cog issues in older adult Flashcards
1
Q
Types of Memory
A
- Sensory
- Short Term
- Long Term
2
Q
types of sensory memory
A
- iconic (visual)
- echoic (auditory)
- haptic (touch)
3
Q
Types of short term memory
A
working
4
Q
Types of long term memory
A
- implicit (procedural)
- explicit
- declarative semantic
- declarative episodic
5
Q
differences between delerium and dementia
A
- delerium short term, demtentia long term
2.
6
Q
delirium or dementia:
long term
A
dementia
7
Q
delirium or dementia:
caused by medication, anesthesia, or encephalopathy
A
delirium
8
Q
delirium or dementia:
caused by degeneration in the brain
A
dementia
9
Q
delirium or dementia:
one of the 1st symptoms of UTI in elderly
A
delirium
10
Q
What % of gen med is affected by delerium?
A
wide range
2-50%
11
Q
What are the types of delirium?
A
- hyperactive
- hypoactive
- mixed
12
Q
In regards to hospitalization, delrium is associated with:
A
- increased length of stay
- prolonged recovery times
- institutionalized care
- increased morbidity and mortality rates
13
Q
Delirium pathophysiology
A
- Brain structural changes
- neurotransmitter disturbance in cholinergic/adrenergic pathways
- elevated inflammatory cytokines
- multifactorial in older adults
14
Q
at least _% of delerium cases are preventable
A
30-40%
15
Q
Prevention and management of delerium
A
- determine cause and remediate ASAP
- ID drugs linked to delirium
- nonpharmacologic interventions
16
Q
drugs linked to delirium
A
- psychoactive agents
- narcotics
- anticholinergics
17
Q
delirium: nonpharmacologic interventions
A
- cog orientation
- early mobility
- enabling adequate hearing and vision
- promote normal sleep-wake cycle
- proper nutrition/hydration
18
Q
dementia: a global impairment impacting intellectual functioning, memory, and at least one of the following:
A
- abstract thinking
- judgement and language
- ID of people/objects
- personality changes
- ability to use object appropriately
19
Q
types of dementia
A
- AD
- vascular dementia
- dementia w/lewy bodies
- frontotemporal dementia
- mixed pathologies
20
Q
Levels of cog impairment
A
- subjective cog impairment
- mixed
- moderate
- severe
- Amnestic vs Nonamnestic
21
Q
Vascular dementia accounts for _ % of dementia cases
A
accounts for 20-30%
22
Q
vascular dementia key features
A
- cerebrovascular disease
- usually abrupt
- less severe memory loss than AD
- can occur w/AD (mixed)
23
Q
vascular dementia:
affected brain areas
A
- medial temporal atrophy
- cortical and subcortical lesions
24
Q
vascular dementia:
clinical symptoms
A
- impaired attention/planning
- difficulty w/complex activities
- disorganized thoughts
25
Dementia w/Lewy Bodies accounts for \_% of dementia cases
8%
accepted to be highly underdiagnosed or misdiagnosed
26
Lewy Body Dementia:
Key Features
* complex visual hallucinations
* parkinsonism
* sleep disturbances
* autonomic symptoms
* fluctuating cog
* can occur w/PD
27
Lewy Body Dementia:
affected brain areas
* medial temporal lobe (less severe than AD)
* occipital hypoperfusion and hypometabolism
* loss of dopaminergic neurons in substantia nigra
* limbic
* brainstem
* neocortex
28
LBD 3 primary presentations
1. PDD
2. dementia w/lewy bodies
1. neuropsychiatric symptoms (leads to DLB)
29
Frontotemporal dementia accounts for \_% of dementa
3-10%
30
frontotemporal dementia:
key features
* more common in 50-60 y.o.
* memory often intact early stage
* sig changes in behavior/personality
* disinhibition
31
types of frontotemporal dementia
1. Pick's disease
2. progressive supranuclear palsy
3. corticobasal degeneration
32
frontotemporal dementia:
affected brain areas
* frontal lobe
* temporal lobe
specific areas of atrophy depend on variant
33
Alzheimer's Disease accounts for \_% of dementia cases
50-60%
34
Alzheimer's Disease:
key features
* gradual loss of memory and function
* eventually total dependence
* eventual inability to recognize family/friends/self
35
Alzheimer's Disease:
diagnoses made through…
* interview
* history
* diagnostic testing
36
Alzheimer's Disease:
affected areas
* entorhinal area
* hippocampus
* amygdala
* regions of neocortex
37
Diagnostic Markers for AD
one of the three must be present:
1. medial temporal atrophy
2. temporoparietal hypometabolism
3. abnormal neuronal CSF markers
38
Less common forms of dementia
* Creutzfeldt-Jakob disease
* HIV related
* Huntington's
* MS
* Normal Pressure hydrocephalus
* Niemann-Pick Disease Type C
38
Less common forms of dementia
* Creutzfeldt-Jakob disease
* HIV related
* Huntington's
* MS
* Normal Pressure hydrocephalus
* Niemann-Pick Disease Type C
39
Anatomy features of Dementia
* communication signals between brain cells diminish
* metabolism impaired w/development of neurofibrillary tangles
* repair disabled by amyloid plaques
* plaques and tangles produce mistakes throughout brain = cell death
40
Amyloid Beta beneficial roles
* antimicrobial activity
* tumor suppression
* sealing leaks into BBB
* promoting recovery from brain injury
* regulating synaptic function
41
relationship between plaque burden and dementia
* cog symptoms linked more closely to #/location of tau tangles
* post mortem: tangles in absence of plaques
* in some cases: plaques are protective
42
AD: drug trial results
**“right drug but too late”**
* plaques can form decades before cog symptoms
* beta amyloid levels may have plateaued by time patient enters trial
43
APOE gene
highest risk for Alzheimer's
* APO2: rarest. 5-10% population (lower risk)
* APO3: doesn’t increase or decrease risk. 7% pop
* APO4: 15% of pop (higher risk)
44
APOE4 affect on brain function
* increased risk of dementia thought to be linked to toxic “gain of function”
* normal healthy brain function appears to diminish (amyloid not cleared)
45
APOE gene:
synthesized in liver to
transport lipids and maintain cholesterol homeostasis
46
APOE gene:
synthesized in brain to regulate
* level of Aβ
* brain lipid transport
* glucose metabolism
* neuronal signaling
* neuroinflammation
* mitochondrial function
47
APOE4 and Amyloid Beta
**ApoE4 carriers have greater AB deposits than non carriers**
* lower APOE levels facilitates AB accumulation
* APOE regulates levels of AB
* **impairs lysosomal degradation of AB, less transport of AB across BBB**
48
current drug treatment options for AD
* neurotransmitter based
* treat symptoms
* delay progression
49
emerging drug treatment for AD
disease modifying drugs
slow/prevent onset of disease
not yet effective
50
AD Drug Options:
Neurotransmitter depletion
* achetylcholine
* neurotransmitters (serotonin, somatostatin, NE)
* Symptomatic Trx
- block acetylcholinesterase
- target NMDA pathway
51
QOL scale:
Mild dementia
schedule for evaluation of individual QOL
52
QOL scales:
mild-mod dementia
* cornell-brown scale
* dementia QOL instrument
* QOL AD scale
53
QOL scales:
advanced dementia
* dementia care mapping
* qualidem and discomfort scale
54
What is the #1 reason families turn to institutionalization
incontinence
55
Zarit Burden Interview
Widely used measure of caregiver burden
* 22 items behavioral and functional impairments
* impact of caregiving on health, relationships, finances
56
What level of the FAST indicates hospice support
level 7
57
Tools to screen for cog loss
* blessed orientation memory-concentration test
* dementia screening indicator
* functional activities questionnaire
* geriatric depression scale
* global deterioration scale
* mini cog
* MMSE
58
7 stages of global deterioration
1. no impairment
2. very mild decline
3. mild
4. moderate
5. moderately severe
6. severe
7. very severe
58
7 stages of global deterioration
1. no impairment
2. very mild decline
3. mild
4. moderate
5. moderately severe
6. severe
7. very severe
59
interpretation: grouping of global deterioration scale scores
* 1-3: pre dementia
* 4: mild dementia
* 5: mod dementia
* 6-7: severe dementia
60
Clinical Dementia Rating (CDR) Scale
0: no cog impairment
0. 5: Very mild cog impairment
1. mild dementia
2. mod dementia
3. severe dementia
61
MoCA
30 question test. evaluates:
* orientation
* short term memory
* executive function
* visuospatial ability
* language abilities
* animal naming
* abstraction
* attention
* clock drawing
62
Trial Making Tests (part A and B)
used to assess:
* executive function
* visual search
* scanning
* speed of processing
* mental flexibility
63
relationship between cog function and gait
* higher brain centers involved for planning, execution, balance
* widespread network to control attention, executive function, visuospatial
* cerebellum, BG, motor cortex
* overlapping brain areas to control gait
64
Gait Speed
* Slower in mild and moderate non-AD dementia compared to AD groups and CHI
* Gait speed predictor of MCI, highly correlated with functional independence and comorbidity
* sig decrease in MCI compared to CHI
* sig difference between CHI and CDR levels for UP and FP in dual task
65
Gait Variability
* decreased stride length and greater CoV in AD
* dual task load sig increased variability in MCI
66
Physical activity and dementia
* exercise provides neuroprotective and neuroplastic effects on brain structures
* Findings suggest HTN underlying precursor to cog impairment
67
Exercise: how much is enough?
* 150 min/week
* 5 days/week
* mod intensity aerobic activity
OR
* 60 min/week vigorous
68
Strength Training: recommended dosage
* Moderate-high intensity resistance strengthening 2 days/week for major muscle groups
* 48-72 hour recovery between sessions
* 60-80% of 1RM for healthy individuals
* 40-50% of 1RM for deconditioned or frail individuals
* 8-12 reps for 2-3 sets
* 2-3 minute rest period between sets
69
6 domains of balance
* biomechanical constraints
* stability limits/verticality
* anticipatory postural adjustments
* postural responses
* sensory orientation
* stability in gait
70
Balance program for cog impairments
Balance programs 3 days/week x 3 months involving standing, challenging balance exercises may provide best outcome
71
Cognitive Training programs
1. 6 week cognitive training program (2 sessions/week, 90min each) targeting attention, working memory, planning, verbal fluency, learning, and memory
2. 10 week computer-based 60 minute cognitive training program, 3 days/week resulted in improved TUG
72
Cognitive Training: VR
VR physical and cog training showed greater improvements in gait and cog compared to traditional training
73
Physical Activity Considerations
* physical activity elicits compensatory brain mechanisms that improve cog function
* 1 year mod aerobic activity improve memory and hippocampal volume in healthy adults
* combining exercise modalities more effective in enhancing cog health
* may require higher doses of activity to affect (+) cog function
74
Communitcation w/individuals w/dementia
* Establish eye contact to ensure attention
* Use short, simple, concrete communication
* Avoid the use of pronouns (too ambiguous)
* One topic as a time and repeat/rephrase as necessary
* Use multisensory input: auditory, visual, tactile
* Use close-ended questions
* Use external orientation/memory aids (calendar, signs, etc)
* Share successful communication techniques with caregivers
* Reduce background noise
* Do not stand with glare behind you
* Always face the patient (avoid standing behind or to the side of pt)
* If possible, remove mask before speaking
* Ask questions to confirm patient has understood
* Avoid interrupting patient
* Do not take negative comments personally
* Be patient
75
Working with individuals w/dementia:
Validation Method
uses empathy and listening.
acknowledge a person's thoughts and reality
76
Working with individuals w/dementia:
Focus on Abilities
gear interventions and trx toward what the person can still do
77
Working with individuals w/dementia:
exacerbation of neg behaviors can occur when
* new/unfamiliar environment
* new/unfamiliar caregiver
* new/unfamiliar routine
* open environment requiring increased cog processing
