Delirium, depression and dementia Flashcards
what is delirium?
it is a state of acute mental confusion that is considered a medical emergency. it is usually related to individual’s underlying condition and precipitating event
what multiple mechanisms is delirium caused by?
can be due to inflammation, hypoxia, chronic stress, neurotransmitter imbalance, cholinergic deficiency
how do you assess delirium?
- detailed health, mental health, and family history
- the confusion assessment method (CAM)
- mini mental state exam
- substance use
- diagnostic tests
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what are the 2 parts to the confusion assessment method (CAM)?
part 1: screens for overall cognitive impairment
part 2: includes four questions
- 1: pt symptom of acute onset, fluctuating course of abnormal behaviour
-2: inattention
3:disorganized thinking
4: altered level of consciousness
what are the core features of delirium?
- disturbance in consciousness
- change in cognition
- disturbance happens over a short period of time: hallucinations, sleep disturbances, labile emotions
what are the 5 precipitating factors that are most predictive of delirium in the first 9 days of hospitalization?
- use of physical restraints
- low serum albumin level
- more than 3 new meds prescribed
- use of urinary catheter
- an iatrogenic event: unexplained event that happens due to hospitalization
what is depression?
cognitive change linked to mood. has physical symptoms such as increased anxiety or agitation, insomnia, loss of appetite, feeling of sadness, pain, poor self-esteem
what is the mnemonic SIGECAPS for assessing depression?
Sleep:insomnia or hypersomnia Interest: reduced, with loss of pleasure Guilt: often unrealistic Energy: mental and physical fatigue Concentration: distractibility, memory, disturbance, indecisiveness Appetite: decreased or increased Psychomotor: retardation or agitation Suicide: thoughts, plans, behaviours
what are some risk factors for depression?
chronic insomnia or fatigue, unexplained somatic symptoms, chronic medical illness, recent cardiovascular event, recent physical or psychological trauma, other psychiatric disorder, family history of mood disorder, extensive use of medical system
what is dementia?
dementia is a collection of symptoms caused by various diseases affecting the brain. can affect cognitive function, memory, communication, mobility, judgement, reasoning
what are the characteristics of dementia?
- progressive neurological disorder, the exact cause is unknown, more women than men are affected
- decreased ability with ADL’s and IADLs
what is the most common type of dementia?
Alzheimers
what are the 4 most common types of dementia?
Alzheimer’s, Lewy body, frontotemporal, vascular
explain alzheimer’s dementia
-memory loss, loss of language, atrophy of brain areas. debris isn’t cleared away in the brain so protein builds up and makes amyloid plagues and tangles made out of tau protein
what is the prognosis for alzheimer’s?
3-20 years
what meds are used for Alzheimers?
cholinesterase inhibitors
what are the early signs of Alzheimer’s?
what are late signs?
early signs = mild forgetfulness, short-term memory, loss of interest, anxiety
late stages = long-term memory loss, unable to communicate, cannot perform ADLs
what is Lewy body dementia?
- have visual hallucinations of little army men or small animals flying into room
what is the prognosis of lewy body dementia?
5-7 years
what is vascular dementia?
it has an abrupt onset due to ischemic damage. vascular dementia has a step wise decline meaning 1 vascular event happening effects 1 type of function and the more that occur the more functions are affected
what are infarcts?
interruption in blood flow or O2 to the area (lack of blood and O2 to vessels)
what is emotional lability r/t vascular dementia?
inappropriate reactions to events that are not consistent with the person’s typical behaviour or the emotion is magnified if it is a socially accepted reaction
what is the prognosis for frontal-temporal atrophy dementia?
8-10 years
how is frontotemporal atrophy dementia treated?
SSRIs, antipsychotic meds and stimulants to treat decreased motivation and apathy
what is the goal for care for dementia?
-improving or controlling decline in cognition
-controlling undesirable behavioural manifestations
providing care for the caregiver
what is sundowning?
it is a specific type of agitation where the client becomes more confused and agitated in the later afternoon and evening
what behaviours are included in sundowning?
agitation, aggressiveness, wandering, yelling, resists redirecting
how can you handle sundowning?
remain calm and avoid confrontation, create a calm, quiet environment, maximize exposure to daylight, limit naps and caffeine
