Cognition

Question 1

what is cognitive impairment? what does it include?

Answer 1

describes a range of disturbances of cognitive functioning including memory, orientation, attention, and concentration.

it includes delirium, depression, and dementia.

Question 2

what are geriatric syndromes?

Answer 2

cognitive impairments is considered a geriatric giant, geriatric syndrome, or an indicator of frailty in the aging population.

three other geriatric syndromes include mobility, continence, and falls.

basically terms used to describe the significance of functional changes in older people. geriatric syndromes are interrelated and conditions that affect older people.

Question 3

delirium, depression, dementia = how do they develop?

Answer 3

delirium = medical emergency, usually has rapid onset
depression = can develop over time
dementia = usually develops gradually over time

Question 4

delirium: what is it? what is it caused by? signs & symptoms? assessment? how do we treat? interventions?

Answer 4

a medical emergency. it is most often caused from interrelated factors such as predisposing conditions (such as dementia), severe illness, sensory impairments, medications, etc.

any time an older person that is hospitalized exhibits “confusion”, they should be assessed for delirium. anytime any older person experiences sudden changes to their cognition, they should be assessed for delirium.

treat the cause!

intervention: identify an older person’s risk factors related to delirium, and always assess for delirium frequently.

Question 5

people who have ______ are at an increased risk of developing ______.

Answer 5

people who have DEMENTIA are an increased risk of developing DELIRIUM.

Question 6

what is delirium characterized by?

Answer 6

characterized by an acute and fluctuating onset of confusion, disturbances in attention, disorganized thinking and/or decline in level of consciousness.

Question 7

what are the three types (clinical presentations) of delirium?

Answer 7

1. HYPOACTIVE DELIRIUM: characterized by lethargy and decreased motor activity. hypoactive delirium can be overlooked because it may appear as if the older person is just sleepy.
2. HYPERACTIVE DELIRIUM: characterized by agitation, vigilance, hallucinations, restlessness, and hyperactivity. most likely to be recognized due to the older person’s behaviours.
3. MIXED DELIRIUM: characterized by alternating features of hypoactive and hyperactive delirium. studies suggest that 46% of delirium is mixed.

Question 8

what are the two most common factors that could cause delirium?

Answer 8

MEDICATIONS: could be due to addition of a new medication or the withdrawal of a medication the older person has been taking for a long time. with older people, the golden rule related to introducing new medications is to start low (dose) and go slow (increasing the dose).

older people are particularly susceptible to delirium from the introduction of a group of medications called BENZODIAZEPINES (sedate)

INFECTIOUS PROCESSES: most commonly respiratory and urinary tract infections.

Question 9

causes of delirium: I WATCH DEATH (acronym)

Answer 9

INFECTION

WITHDRAWAL
ACUTE METABOLIC
TOXINS, DRUGS
CNS PATHOLOGY
HYPOXIA

DEFICIENCIES
ENDOCRINE
ACUTE VASCULAR
TRAUMA
HEAVY METALS

Question 10

delirium assessment and prevention:

Answer 10

• Determine the risks
  
  • Hydration
  • Nutrition
  • Limiting tubes (Intravenous tubes and catheters) that hamper movement
  • Hearing aids and eyeglasses on
  • White orientation boards -where you write your name and the date
  • Clocks
  • Preventing constipation
  • Use of bed alarms and chair alarms
  • Active engagement of family members can help orientate and calm
  • Non-pharmacological sleep protocol
  • Early mobilization
    Responding to possible unmet needs, such as hunger, thirst, pain, the need to use the toilet.

Question 11

cause of depression in older people

Answer 11

complex; it is often an interaction between biological vulnerabilities, psychological vulnerabilities, and stressful events.

Question 12

AFFECTIVE symptoms of depression:

Answer 12

sad, irritable mood, feelings of worthlessness or guilt, and or loss of pleasure
Cognitive symptoms: decreased concentration and/or suicidal thoughts or behaviours.

Question 13

SOMATIC symptoms of depression:

Answer 13

fatigue, decreased energy, increased or decreased appetite, sleep disturbances and psychomotor agitation or retardation.

Question 14

how does depression manifest in older people that makes it hard to recognize that it is depression?

Answer 14

somatizing complaints with the presence of a chronic condition.

Question 15

why is depression often under-recognized in older people?

Answer 15

because it can be associated with confusion and believed to be dementia, and older people do not complain of depression, rather have physical complaints.

Question 16

what is dementia? what does it affect?

Answer 16

an umbrella term used to describe a set of symptoms affecting brain function that are caused by neurodegenerative and vascular diseases or injuries.

it is a gradual and progressive decline in mental processing abilities, affecting short term memory, language, judgment, reasoning, communication, and abstract thinking.

Question 17

what is dementia characterized by?

Answer 17

it is characterized by a decline in cognitive abilities.

Question 18

is dementia a normal part of aging?

Answer 18

no. though, the prevalence of dementia increases with age, particularly over the age of 85.

Question 19

what are the five main types of dementia?

Answer 19

Alzheimer’s disease
Vascular dementia
Lewy body disease
Frontal temporal dementia
Creutzfeldt-Jakob dementia

Question 20

potential risk factors for dementia (particularly for Alzheimer’s Disease and vascular dementia)

Answer 20

vascular disorders or events (such as stroke, hypertension, head trauma)

Question 21

explain Alzheimer’s Disease (progression, presentation, interventions)

Answer 21

most common – accounts for 50-60% of dementias.

course/progression: ranges from 1-20 years. characterized by a gradual decline over the years.

presentation: personality disintegration, amnesia, agnosia (ability to recognize people/objects), apraxia (loss of ability to perform familiar tasks), aphasia (loss of language skills)

interventions: directed at managing the symptoms and does not influence decline.
- cholinesterase inhibitors increase the amount of acetylcholine in the brain. acetylcholine helps cells communicate w/ one another.
- Memantine blocks the effects of abnormal glutamate activity that may lead to neuronal cell death and cognitive dysfunction.

Question 22

explain vascular dementia (cause, progression, presentation, intervention)

Answer 22

cause: AKA multi-infarct, vascular dementia is caused by interruption of blood supply to areas of the brain by thromboembolism, hemorrhage or ischemia.
progression: can either be stepwise after an episode in the brain or a steady decline.
presentation: varies according to the type of brain affected.
interventions: same for alzheimer’s

Question 23

risk factors of vascular dementia

Answer 23

HTN, cardiac disease, diabetes, smoking, alcoholism, dyslipidemia

Question 24

screening tools for dementia

Answer 24

SLUMS and RUDAS

Question 25

what is responsive behaviours?

Answer 25

responsive behaviours are gestures, words, or actions used, often unintentionally, to communicate personal meanings, needs or concerns related to the individual’s personal, social, or physical environment.

responsive behaviours are more often associated with dementia, but can also be related to delirium.

Question 26

responsive behaviours: name some gestures, words, or actions used

Answer 26

Repetitive vocalizations e.g., cursing and swearing
Sleep disturbances
Sun-downing effect 
Wandering
Pacing
Exit seeking
Hoarding/Gathering
Rummaging
Inappropriate sexual behaviors (15-25%)
Chronic pain syndromes.
Agitation and restlessness
Screaming
Suspiciousness
Apathy
Inappropriate elimination
Ingestion of foreign substances
Resistive to care
Anxiety
Agitation
Aggression

Question 27

what is the Progressively Lowered Stress Threshold Model?

Answer 27

a way of explaining how behavioural symptoms such as agitation are a result of a progressive loss of the person’s ability to cope with demands and stimuli in the environment.

Question 28

what is the Need-Driven Dementia Model?

Answer 28

proposes that the behaviour of a person with dementia can be addressed if we understand the person’s history, physiological status, physical, and social environment.

Question 29

what are psychotic features?

Answer 29

Illusions: misrepresentation of a sensory experience

Delusions: a fixed, false belief that guides a person’s interpretation of events

Paranoia: inability to evaluate the social circumstances appropriately, and feel external circumstances are controlling one’s life

Hallucinations: the sensory perception of a non-existent object or persons

Question 30

are psychotic features and responsive behaviours the same thing?

Answer 30

no!

Question 31

what is the difference between psychotic features and responsive behaviours?

Answer 31

psychotic features can be treated pharmacologically, but responsive behaviours can not.

Question 32

are responsive behaviours amenable to antipsychotics?

Answer 32

NO. administering antipsychotic medications for responsive behaviours such as aggression or wandering, will not meet the older person’s unmet need and will put them at risk for a fall and more responsive behaviours.