DDD Flashcards
Dementia definition
General disorder that causes significant decline in one or more areas of cognitive functioning severe enough to retire in functional decline
Not an inherent part of aging
Different from normal cognitive lapses
Progressive and disabling
Dementia types
Alzheimer’s caused by amyloid plaques and oligomers, tau neurofibrillary tangles/lewy body or PD caused by cytoplasmic a synuclein incision bodies/frontotemporal caused by tau or ubiquintin plaques
Dementia factors
Protective-unknown, possibly NSAIDs, antioxidant, intellectual activity, physical activity, statin
Risk factors -age: family history, APOE4 allele, Down syndrome, head trauma, fewer years of formal education, history of MDD, life style and psychical environment factors and vascular factor
Screening for dementia
Mini cog
SLUMS
MoCA
Folsteins MMSE
CBC, lytes, renal, glucose, thyroid, vitamin B12, LFTs, folic, homocysteine, methylmalonic acid, UA, toxin screen; CSF, HIV, RPR
Neuro imaging- especially in less than 65 years, sudden onset or progress rapidly, neuro deficits, CT/MRI/PET
Dementia DD
Normal aging
Mild neuro cognitive disorder or mild cognitive impairment
Alzheimer’s disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia
Delirium
Depression
Other- PD, alcohol, neurosyphillis
Mild cognitive impairment
Differs in that it’s subjective in at least one cognitive domain
No impairment in independent living
Can covert to AD later q
Alzheimer’s disease
Gradual onset
Memory impairment with difficult learning new information, language and visual spatial
Rare motor symptoms early but have apraxia later
Progresses 8-10 years
Normal lab test
Imaging shows global atrophy, small hippocampus
Vascular dementia
Onset- may be sudden or stepwise
Symptoms depend on anatomy of ischemia but dysexectutive deficits and slowing common
Labs normal
Imaging shows cortical or sub cortical changes on MRI
Lewy body dementia
Gradual onset faster than AD
Symptoms- memory, visual spatial, hallucinations, fluctuations
Motor type is Parkinson like
normal labs
Imaging shows global atrophy
Frontotemporal dementia
Gradual usually less than age 60
Symptoms-executive, disinhibition, apathy, language, +- memento
No motor symptoms
Labs normal
Imaging shows atrophy in the frontal and temporal lobes
Delirium versus dementia
Dementia and delirium can occur together especially in hospitalized older patients
Delirium- acute onset; cognitive fluctuations throughout course of the day, impaired consciousness and attention, fluctuations in level of alertness; altered sleep cycles
Depression versus dementia
Symptoms may overlap
Patients with primary dementia commonly experienced symptoms of depression and may minimize cognitive losses
Depression patient demonstrate decrease motivation during cognitive testing, express cognitive complaints that exceed measured deficits; maintain intact language and motor skills
Stages of dementia
1- not cognitive impairment
2- very mild cognitive decline-memory lapses, forgetting words or household items, not usually evident during exam family or friends may notice
3- mild cognitive decline- may be diagnosed at this stag, memory and concentration issues, some measurable clinical issues
4- moderate cognitive decline- clear cut deficiencies, withdrawn,
5- moderately severe cognitive decline- major gaps in memory and deficits in cognitive function, assistance with ADLs
6- severe cognitive decline-personality changes; need extensive ADL help
7-very severe cognitive decline- final stage; loss ability to respond to environment, speak or control movement
Management dementia
Non pharm- cognitive training, therapy, physical and mental activity, education and support, safety plan
Pharm- cholinesterase inhibitors like donepezil, rivastigmine; galantamine, memantine, other cognitive enhancers, antidepressants, psychoactive medications, vitamin E, selegiline, ginkgo biloba
Delirium AKA acute confusion state AKA altered mental status AKA acute mental status change AKA toxic or metabolic encephalopathy
A disorder of attention and awareness that develops acutely and fluctuates
Disorganized thinking and altered LOC
Assess using B CAM, 4AT, 3D CAM, CAM ICU
Can be due to inflammation, infection, anticholinergic drug OD, carries events, pulmonary events, withdrawal, fecal impaction, electrolyte disturbances, unwilling catheter; restraints, anemia, pain, urinary retention
Peak onset POD 1
R/O with UA, CBC, CMP, LFT, drug levels, ABG, CXR, EKG, cultures, EEG and CSF, cerebral imaging
Treatment is determining underlying cause, avoiding sedating drugs and alcohol, orientation
Depression
PHQ 9 scale, geriatric depression scale
Psychotic depression
Follow up within 10 days to ensure adequate dosage and adherence and at 4 weeks to assess response
Serotonin syndrome
Agitation
Hyperactivity
Worsening confusion
Restlessness
Swearing
Diarrhea
Fever
Rhabdo
Seizures or tremors
Ataxia
Depression TX
SSRI
SNRI
TCA
And others
ECT- DO NOT USE IN INCREASED ICP, ANGINA, MI OR CVA
Psychotherapy
Exercise
