Cognitive Impairment and Neurological disorders Flashcards
Affect
A person’s prevailing emotion, as observed by an interviewer or assessor
Agnosia
Inability to recognize common objects, familiar faces, or sounds, despite intact sensory abilities
Aphasia
Loss of the ability to use and understand spoken or written language
Apraxia
Impaired ability to manipulate objects or perform purposeful acts
Ataxia
Impaired ability to coordinate movement, staggered gait
Cognitive functioning
Process by which an individual perceives, stores, retrieves, and uses information
Dysarthria
A speech disorder caused by a weakness or incoordination of the muscles used for speech
Hallucinations
Perceptions of sensory experiences with no external stimuli
Computed tomography
An X-ray technique producing an image of cross-section of tissue
Electro-encephalogram
Recording of the electrical activity of the brain by means of electrodes on the scalp
The three D’s
Delirium, dementia, depression
- Not normal process of aging, incidences increase with age
Delerium
- Relatively rapid onset
- Over hours or days
- Symptoms fluctuate throughout day
Dementia
- Gradual onset
- Slow, steady pattern of decline
- without alterations in consciousness
During Assessment…
Physical environment should be comfortable and free from distractions that could affect the older person’s performance
Components of a cognitive assessment
LOC, orientation x3, immediate, short, and long term memory, attention and concentration, abstract reasoning and problem solving
What is assessed when there is an indication pf cognitive impairment?
aphasia, apraxia, and agnosia
what is included in a comprehensive assessment?
Lab workup, formal cognitive evaluation, neuro-physical, interview, observation, and a functional assessment
Mini-cog, confusion assessment, neecham-champagne confusion scale and the montreal cognitive assessment are…
Examples of screening instruments to monitor and evaluate cognitive status
Delirium is often a result of:
vulnerability due to predisposing conditions (cognitive impairment, severe illness, sensory impairment) or
precipitating factors (medications, procedures, restraints, iatrogenic events)
Delirium is most likely to occur…
Due to several coexisting factors
A highly vulnerable older person requires fewer precipitating factors
Pathophysiology of Delirium
disturbances in neurotransmitters
Delirium is most common in
Older people who have undergone surgery and those with dementia
Delirium in older adults vs younger persons
Seen as normal part of aging, not seen as a medical emergency
HELP
Hospital Elder Life Program
Causes of delirium
Unrelieved/inadequately treated pain
Medications
Invasive equipment
Those with little-no vulnerability:
Delirium only develops with exposure to a series of noxious insults
What is the most predictive assessment of delirium in LTC residents
predisposing factors rather than precipitating factors
Risk factors for delirium severity in LTC
Absence of:
- Reading eyeglasses
- Aids to orientation
- Family member
- Glass of water
Presence of:
- Bed rails
- Other restraints
Three clinical subtypes of delirium
Hyperactive, hypoactive, and mixed
Hyperactive delirium
Agitation, hallucinations, vigilance, restlessness, hyperactivity
Hypoactive delirium
Lethargy, decreased motor activity
Mixed delirium
Alternating features of hypo and hyper active delirium
Hypoactive delirium is associated with:
Increased hospital stay, longer duration of delirium, higher mortality
Although delirium is considered reversible…
A significant number of older persons to not go back to their baseline cognitive status
Who can provide info about mental status?
Patient
Family/caregivers who are with that person
Responsible party/institution if patient is alone
CAM
Confusion Assessment method
- used in hospital settings
CAM ICU
Used for nonverbal CCU patients
Who can provide assessments about a pt with dementia’s baseline?
Family, those whom have worked with them in the LTC home for a long time
When should cAM assessments be implemented for pts with delirium?
During routine assessments
Interventions for Delirium
- Vigilant prevention efforts
- Risk screening
- Ongoing assessment
- HELP (managing cognitive impairment, hearing impairments, sleep deprivation, immobility, dehydration
Family HELP program
Extension of HELP
Trains family caregivers in selected protocols in preventing delerium
Sitters/Constant observers
High cost
Does not consistently improve safety
Pharmacological interventions: Delirium
Not recommended, studies show no change or even worse outcomes for pts
