Delirium, depression and dementia

Question 1

what is delirium?

Answer 1

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

Question 2

what multiple mechanisms is delirium caused by?

Answer 2

can be due to inflammation, hypoxia, chronic stress, neurotransmitter imbalance, cholinergic deficiency

Question 3

how do you assess delirium?

Answer 3

• detailed health, mental health, and family history
• the confusion assessment method (CAM)
• mini mental state exam
• substance use
• diagnostic tests

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Question 4

what are the 2 parts to the confusion assessment method (CAM)?

Answer 4

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

Question 5

what are the core features of delirium?

Answer 5

• disturbance in consciousness
• change in cognition
• disturbance happens over a short period of time: hallucinations, sleep disturbances, labile emotions

Question 6

what are the 5 precipitating factors that are most predictive of delirium in the first 9 days of hospitalization?

Answer 6

• 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

Question 7

what is depression?

Answer 7

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

Question 8

what is the mnemonic SIGECAPS for assessing depression?

Answer 8

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

Question 9

what are some risk factors for depression?

Answer 9

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

Question 10

what is dementia?

Answer 10

dementia is a collection of symptoms caused by various diseases affecting the brain. can affect cognitive function, memory, communication, mobility, judgement, reasoning

Question 11

what are the characteristics of dementia?

Answer 11

• progressive neurological disorder, the exact cause is unknown, more women than men are affected
• decreased ability with ADL’s and IADLs

Question 12

what is the most common type of dementia?

Answer 12

Alzheimers

Question 13

what are the 4 most common types of dementia?

Answer 13

Alzheimer’s, Lewy body, frontotemporal, vascular

Question 14

explain alzheimer’s dementia

Answer 14

-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

Question 15

what is the prognosis for alzheimer’s?

Answer 15

3-20 years

Question 16

what meds are used for Alzheimers?

Answer 16

cholinesterase inhibitors

Question 17

what are the early signs of Alzheimer’s?

what are late signs?

Answer 17

early signs = mild forgetfulness, short-term memory, loss of interest, anxiety
late stages = long-term memory loss, unable to communicate, cannot perform ADLs

Question 18

what is Lewy body dementia?

Answer 18

• have visual hallucinations of little army men or small animals flying into room

Question 19

what is the prognosis of lewy body dementia?

Answer 19

5-7 years

Question 20

what is vascular dementia?

Answer 20

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

Question 21

what are infarcts?

Answer 21

interruption in blood flow or O2 to the area (lack of blood and O2 to vessels)

Question 22

what is emotional lability r/t vascular dementia?

Answer 22

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

Question 23

what is the prognosis for frontal-temporal atrophy dementia?

Answer 23

8-10 years

Question 24

how is frontotemporal atrophy dementia treated?

Answer 24

SSRIs, antipsychotic meds and stimulants to treat decreased motivation and apathy

Question 25

what is the goal for care for dementia?

Answer 25

-improving or controlling decline in cognition
-controlling undesirable behavioural manifestations
providing care for the caregiver

Question 26

what is sundowning?

Answer 26

it is a specific type of agitation where the client becomes more confused and agitated in the later afternoon and evening

Question 27

what behaviours are included in sundowning?

Answer 27

agitation, aggressiveness, wandering, yelling, resists redirecting

Question 28

how can you handle sundowning?

Answer 28

remain calm and avoid confrontation, create a calm, quiet environment, maximize exposure to daylight, limit naps and caffeine