DDD-Shumaker Flashcards
65+ patients with cognitive impairment of some degree?
dementia in >65 yo?
dementia in >85?
59%
>65 yo: 8%
>85 yo: 40% (not including MCI)
65+ patients with cognitive impairment of some degree?
59%
What is the biggest barrier to dementia detection in the clinic?
Health care team processes are poorly designed to detect or manage dementia
Barriers to dementia recognition?
Lack of support for caregiver or PCP Time constraints Financial constraints Stigma Diagnostic Uncertainty Disclosure of Diagnosis
Medical Home principles?
Partnerships with patients
Access to care using diverse methods
Coordinated care among team members
Team-based care with Patients at the center of their Team
What is dementia?
Dementia is a progressive decline in memory and at least one other cognitive area in an alert person. These include language, orientation, judgment, abstract thinking and personality.
Diagnosis of dementia?
Memory loss plus one or more of the following:
aphasia – language problems
apraxia – functional, organizational problems
agnosia – unable to recognize objects or tell their purpose
disturbed executive function – planning, sequencing
changes in personality
DSM5 definition of dementia?
A condition involving impairments in thinking, remembering, and reasoning, which affects a person’s function and safety
Irreversible and progressive dementias include Alzheimer’s Disease, Vascular dementia, Lewy Body dementia, and Frontotemporal dementias (FTD)
NCD of Alzheimer’s disease presents with impairments in memory, language and executive function; other NCDs may present with personality/behavior changes or with neurological deficit
Individuals with major neurocognitive disorders exhibit cognitive deficits that interfere with independence, while persons with mild neurocognitive disorders may retain the ability to be independent
What are some subtypes of neurocognitive disorders?
Alzheimer’s Disease (most common) Vascular dementia Lewy body dementia Frontotemporal dementias Parkinson’s disease Huntington’s disease Downs Syndrome Prion diseases AIDS, alcoholism, and other neurodegenerations
Why should we identify dementia?
see if it is treatable: sleep disorders, nutritional deficiencies, med toxicity, major depression, thyroid disease
treat comorbidities: depression, delirium, delusions, hallucinations
help the caregivers w/ their responsibilities
What are some domains that dementia will functionally impair?
- memory
- reasoning & problem-solving
- planning & sequencing everyday tasks
T/F Dementia is NOT delirium or a psychiatric disorder.
True.
T/F Screening for dementia is routinely recommended.
False. But you should keep your eyes/hears open for signs of dementia.
Note: We don’t have curative therapy, so screening isn’t recommended.
Warning signs for dementia?
Fail to keep appointments, or appears at the wrong day or wrong time for an appointment?
A “poor historian” or seem “odd”?
Inattentive to appearance or appear unkempt, inappropriately dressed for weather, or disheveled?
Repeatedly and apparently unintentionally fail to follow directions?
Have unexplained weight loss, “failure to thrive” or vague symptoms?
Seem unable to adapt or experiences functional difficulties under stress?
Defer to a caregiver or family member to answer questions?
What is the SET test?
name 10 animals, fruits, colors, places
What is the SET test?
name 10 animals, fruits, colors, places
X/40, 25 is considered normal.
What is the SET test?
name 10 animals, fruits, colors, places
X/40, 25 is considered normal.
This is a diagnostic test, the MMSE is NOT
What does the SET test pick up on?
Memory
Executive functioning
What are some dementia assessment tools?
Mini Mental State Exam (MMSE) – classic tool, misses early dementia, copy-righted
Montreal Cognitive Assessment (MoCA) – open source – can detect early dementia – somewhat complex
St Louis U Mental Status (SLUMS) – open source VA tool – can detect early dementia – easy to use
MiniCog- screening test – no form required
Set Test – diagnostic test – no form required
What is delirium?
Delirium is defined as a transient, usually reversible cause of cerebral dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. It can occur at any age, but it occurs more commonly in patients who are elderly and have compromised mental status.
What is the DSM5 criteria for delirium?
Disturbance in attention (ie, reduced ability to direct, focus, sustain, and shift attention) and awareness.
Change in cognition (eg, memory deficit, disorientation, language disturbance, perceptual disturbance) that is not better accounted for by a preexisting, established, or evolving dementia.
The disturbance develops over a short period (usually hours to days) and tends to fluctuate during the course of the day.
What is the mortality rate of delirium?
10-26% of patients admitted w/ delirium
22-76% of patients who develop delirium in the hospital
What are some delirium assessment tools?
Confusion Assessment Method (CAM)
Delirium Symptom Interview (DSI)
Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)
Intensive Care Delirium Screening Checklist (ICDSC)
Delirium symptom severity can be assessed by the Delirium Detection Scale (DDS) and the Memorial Delirium Assessment Scale (MDAS)
T/F Dementia & Delirium have no relationship w/ each other.
False. Delirium can be the first sign of dementia. Dementia never develops suddenly, though.
What are possible medical causes of delirium?
Common underlying causes – medication adverse effect, acute infection, acute myocardial infarction, hypoglycemia, hypoxia, liver/renal failure, dementia
CBC, electrolytes, complete metabolic panel, thyroid function, U/A, EKG, drug screens, alcohol level, cultures, HIV, thiamine level
DSM5 criteria for major depressive disorder?
Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks
Mood represents a change from the person’s baseline
Impaired function: social, occupational, educational
Specific symptoms, at least 5 of these 9, present nearly every day:
1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (feels sad or empty) or observation made by others (appears tearful)
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: Insomnia or hypersomnia
5. Change in activity: Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: Thoughts of death or suicide, or has suicide plan
How should you screen for depression in geriatric population?
focus on anhedonia, guilt
Older adults may present with more somatic complaints and may avoid discussing mood
The Geriatric Depression Scale is a validated tool that addresses differences in the presentation of geriatric depression
**depression more common in younger people
What are some key distinguishing features b/w the 3 Ds?
onset pattern disorientation-acute or gradual Don't know response-depression effort, but can't do it--dementia
If you see apathy–what does that point to?
dementia, rather than depression
What is pseudo bulbar affect?
Sudden and uncontrollable episodes of crying or laughing
PBA can occur in stroke survivors or people with dementia, multiple sclerosis, Lou Gehrig’s disease (ALS) or traumatic brain injury. PBA is often mistaken for depression.
Once again, what are the screening tools for neurocog, depression, delirium?
Neurocognitive disorders – Mini-Cog, MoCA, SLUMS, MMSE (copyright), Set Test, formal neurocognitive testing (psychologist)
Depression – PHQ2, PHQ9, Geriatric Depression Screen, full mental status assessment
Delirium – Confusion Assessment Method (CAM), CAM-ICU, Delirium Symptom Interview (DSI), Delirium Detection Scale (DDS) etc.
NCD w/ personality & behavior changes?
frontotemporal dementia
NCD w/ focal neurological deficits?
vascular dementia
NCD w/ Parkinsonian features & hallucinations?
Dementia w/ Lewy bodies
T/F Hypoactive delirium is easy to miss.
True.
