Basics of Delirium, Dementia, and Depression Flashcards
Basic Activities of Daily Living (BADLs)
DEAT2H: Dressing, Eating, Ambulating, Transferring, Toileting, Hygeine
The things that keep you out of the nursing home
Instrumental Activities of Daily Living (IADLs)
SHAFTT: Shopping, Housekeeping, Accounting, Food prep/meds, Transportation, Telephone
Delirium or “Acute Brain Failure”
Acute (doesn’t come on slowly) disorder of attention & cognitive function
Usually secondary to other illness (infection, CNS disease, withdrawal, etc.)
Significant morbidity and mortality
Potentially preventable
Initiates downward spiral
Inc need for institutionalization/rehab
Unrecognized up to 70% of the time
Most common in ICU, inpatient units etc
1 year mortality after hospitalization with delirium 35-40%
May be caused by medications
DeliRIUM = changes in sensoRIUM
Reversible
Can be differentiated by diffuse slowing of EEG (although this is also sometimes shown with dementia)
Can last days, weeks, or long term. Poor prognosis in first year
CAM Criteria
Used for diagnosis of delirium 1: Acute onset and fluctuating course 2: Inattention 3: Disorganized thinking OR 4: Altered consciousness
Symptoms of Delirium
Disorganized thinking Hallucinations Illusions Misperceptions Disturbance in sleep/wake cycle Cognitive dysfunction
Etiology of Delirium
Possible cholinergic deficiency
Dysfunction of multiple brain regions and neurotransmitter systems
Older adults more vulnerable because of age related changes in central neurotransmission, stress mgmt, hormonal regulation, immune response
Predisposing factors for Delirium (Vulnerability)
Severe dementia, Severe illness, Major depression, Sensory impairment, Older age, History of delirium, Functional impairment
Precipitating factors for Delirium (Insults)
Major surgery/anesthesia, ICU stay, physical restraints, multiple psychoactive meds, metabolic derangement or infection, sleep deprivation, sleep meds
Treatment of Delirium
- Nonpharmacologic: reorientation, family involvement, eyeglasses/hearing aids, sleep protocol, encourage mobility/self care, ensure hydration, quiet room at night
- Pharmacologic: use ONLY when severely agitated patient at risk of 1. interruption of essential medical care, or 2. posing as safety hazard for themselves/staff
Meds: Haloperidol .25-1mg
AVOID benzodiazepines (except with alcohol withdrawal) and psychoactives
Dementia
Progressive
Cognitive/behavioral symptoms must: interfere with function (vs normal aging does not)
Cannot be explained by delirium or another psych disorder
Can lead to delirium (esp. when leads to illness first) Irreversible (if truly dementia)
DeMEMentia = MEMory loss
EEG usually normal
Terminal
Etiology of Dementia
Irreversible causes: AD, Lewy body dementia, Huntington disease, Pick disease, cerebral infarct, Wilson disease, Creutzfeldt-Jakob disease, chronic substance abuse (neurotoxicity of drugs), HIV
Reversible causes: Hypothyroidism, depression, vitamin deficiency (b1, b3, b12), normal pressure hydrocephalus, neurosyphilis
Symptoms of Dementia
Memory deficits (can’t learn new info well)
Problem-solving & judgement
Loss of abstract thought
Loss of semantic processing (listing animals)
Apraxia (motor speech disorder)
Aphasia (comprehend/formulate language, finding “right” words for thoughts)
Agnosia (inability to process sensory info)
Visuospatial (driving)
Behavioral (poor awareness, emotional lability)
Alzheimer Disease
Most common cause of dementia in elderly
Affects 5-10% of population over age 65
Amnesia (ST then LT memory loss) + language presentation, visuospatial presentation, or executive dysfunction
Changes in behavior and personality
Patients become bedridden and mute (infection is a common cause of death)
Focal neurologic deficits (affect a certain area of body) not seen in early disease
Decrease in ACh
Early onset AD
Seen in familial cases (associated with presenilin 1 and presenilin 2 mutations), APP
Down syndrome (commonly occurs by 40 years of age); APP is located on chromosome 21
Presenilin-1
One of four proteins considered to play an important role in generation of AB (beta amyloid) and Amyloid Precursor Proteins (APP)