cognitive and behavioral changes Flashcards
geriatric assessment
- medical
- functional: physical (ambulation - ADLs), cognitive
- psychosocial: caregiver
dementia risk factors
- age
- affects females more
- down’s syndrome
- genetic: AD gene mutations (amyloid precursor protein). e4 allele: increases risk of dementia
- family history
dementia pathology:
Medial temporal lobe atrophy/
Amyloid plaques develop in the hippocampus
modifiable risk factors for dementia
- cognitive reserve: capacity beyond what is needed for daily functioning, to be able to be more resilient or adaptive to brain pathology
brain plasticity - use-dependent - use brain more to reduce risk - diabetes
- HTN
- head injury
- smoking
- air pollution
- midlife obesity
reduce risk of dementia
frequent exercise reduce occurrence of depression avoid alcohol social contact education
dementia definition
decline in memory and cognitive domains, affecting daily fn
progressive and disabling
reversible causes of dementia
D - drugs (anti-cholinergics/H2 blockers/ benzodiazepines) E - emotion (depression) M - metabolism (hypothyroidism, hypercalcemia) E - eyes/ears (sensory isolation) N - normal ICP pressure (hydrocephalus) T - tumour/space occupying lesion I - infection (syphilis/HIV) A - anemia/alcohol
irreversible causes of dementia
alzhiemer’s disease
vascular dementia: stepwise decline, focal signs
alzhiemers disease
symptoms: 4As (amnesia, apraxia, aphasia, agnosia - loss of sensory)
imaging signs: medial temporal lobe atrophy, small hippocampus
formation of amyloid plaques
clinical features of dementia
(ABC)
Activities: loss of independence for daily activities
Behavioral changes
Cognitive: memory deficit - esp for new things
disorientation/impaired judgement
depression definition
mental disorder characterised by low mood, loss of interest.
present w/ affective, physical and cognitive symptoms
can become chronic -> substantial impairments in one’s ability to take care of everyday responsibilities
mechanism of depression
decrease neurotransmitters: serotonin, norepinephrine, dopamine
risk factors for depression
- biological: family/past history
- social: isolation, loss of kin/job
- physical: chronic pain, diseases (cancer/CVA), beta blockers
- psychological: dementia, anxiety
features of depression
(ABC)
Affective: low mood, loss of interest
Behavioral: agitation, fatigue, altered appetite
Cognitive: poor memory and decision making
under-treated depression
decreased QOL
caregiver stress
suicide
delirium definition
non-specific neuropsychiatric manifestation of a generalised disorder of cerebral metabolism and neurotransmission
- acute confusional state
- altered mental state
- organic brain syndrome
- toxic/metabolic encephalopathy
delirium characteristics
high vulnerability, small insult
low vulnerability, high insult
- means a fit person not likely to get delirium -> if he appears with delirium probably means that there is a major insult somewhere - find out what!
delirium mordibity
high morbidity
poor recovery
increase risk of death following discharge
causes of delirium
D: drugs E: eyes/ears L: low O2 states (AMI, stroke, GI bleed) I: infection R: retention (urine/poop) I: ictal (seizure/stroke/headache) U: underhydration/ nutrition M: metabolic S: subdural hemorrhage (esp in elderly w/ shrunken brain)
delirium diagnosis (confusion assessment method**)
acute change/fluctuation in mental status or
inattention
and
disorganised thinking
altered level of consciousness
delirium vs dementia vs depression
delirium: acute onset, fluctuating, clouded disorientation, poor STM w/ inattention, psychosis
dementia: gradual onset, steadily progressive, poor STM w/o marked inattention
depression: variable onset, usually diurnal (daytime), does not affect consciousness, poor attention but memory intact
STM = short term memory
