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Geriatrics > Cognitive changes > Flashcards

Cognitive changes Flashcards

1
Q

What are normal brain changes that occur in the older adult?

A
  1. Decrease in brain weight
  2. Gyral atrophy
  3. Ventricular dilatation-increase in CSF
  4. Decrease in brain metabolism
  5. No cortical neuron loss
  6. Neuronal loss in subcortical regions
  7. Loss of Purkinje Cells
  8. Myelin loss
  9. Impaired myelin integrity
  10. Neuritic plaques
  11. Loss in dendritic population
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2
Q

What are normal neurochemical changes in the older adult?

A

Decline in ACH
Dopamine
Others

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3
Q

What are treatable conditions that can “look” like dementia?

A
  1. Delirium
  2. Depression (Pseudo-dementia)
  3. Normal Pressure Hydrocephalus (NPH)
  4. Brain tumor
  5. Inflammatory pathology
  6. Endocrine, hormonal, metabolic dysfunction
  7. Paraneoplastic syndrome
  8. UTI
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4
Q

SUDDEN, rapid change in mental function; Typically secondary complication - Illness, Surgery, Polypharmacy; Comorbidities increase risk; Increases length of stay

A

delirium

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5
Q

Generic term, not a specific disease; Group of symptoms caused by disorders of the brain; Most commonly affect memory and language; ACQUIRED and PERSISTENT; Major cause of disability in elderly

A

dementia

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6
Q

How is dementia diagnosed?

A

2 or more brain function are significantly impaired without loss of consciousness (Generally Memory) and 1 or more of:

  1. Communication and language
  2. Ability to focus and pay attention
  3. Reasoning and judgment
  4. Visual perception
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7
Q

What are diseases that cause symptoms of dementia?

A
  1. Alzheimer’s disease
  2. Vascular dementia
  3. Lewy body dementia
  4. Frontotemporal dementia
  5. Huntington’s disease
  6. Creutzfeldt-Jakob disease
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8
Q

What are the characteristics of dementia?

A
  1. Impairment of short-term memory*** - Declarative (more impacted) and Procedural
  2. Impairment of long-term memory
  3. Impairment of abstract memory
  4. Impairment of judgment
  5. Personality changes
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9
Q

Progressive dementia characterized by slow decline in memory, language, visuospatial skills, personality, and cognition

A

Alzheimer’s disease

  • most common form
  • nonreversible
  • amyloid beta protein in brain that should not be there
  • plaques and tangles stop the appropriate nutrient production in the brain; portions essentially die off
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10
Q

What are the 3 stages of AD?

A
  1. Pre-Clinical AD - Pathological Changes but asymptomatic
  2. Mild Cognitive Impairment due to AD - Notable deficits does not affect independent functioning
  3. Dementia due to AD - Notable deficits does affect independent functioning
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11
Q

What are the contemporary guidelines to dx AD?

A
  1. 3 stages of AD
  2. biomarkers
  3. The DSM-5 replaces the term “dementia” withmajor neurocognitive disorderand mild neurocognitive disorder. 

    - Persons with major neurocognitive disorder exhibit cognitive deficits that interfere with independence
    - Persons with mild neurocognitive disorder may retain the ability to be independent
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12
Q

What are risk factors for AD?

A
  1. Age. Genetics/family history
  2. Smoking and alcohol use
  3. Atherosclerosis
  4. Cholesterol
  5. Plasma homocysteine
  6. Diabetes
  7. Mild cognitive impairment
  8. Down syndrome
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13
Q

What are the 10 warning signs according to the Alzheimer’s association?

A
  1. Memory Loss
  2. Difficulty performing familiar tasks
  3. Problems with language
  4. Disorientation to time and place
  5. Poor or decreased judgment
  6. Problems with abstract thinking
  7. Misplacing things
  8. Changes in mood or behavior
  9. Changes in personality
  10. Loss of initiative
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14
Q

What are the S and S of depression?

A
  1. Changes in mood or behavior
  2. Changes in personality
  3. Loss of initiative
  4. Memory loss
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15
Q

What is the pharmacologic treatment of AD?

A
  1. Cholinesterase inhibitors (Aricept) - prevent breakdown of acetylcholine; Delay worsening of symptoms for 6-12 months
  2. Neuropeptide-modifying agents (Mentamine) - Can treat severe Alzheimer’s - Regulates activity of glutamate; Slows progression
    - Combination of 2 most effective
  3. Others - Antidepressants, Antipsychotics, Mood stabilizers
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16
Q

What are non-pharmacological management strategies for AD?

A
  1. Communication and Behavioral - Redirection; Validation
  2. Environmental Design - Safe and Secure, Well lit (avoid sun downing), Allow for exploration (AKA wandering); Use of facilities to promote continuation of ADL’s; Adapt environment
  3. Exercise - Better cognitive function and decreased decline; Maybe even improvement in memory; Positive effects (Strength, sleep, endurance, ADL function, balance, mood)
  4. Restraint Release/Fall Prevention
  5. Positioning
  6. CAREGIVERS
17
Q

What are caregiver roles?

A
  1. Managing and taking meds
  2. Helping person to adhere to prescribed regimens
  3. Help with ADL’s
  4. Help with behavior management
  5. Finding and using support services
  6. Arranging for paid in home, ALF, or SNF
  7. Hiring and supervising caretakers
  8. Family Management - Ie communication among family members
18
Q

What are the goals of rehab management in someone with AD?

A
  1. Maintain optimal level of function for as long as possible - Restore and compensate
  2. Maximize opportunities (especially for learning) in early and possibly middle stages of dementia.
19
Q

What is PT management in AD?

A
  1. Assist pt., family, and caregivers
    - Maximize functional abilities
    - Slow physical decline
    - Functional, meaningful, pleasant and safe activities
  2. Adapt environment
    - Over/under stimulation
    - Safety
    - Lack of structure
    - Lack of routines
20
Q

What are general principles for working with pts with AD?

A
  1. Simplify
  2. Listen
  3. Explain
  4. Educate
  5. (don’t) Reorient
  6. Slow Down
  7. Avoid Change
  8. Touch
  9. Encourage
  10. Respect Dignity
21
Q

What are communication approaches?

A
  1. Don’t reorient
  2. redirect - distract/ alternative activity or topic
  3. validate - art of assisting the psn to feel that the problem and the responses to the problem are acknowledged and understood
22
Q

What movement disorders are seen in AD?

A
  1. Bradykinesia

2. Apraxias

23
Q

What are gait deviations in individuals with AD?

A

↓ gait velocity
↓ step &/or stride length
↑ stance time &/or total double limb support time
↑ variability of stride length & width
↑ variability of stride time

24
Q

What are motor learning principles for people with AD?

A
  1. Exploit Implicit Learning
  2. Optimize early phase for skill teaching
  3. Blocked** vs. Random
  4. Constant** vs. Variable
  5. Train to specific & relevant functional task(s); do not expect transfer of training
  6. Appropriately challenge
  7. Eliminate / minimize the possibility and/or impact of errors during learning
25
Q

What are evidence based outcome measures to use with people with AD?

A

6 meter walk
TUG
6 minute walk
Gait Speed

26
Q

What are some other strategies for treating someone with AD?

A
  1. cognitive training - Activities to stimulate thinking, memory and concentration; Mixed Evidence; Most effective in early stages; Do during PT intervention
  2. Music therapy - Increase cognitive function, attention, communication and speech
  3. Aroma therapy - safe, well tolerated; lavender = relaxing, peppermint = exciting
  4. Massage - hand, foot back, 3-5 minutes effective; trial 1st, may be overstimulating; reduces agitation ST
  5. Pet therapy - limited evidence
27
Q

What are the impacts of lifestyle and diet on AD?

A
  1. Reduced risk from eating fish frequently and a diet high in unsaturated fats
  2. No association between risk of dementia and mid-life intakes of antioxidants
  3. Women with a graduate degree had decreased odds of cognitive decline
  4. Participation in leisure activities have lower risk of dementia
28
Q

What are the impacts of vascular disease on AD?

A
  1. Function of neurons in key parts of the brain increased along with improvement in cardiovascular fitness
  2. Heart disease and stroke contribute to development and severity of AD - AD 60% higher in individuals with stroke
  3. High blood pressure during mid-life increased risk of dementia later in life
  4. Women with diabetes performed worse on cognitive tests than those without diabetes
  5. Strong evidence that diabetes is a risk for dementia
29
Q

What is correlated with reducing risk for AD?

A

Physical activity!

  • and cognitive engagement
  • Mediterranean diet may help

Geriatrics (12 decks)

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