dementia Flashcards
define
degeneration, progressive, results in cog impairment, emotional and behavioral change, phys and functional deficit, death
dont refer to specific disease, collection of s/s
neurocog disorders
progressive deterioration of cog functioning and global impairment of intellect
no change in consciousness, acquired not developmental, difficulty with mem, problem solving, complex attention; affects orientation, attention, mem, vocab, calculation, abstract thinking
major = interfere with functioning and indep
mild = dont interfere with ADLs, dont necessarily progress
major neurocog disorders
AD, frontotemporal demential, dementia with Lewy bodies, vascular dementia, TBI, substance induced dementia, prion disease, parkinson’s huntingtons
alzheimers
progressive, irreversible, not normal aging, fatal
dx by ruling out others
disturbance in executive functioning
aphasia: expressive, receptive, loss of lang ability
apraxia: loss of purposeful movement -> dressing
agnosia: dont recognize objects/people
can compensate when subtle, hide, denial
sundowning
mood down, agitation up, later on in day
mem impairment
confabulation: unsconsicous creation of stories or answers in place of actual mems, maint self esteem
not lying, think its true
perseveration
persistent reception of word, phrase, gesture
hyperorality
tendency to put everything in mouth, taste and chew
etiology - rf
age (65+), fam hx (genetic mutations, early onset, lifestyle), CV disease, social engagement, diet (and activity, chol, brain health), head injury, TBI, htn, dyslipidemia
etiology - biologic
oxidative stress, free radicals (cellular damage, tangles and plaques, high dose vit E), inflam (post stroke, low dose ASA)
etiology - hallmark
tau P, beta amyloid plaques (Sticky clumps btw nerve cells) create neurofibrillary tangles (abn collection of P threads inside nerve cells -> starve) brain atrophy (cerebral cortex, hippocampus, ventricles larger, decreased thinking, mem, planning)
etiology - NT: acetylcholine
learning, mem, mood
decrease as disease progresses
cholinesterase I keep acetylcholinesterase enzyme form breaking down acetylcholine (increase level and duration)
etiology - NT: glutamate
cell signaling, learning, mem
increase as disease progresses
NMDA antagonist decreases excess Ca by blocking some NMDA receptors
Ca leads to cell damage
stages: mild
forgetful, misplace, decreased recall, social withdrawal (r/t dep, afraid), frustration with self, change may not be apparent to others (spouse likely to realize), good mem test results
stages: mod
decreased self care (+ADLs), disoriented to time and place, wander, pace, delusions, hallucinations (paranoid), decreased visual perceptions -> accidents (tripping), need supervision, emotional labile (mood swings), noticeable s/s
stages: severe
dont care for self, loss use of lang, minimal long term mem, constant complete care
assess
bio: past and present health, PA, ROS, compare to normal
phys: self care, sleep - wake, activity and exercise, nut, pain
confabulation, perseveration, agraphia (decreased ability to read/write), hyperorality, aphasia, apraxia, agnosia, sundowning
psychological: sus, delusions, illusion (son v husband), hallucinations, mood change, anx, catastrophic rxn (over the top)
defense mech: denial, confabulation, perseveration, avoidance of Q, resistance
behavioral response: apathy and withdrawal, restless (fold linens), agitation, aggression, disinhibition, hypersexuality, s of stress, anx, aberrant motor behavior -> OCD like
social: functional status, social system, spirituality, legal status (guardianship, DNR, will), WOL, primary caregiver support essential (respite)
dx
rule out met disease
usually dont know cause until death
CT, PET, MMSE, PA and neuro, med and psych hx, recent s/s, meds, nutrition
priority care
as it progresses…
delay decline -> protect -> phys needs
interventions for confusion or agitaiton
speak clear, slow, direct, dont approach from behind, face pt, paraverbal and nonverbal, walk with if restless, picture albums, music, patience, dont argue, 1 step at a time
nc
indep (time, allow as much indep as possible), oral hygiene, try not to say no
weight, intake, hydrate, well balanced, swallow difficulties
bowel and bladder (freq trips to bathroom), sleep interventions, activity and exercise, pain and comfort (dont rely on verbalizing), relax
AD meds: acetylcholinesterase I
galantamine: mild - mod
all stages: donepezil, rivastrigmine (PO or transderm -> dofficulty swallowing, less GI upset, skin irritation)
delay, dont lessen cognitive decline, stabilize mem, lang, orientation
SE - risk 2x >65: n/v (take with food), brady -> antichol, syncope, CNS stuff
peak in 3 mo (minimal benefit after 1 yr, SE increase), continue to delay decline, temporary improvement
AD meds: NMDA antagonist
memantine
2nd line, later on
modulation of N methyl D aspartate receptor activity
restore function of damages nerve cells, decrease abn excitatory signals of glutamate (stick to receptor, increase Ca, increase damage)
SE: dizzy, confusion, HA, c
AD meds for behavioral s/s
antipsych: may increase r/o mortality (infection, CVD), use with caution
antidep, anti anx, anticonvulsants: smallest dose for shortest time, try non pharm first
