Cognitive Issues in Older Adults Pt 2 Flashcards
What should be included in your subjective exam in a geriatric pt with cognitive issues?
- PLOF
- Orientation/cognition
- Hx of falls
- Current physical activity
- Functional limitations
- Living environment
- Social interactions
- Community activities
- Behavior changes
- Goals from pt/caregiver
- Functional Comorbidity Index
list the 3 types of memory
- short-term → registration
- working → processing
- long-term → storage and retrieval
clinical context of memory
- recognize and understand pts cognitive level/stage of dementia
- present info at slower rate
- increase repetition of info
- recall greatly improved by compensating for age-related changes and making info personally relevant
QOL scales for mild dementia
Schedule for Evaluation of Individual QOL
QOL scales for mild-moderate dementia
- Cornell-Brown Scale for QOL in dementia
- Dementia QOL Instrument
- QOL Alzheimer’s Disease Scale
QOL scales for advanced dementia
- Dementia Care Mapping
- Qualidem and Discomfort Scale
are there caregiver burden scales available?
yes
16 scales specific to dementia, more than 35 available
what are the dimensions of caregiver burden in dementia?
- Direct impact of caregiver on caregiver’s lives → predicted by level of relationship satisfaction w/pt and pt’s functional independence
- also predicted by caregiver depression and age (younger age > guilt)
- Guilt → predicted by caregiver’s depression and age
- Frustration/embarrassment → predicted by pt’s behavioral problems and level of relationship satisfaction w/pt
- behavioral problems a strong predictor of nursing home placement
what is the Zarit Burden Interview?
a widely used measure of caregiver burden
covers impact of caregiving on caregivers in their health, relationships, and finances
List tools to screen for cognitive loss
- Blessed Orientation Memory Concentration Test
- Dementia Screening Indicator
- Functional Activities Questionnaire
- Geriatric Depression Scale (GDS)
- Global Deterioration Scale
- Mini-Cognitive Assessment Instrument (Mini-Cog)
- Mini Mental State Exam
- Montreal Cognitive Assessment (MoCA)
- Trial Making Test (parts A and B)
What are the 7 stages of Global Deterioration Scale
- No Impairment
- Very Mild Decline
- Mild Decline
- Moderate Decline
- Moderately Severe Decline
- Severe Decline
- Very Severe Decline
describe the Clinical Dementia Rating (CDR) Scale
0 → no cognitive impairment (NCI)
0.5 → very mild cognitive impairment (MCI)
1 → mild dementia
2 → moderate dementia
3 → severe dementia
what is the ACLS?
Allen Cognitive Level Screen
uses the task of sewing stiches to evaluate cognition using 3.0-5.8 scale
what should be included in physical performance testing of geriatric dementia pts?
- Activity tolerance
- Functional Mobility
- Balance/fall risk
things to remember when selecting the appropriate test in geriatric dementia pts
- use short instructions with no more than 3 steps
- tests of short duration best to avoid fatigue
- select tests based on goal
List several activity tolerance outcome measures
- 2-min walk test
- 6-min walk test
list several functional mobility tests
- repeated chair stand test
- 30-sec CRT
- 5x STS
- TUG
- TUG-Cog
- FIM
- DEMMI
- Short Physical Performance Battery
List Balance/Fall Risk outcome measures
- Berg Balance Scale
- Mini BESTest
- Figure-8 Walk Test (F8W)
- Groningen Meander Walking Test
- FICSIT-4
- Instrumented postural sway
- FEC-I
what is the Groningen Meander Walking Test?
measures dynamic walking ability by walking over meandering curved line with emphasis on walking speed and stepping accuracy while changing directions
what is the FICSIT-4?
test of static balance → parallel stance, semi-tandem, tandem, and one-legged stance tests
what is the relationship between cognitive function and gait?
- gait → automated rhythmic action
- higher brain centers involved for planning, execution, balance
- widespread network to control attention, executive function, visuospatial
- cerebellum, basal ganglia, motor cortex
- overlapping brain areas to control gait
list equipment that can be used to measure gait
- pressure sensitive walkways
- optical sensors
- accelerometer
- other → ink footprint, stop-watch
list several gait conditions
- single task
- usual pace
- slow pace
- fast pace
- dual task
- counting backwards
- letter fluency
- word fluency
T/F: exercise is beneficial for dementia pts
TRUE
exercise provides neuroprotective and neuroplastic effects on brain structures