline in function and/or cannot be explained by delirium or another psychiatric disorder
what are the domains of dementia?
memory, attention and executive function, language, visuospatial function, motor function, behavioral changes
what are the primary types of dementia?
Alzheimers vascular dementia lewy body dementia frontotemporal dementia alcohol related dementia normal pressure hydrocephalous pseudodementia
what is MCI?
mild cognitive impairment, can precede dementia
what characterizes Alzheimer?
insidious onset, amnesia + language presentation/visuospatial presentation/executive dysfunction
what characterizes depression?
high prevalence and underdiagnosed, risk factors: loss of social support, death of family/friends, changing social roles, physical limitations
how does depression impact dementia?
an independent risk factor
what is the gold standard in depression treatment?
medication and cognitive behavioral therapy
