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MT 364 > Delirium, Dementia, Alzheimer > Flashcards

Delirium, Dementia, Alzheimer Flashcards

1
Q

Cognitive failure

A

dysfunction/loss of cognitive function

ex: delirium (acute)
ex: demential (chronic)

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2
Q

Delirium

A

acute, transient (comes and goes), flunctuating changes in mental state; attention, cognition & consciousness levels (lethargy-> drowsy -> agitation), usually reversible

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3
Q

Incidence

A

15-50% amongst hospitalized elders, post surgery, etc

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4
Q

signs & symptoms (3/7)

A
  1. shifting levels of attention-difficulty focusing
  2. altered level of consciousness (LOC)-less aware environment
  3. fluctuating changes of cognition-ex: transient (temporary) memory loss, disorganized
  4. sensory misperceptions common (illusions), hallucination
  5. disturbed psychomotor activities (restlessness, picking at things)
  6. sleep-wake cycle disturbances-symp. worsen at night
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5
Q

diagnosis

A
  • run test & imaging search for causes, hx
  • immediate medical evaluation & treatment
  • can be life threatening
  • R/O (rule out) dementia & depression
  • neurological signs & symptoms (ex:paralysis), which would not show right away
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6
Q

Key diagnostic aspects, 3

A
  1. acute onset: s&s develop over hours/days
  2. fluctuating s&s (during course of day)
  3. evidence of med. condtn., toxin, w/drawal (ex: potentionlly reversible)
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7
Q

causes of delirium, 3

A
  1. drugs:
    - analgesic (narcotics, etc)
    - anticholiergics (cardiovascular & antiparkinsons drugs etc)
    - psychotropic drugs (antidepressants, steroids)
    - prescribed, abused, overdose, or w/drawal
  2. Infection:
    - Urinary tract infection (UTI),
    - pneumonia
    • dehydration & causes of decrease cardiac output (ex: acute blood loss
    • MI (heart attack)
  4. -stroke: high bl. pressure, TIA)
    -metabolic disorders (malnutrition
    -hypoxia etc)
    -intoxicants (alcohol)
    -hypo/hyperthermia
    acute psychoses
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8
Q

predisposing factor

A
  • aging
  • male
  • damaged brain (head injury, CVA, pre-existing dementia)
  • impaired sensory fnctng. & sensory deprivations (hospital light on all night/uncomfortable hospital beds) (anyone who gets older)
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9
Q

precipitating factors (causes)

A

*-immobilization, fractures (death nail for heart attack, weaker everyday when staying in bed)
-drugs
-infection
-dehydration
-sleep deprive, shock, exhaustion
-malnutrition, under-nutrition
transfer to unfamiliar environment
-psychomotor stress (restraints)
-decreased sensory stimulation
-fecal impaction
Therefore, delirium common complication of hospitalization

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10
Q

prognosis

A
  • increase morbidity & mortality

- 35-40% hospitalized elders experiencing delirium die w/in a year due to vulnerability from serious health problems

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11
Q

prevention

A
  • prepare OA for changes in location
  • place familiar objects surrounding
  • maximize sensory input (lighting, clocks, calendars)
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12
Q

treatment

A
  • reverse underlying cause
  • medications for delusions
  • supportive: restore sleep/wake cycle, reassurance
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13
Q

Dementia (general)

A

a clinical syndrome involving a sustained loss of intellectual funct. & memory loss severe enough to cause dysfunction in daily living (de=loss, mentia=mind)

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14
Q

Key features

A
  • gradually progressing course (over months & years)

- no disturbance of consciousness (vs. delirium)

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15
Q

reversible dementia

A
  • R/O reversible & potentially reversible; 20% of all dementia
  • responds to tx
  • damage may be reversed
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16
Q

causes of potentially reversible dementia

A
  • drugs toxicity ex: alcoholism (acute brain reaction to acute lack of vit. B-1) common, causes delirium, dementia, depression, falls
  • heavy metals (lead), organic poison (carbon monoxide)
  • Trauma
  • Infection (viral, HIV)
  • autoimmune disorders (multiple sclerosis)
17
Q

dementia (irreversible)

A

a chronic, irreversible, progressive, incurable structural, damage to brain tissue

18
Q

Types of dementia, 3

A
  1. degenerative disease of the CNS (AD)
  2. vascular dementia (Multi-infarct dementia MID)
  3. Mixed: AD & MID; Korsakoff Syndrome
19
Q

AD (degenerative disease of the CNS)

A

-2/3 of dementia in geriatric population, onset >65, F>M

Lewy Body Dementia:

  • > DLB=Dementia of Lewy Body type [also occur in late PD]
  • > Lewy Body (clumps of specific protein, don’t need to know
  • > 3rd most common after AD & MID, onset
  • > onset >60, M>F
  • > lewy body proteins=decreased & fluctuating alertness, halluc., PD signs

Frontotemporal Lobe (FTD,aka Pick’s disease):

  • > common cause young-onset dimentia, onset <65, M=F, ->Tau proteins in brain,
  • > 50% heredity
  • > less memory affected, variants: increased behavior & increased language impact

L.A.T.E (limbic-predominant age-related TDP-43 Encephalopathy)
->recently discovered on autopsy, similar to AD

20
Q

Vascular dementia:

Multi-infarct dementia (MID)

A
  • 15% of dementias in geriatirc population (M>W, >60)
  • course: step-wise deterioration
  • more changes of HBP (high blood pressure), neurological signs (ex: unilateral weakness, sensory deficit, loss of speech, gait earlier than AD)
  • occlusive cerebrovascular disease
21
Q

Korsakoff syndrome (Mixed AD & MID)

A

chronic memory disorder often proceed by acute Wernicke Encephalophaty=severe lack Vit B-1, ex: due to alcohol, infection, AIDS, cancer, malabsorption

22
Q

AD (in details)

A

a progressive neurological disease which affects the brain, causing mental deterioration

23
Q

incidence

A
  • most common form of irreversible dementia,
  • 2/3rds of dementia in geriatric population
  • 4th leading cause of death in OA (after heart disease, cancer & stroke)
  • single major cause of institutionalization of OA
  • by 85, 25% of popul., by 90, 50% of popul.
24
Q

pathophysiology

A

presence of neurofrillary tangles, prions (misfolded proteins) & beta-amyloid deposits leading to neuron death & formation of plaque

25
Q

etiology

A

unkown

26
Q

risk factors

A
  • family hx (5-15% have familial form, half can have ‘early onset’ before 60)
  • increasing age
  • genetic link
  • previous head injury (brian damage=lose neurons)
  • female 2:1 (live longer)
27
Q

prevention

A

possible protective factors:

  • increase exercise
  • control & decrease hypertension
  • decrease cholestrol
28
Q

Diagnosis

A

Hx & lab tests:

  • -Mental status screening (mini mental state examination)
  • assess function, sensory & physical impairments
  • r/o reversible dementias, delirium, depression, MID, normal aging change of cognition
  • Mild Cognitive impairment (MCI)
29
Q

diagnostic criteriafor AD

A

multiple cognitive deficits manifested by:

  • memory impairment; learning & retaining new info (missed appointments) and one/more:
  • > aphasia, language disturbance
  • > apraxia, impaired ability to perform motor activities despite intact motor funct.
  • > agnosia, failure to identify objects despite intact sensory function ex: can’t tell key in pocket
  • > impaired executive funct., handling complex task (balancing chequebook)

deficits cause SEVERE impairments in social/occupational functioning, which represent a SIGNIFICANT DECLINE form previous level of functioning AND there is continuous cognitive decline (no disturbances of consciousness)

30
Q

Onset/course

A
  • insidious,
  • age 65-84,
  • continuing progressive, cognitive decline (2-20) years until death
31
Q

symptoms: behavior & other pathological (may not have all)

A

affective disturbances: tearfulness, depression

paranoid delusional (false belief), all due to memory loss:

  • ppl are stealing from them
  • house is not one’s home
  • spouse is an imposter
  • abandonment
  • infidelity

hallucinations: visuel & auditory incorrect perception

activity disturbances: wondering, purposeless activity (cognitive abulia), frequent repetitive activities, pacing

aggressivity: verbal outburst, physical outburst

diurnal rhythm disturbance: day/night disturbance, multiple awakenings-pacing

anxieties & phobias

32
Q

Reisberg’s global deterioration scale, 3 stages

A

mild stage (don’t know have AD):

  • > no memory prob.,
  • > normal aging (memory lapse, forgets familiar names & locations)
  • > mild cognitive decline (mild cognitive impairment=MCI, not all progress to AD) - mild forgetfulness noticeable to others

moderate stage:

  • > moderate- mild/early AD diagnosed (course 2 years) can live in community w/ financial superv.
  • > moderately severe cognitive decline (mid stage AD) - needs assistance (1 1/2years) unsafe live alone & drive, need supportive safe home

mod-severe AD - need help w/ ADL (2 1/2 yrs), unsafe judging bath temperature, need full-time supervision, may need placement, forget spouse name, more delusion, agitation and rigidity

severe stage

  • > late stage AD
  • > lost verbal abilities lost (50% dead after 2-3 yrs, some survivefor 7 yrs)
  • > unable to walk/use toilet/feed self
  • > placement needed
  • > rigidity causes joint contractues in nonambulatory (unable to walk) patients
  • > pneumonia (aspiration) frequent cause of death

very severe

  • > lost all verbal abilities
  • > incontinent of urine
  • > lose basic psychomotor skills (walk)
  • > brain no longer able tell body what to do
33
Q

treatment principles

A
  • no cure, treatment is supportive
  • prolong first stages, when “person” still there, and try to postpone final stage
  • drugs to try and enhance cognitive funct.n
  • major support for caregiver
34
Q

general management (Rx) for AD & dementia, 8

A
  1. optimize patient’s FUNCTION
    - assess & adapt environment-> supportive measure: ex: lighting
    - socialization, reminiscence, communication-> groups
    - encourage physical activity, exercise & mental activity -> PT/OT, groups
  2. identify & manage complications-ensure safety
    - dangerous driving-> screening
    - malnutrition-> meals-on-wheels
    - wandering, getting lost-> safe housing
  3. provide ongoing care (assess medical & cognitive condition)
    - colinestrerase inhibitors
  4. provide medical info to patients & family (pronosis, end of life)
    - education
  5. social service support (caregiver, ADL, Legal , financial)
    - support groups
  6. family counselin for anger, guilt, ethical concerns
  7. stigma
    - use sensitive, person-centred terms
    - carer, person with dementia, clothing protector, incontinence product
  8. Music therapy
35
Q

drugs to aid cognition & functn.

A

Cholinesterase inhibitors (eacrine, shown some temproary help w/ cognitive function)

36
Q

guidlines for workn w/ dementd persons

A
  • respect, accept ‘where’ client is (not reality orientation)
  • simple activities form past (music, photographs, stuffed animal)
  • risk falls later stages

MT 364 (7 decks)

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