Dementia Flashcards
dementia is now known as ___________
major neurocognitive disorder
def major neurocognitive disorder
sig decline in at least 1 domain of cognition from the pt’s baseline AND persistent + progressive over time AND decrease ability to perform instrumental activities of daily living and activities of daily living
dementia mimics
Head trauma
Delirium
Depression
Normal Pressure Hydrocephalus
Lyme disease
Toxic metals
Malnutrition
Cancer or paraneoplastic syndrome
Kidney or liver disease → accumulation of toxins
reversible causes of dementia?
- alcohol
- medications
- heavy metal toxcitity
- hepatic or renal failure
- B12 deficiency
- metabolic: glucose, cortisol, increase Ca, and thyroid dysfunction
- normal pressure hydrocephalus
- depression
- tumour
etiological causes of dementia?
- MC: Alzheimer
- 2nd: vascular ➔ HTN
- frontotemporal lobar degeneration
- lewy body
- parkinson disease
- HIV
- huntington disease
- prion
- substance/meds
- trauma
general pathophys of major neurocognitive disorder
MC there is an accumulation of native proteins in the brain which results in deposits and subsequent neuronal degeneration
proteins involved with Alzheimer
tau tangles and amyloid plaques
proteins involved in lewy body dementia
lewy bodies ➔ alpha-synuclein
protein involved in Huntington disease
huntingtin protein
RF for major neurocognitive disorder
Family hx / genetics (Alzheimer)
↑ age (Alzheimer)
Low SES and education
Comorbidities for CVD (vascular)
Main s/s of Alzheimer
amnesia
aphasia: language impairment
apraxia: motor impairment
agnosia: inability to remember prev known objects
Main s/s of lewy body dementia
mainly visual hallucinations ➔ rabbits
parkinsonism
disordered sleep
Main s/s of frontotemporal dementia
personality changes
poor executive functions - disinhibition, decrease social awareness
memory is relatively spared
Main s/s of Huntington’s
chorea
irritability and depression
Main s/s of vascular major neurocog disorder
step wise decline of A s/s bc of the infarcts
main s/s of parkinson dementia
parkinsonism
timeline - the dementia s/s comes years later after showing the s/s of parkinsonism
what are 4 or a potential 7 A’s of major neurocognitive disorders
- Amnesia
- Aphasia: language impairment
- Apraxia: inability to perform motor activities
- Agnosia: inability to recog prev known objects
- Altered perception and personality
- Anosognosia: unaware of what they don’t know
- Apathy
what does sundowning mean?
context of major neurocog disorder
worsening of symptoms once the sun goes down
what testing can you do for major neurocognitive disorder? (3)
- mini cog: 3 words immediate, clock-drawing, and 3 word delayed recall
- mini-mental state exam (MMSE)
- Montreal cognitive assessment (MoCA)
how to tx major neurocognitive disorder to stop cognitive decline?
acetylcholinesterase inhibitors and NMDA antagonists
how to manage major neurocog disorder s/s?
- consider antipsychotics for agitation and behavioural problems
- consider SSRI for depression
- consider trazodone for sleep disturbances
nonpharma
- redirection
- explore triggers and modify
- day centers or overnight centres
patient safety considerations
- ministry of transport
- social work and OT
- caregivers
- fall safety/prevention
- provide environmental cues and structure
- ensure power of attorney nad legal will is put in place before decline
