Cognitive Impairment and Neurological disorders

Question 1

Affect

Answer 1

A person’s prevailing emotion, as observed by an interviewer or assessor

Question 2

Agnosia

Answer 2

Inability to recognize common objects, familiar faces, or sounds, despite intact sensory abilities

Question 3

Aphasia

Answer 3

Loss of the ability to use and understand spoken or written language

Question 4

Apraxia

Answer 4

Impaired ability to manipulate objects or perform purposeful acts

Question 5

Ataxia

Answer 5

Impaired ability to coordinate movement, staggered gait

Question 6

Cognitive functioning

Answer 6

Process by which an individual perceives, stores, retrieves, and uses information

Question 7

Dysarthria

Answer 7

A speech disorder caused by a weakness or incoordination of the muscles used for speech

Question 8

Hallucinations

Answer 8

Perceptions of sensory experiences with no external stimuli

Question 9

Computed tomography

Answer 9

An X-ray technique producing an image of cross-section of tissue

Question 10

Electro-encephalogram

Answer 10

Recording of the electrical activity of the brain by means of electrodes on the scalp

Question 11

The three D’s

Answer 11

Delirium, dementia, depression

• Not normal process of aging, incidences increase with age

Question 12

Delerium

Answer 12

• Relatively rapid onset
• Over hours or days
• Symptoms fluctuate throughout day

Question 13

Dementia

Answer 13

• Gradual onset
• Slow, steady pattern of decline
• without alterations in consciousness

Question 14

During Assessment…

Answer 14

Physical environment should be comfortable and free from distractions that could affect the older person’s performance

Question 15

Components of a cognitive assessment

Answer 15

LOC, orientation x3, immediate, short, and long term memory, attention and concentration, abstract reasoning and problem solving

Question 16

What is assessed when there is an indication pf cognitive impairment?

Answer 16

aphasia, apraxia, and agnosia

Question 17

what is included in a comprehensive assessment?

Answer 17

Lab workup, formal cognitive evaluation, neuro-physical, interview, observation, and a functional assessment

Question 18

Mini-cog, confusion assessment, neecham-champagne confusion scale and the montreal cognitive assessment are…

Answer 18

Examples of screening instruments to monitor and evaluate cognitive status

Question 19

Delirium is often a result of:

Answer 19

vulnerability due to predisposing conditions (cognitive impairment, severe illness, sensory impairment) or

precipitating factors (medications, procedures, restraints, iatrogenic events)

Question 20

Delirium is most likely to occur…

Answer 20

Due to several coexisting factors

A highly vulnerable older person requires fewer precipitating factors

Question 21

Pathophysiology of Delirium

Answer 21

disturbances in neurotransmitters

Question 22

Delirium is most common in

Answer 22

Older people who have undergone surgery and those with dementia

Question 23

Delirium in older adults vs younger persons

Answer 23

Seen as normal part of aging, not seen as a medical emergency

Question 24

HELP

Answer 24

Hospital Elder Life Program

Question 25

Causes of delirium

Answer 25

Unrelieved/inadequately treated pain
Medications
Invasive equipment

Question 26

Those with little-no vulnerability:

Answer 26

Delirium only develops with exposure to a series of noxious insults

Question 27

What is the most predictive assessment of delirium in LTC residents

Answer 27

predisposing factors rather than precipitating factors

Question 28

Risk factors for delirium severity in LTC

Answer 28

Absence of:

• Reading eyeglasses
• Aids to orientation
• Family member
• Glass of water

Presence of:

• Bed rails
• Other restraints

Question 29

Three clinical subtypes of delirium

Answer 29

Hyperactive, hypoactive, and mixed

Question 30

Hyperactive delirium

Answer 30

Agitation, hallucinations, vigilance, restlessness, hyperactivity

Question 31

Hypoactive delirium

Answer 31

Lethargy, decreased motor activity

Question 32

Mixed delirium

Answer 32

Alternating features of hypo and hyper active delirium

Question 33

Hypoactive delirium is associated with:

Answer 33

Increased hospital stay, longer duration of delirium, higher mortality

Question 34

Although delirium is considered reversible…

Answer 34

A significant number of older persons to not go back to their baseline cognitive status

Question 35

Who can provide info about mental status?

Answer 35

Patient
Family/caregivers who are with that person
Responsible party/institution if patient is alone

Question 36

CAM

Answer 36

Confusion Assessment method

- used in hospital settings

Question 37

CAM ICU

Answer 37

Used for nonverbal CCU patients

Question 38

Who can provide assessments about a pt with dementia’s baseline?

Answer 38

Family, those whom have worked with them in the LTC home for a long time

Question 39

When should cAM assessments be implemented for pts with delirium?

Answer 39

During routine assessments

Question 40

Interventions for Delirium

Answer 40

• Vigilant prevention efforts
• Risk screening
• Ongoing assessment
• HELP (managing cognitive impairment, hearing impairments, sleep deprivation, immobility, dehydration

Question 41

Family HELP program

Answer 41

Extension of HELP

Trains family caregivers in selected protocols in preventing delerium

Question 42

Sitters/Constant observers

Answer 42

High cost

Does not consistently improve safety

Question 43

Pharmacological interventions: Delirium

Answer 43

Not recommended, studies show no change or even worse outcomes for pts