Delerium and Dementia Flashcards
Dementia
- onset
- clinical features
Onset: slow onset over years
Sx:
- sx do not rapidly fluctuate
- memory impairment
- at least one of the following:
- -aphasia = unable to understand or express speech
- -apraxia = inability to perform required movements
- -agnosia = cannot recognize and object
Delirium:
- what is this?
- onset
- clinical features
- prognosis
What: disturbance in consciousness and reduced ability to focus, to sustain focus, or shift attention.
Onset: may be rapid
Clinical features:
- change in cognition
- disturbance in consciousness that develops over a short period of time and fluctuates
- may also have:
- -disturbance in sleep-wake cycle
- -disturbance in psychomotor behavior
- emotional disturbance
- rapid unpredictable shifts from one emotional state to another.
Prognosis:
-lasts days to weeks, but rarely months. usually completely reversible.
Delirium:
- initial dx work up
- risk factors
Work up:
- all medical hx (esp psych, CA, infection, SHx, medications)
- look for drug or alcohol abuse/poisons
- VS
- Blood and urine tests
- Radiology
Risk factors:
- dietary difficulties
- in hospital
- dementia
- FHx of mental illness
- acute stress (loss of spouse or change in environment)
What are some Initial interventions for changes in mental status: Delirium?
recognize and treat underlying cause
Reduce stimuli
use simple, clear language
reassurance for person and family
be aware of increased risk for mortality
Initial interventions for changes in mental status : DEMENTIA
Testing to ensure dx: neuropsych testing, mental status assessment, neurological exam
Discuss long term care plans
discuss advance directives
refere to alzheimers association
Slow down and be present
Dementia:
-what is this?
What: neurocognitive disorder, significant cognitive decline that interferes with daily living
Alzheimers Dz:
- pathophys
- prognosis
- stages
patho: progressive accumulation of protein fragment beta amyloid plaques outside neurons and twisted strand of the protein tau inside neurons which damage and kill brain cells.
prognosis: cannot be slowed down or cured, fatal
Stages:
- Preclinical: measurable changes in the brain may be present 20yrs before sx
- Minimal cognitive impariment d/t AD: mild but measurabl changes in thinking abilities that are noticeable but do not affect daily acitivies
- Dementia d/t AD: quite noticeable memory, thinking, and behavioral sx that impair ability to function in daily life with a steady gradual progression over 10-15Yrs.
What are the sx of:
-mild (early stage)
of Active AD?
Mild: problems coming up with the right word or name, trouble remembering names when introduced to new ppl, greater difficulty performing tasks in social or work settings, forgetting material that one just read, losing or misplacing a valuable object, increasing trouble with planning or organizing.
**can be in this stage 1-5years
What are the sx of:
-moderate (middle stage)
of Active AD?
Moderate:
- forgetfulness of events or about ones own person hx
- feeling moody or withdrawn
- being unable to recall address or phone numbers
- confusion about where they are or what day it is
- needing help choosing proper clothing for the day or season
- trouble with bowel and bladder control
- changes in sleep patterns
- personality and behavioral changes
- can last 1-5 years in this stage
What are the sx of:
-severe (late stage)
of Active AD?
Severe:
- require full time around the clock assistance including personal care
- lose awareness of recent experiences as well as their surroundings
- require high level of assistance with ADL
- experience changes in physical abilities: walk, sit, swallow
- have increasing difficulty communicating
- become vulnerable to infections, especially pna.
- usually lasts 1-2yrs
What do alzheimers pts usually die from?
aspiration pna.
Risk factors of AD?
age, FHx, HTN, DM, high cholesterol, African american. female, level of education, socio-economic status
alcohol use, downs syndrome, head trauma, depression, exercise, obesity, smoking
Vascular Dementia:
- what is the initial sx
- who is high risk for this?
- progression
Initial sx:
-impaired judgement or impaired ability to make a decision
- high risk individuals:
- -HTN, DM, high cholesterol
Progression:
slow progression over years
Dementia w/ Lewy Body:
- sx
- what are lewy bodies?
- associated conditions
- progression
Sx: similar to AD
early on: sleep disturbances, VISUAL HALLUCINATIONS**, gait imbalance, and parkinsonian movement features.
Lewy bodies: abnormal aggregations of the protein alpha synuclein that accumulates in neurosn
may coexist with parkinsons or alzheimers
Progression: steady, gradual
Frontotemporal lobar degeneration:
- includes what syndromes?
- sx
- progression
INcludes: behavioral varient-FTLD, primary progressive aphasia, picks dz, corticobasal degeneration, and progressive supranuclear palsy
Sx: marked changes in personality and behavior and difficulty with producing or comprehending language, memory is spared***
-progression: usually starts at 60Yo and is steady and rapid
