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Neuro Final Sarah > Dementia > Flashcards

Dementia Flashcards

1
Q

Dementia

A

an acquired neurological syndrome associated with persistent or progressive deterioration in intellectual functions.
It occurs later in life and its incidence increases with age

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2
Q

Deficits of Dementia

A

Impaired short-term memory
Impaired long-term memory
Impairment in at least one of these:
Abstract thinking, personality, judgment, constructional abilities, language, praxis, visual recognition

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3
Q

Early signs of dementia include the following:

A

memory failure, disorientation, lapses in judgment, difficulty performing ADLs, difficulty performing mentally challenging tasks, misplacing things, apathy and loss of initiative, changes in mood. The severity and persistence that marks dementia

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4
Q

Dementia is progressive, occurs later in life and its incidence increases with age

A

true

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5
Q

Subcortical Dementias impairments of ___ occur later than in cortical dementias

A

memory, IQ, and language

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6
Q

What is the first impairment to appear in subcortical dementias?

A

motor problems

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7
Q

Subcortical dementias can occur in

A

Parkinsons
Huntingtons
Progressive Supranuclear Palsy
HIV encephalopathy

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8
Q

Dementia and Parkinson’s

A

if dementia occurs, its usually mild to moderate

its treated with meds (L-dopa) and deep brain stimulation

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9
Q

Dementia and Huntington’s

A

Patients are usually put in institutions at the end of life and in the end stages, the patient is often mute and profoundly demented

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10
Q

Progressive Supranuclear Palsy and Dementia

A

It is rare and in its final stages, patient is very unintelligible and may become mute

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11
Q

HIV encephalopathy and Dementia

A

No cure for AIDS or AIDS dementia complex. as dementia worsens, spontaneous speech decreases to single words or short phrases

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12
Q

Vascular Dementia

A

caused by multiple infarcts at different locations of the brain, its the second most common type of dementia in the US

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13
Q

Lewy Body dementia

A

caused by proliferation of Lewy bodies (abnormal protein deposits in neurons)

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14
Q

Frontotemporal dementia

A

caused by pathological changes in the frontal and temporal lobes

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15
Q

Cortical Dementias

A

Alzheimer’s Disease

Pick’s Diease

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16
Q

Alzheimer’s Disease is characterized by these changes in neurons

A
  • neurofibrillary tangles: threadlike structures in cell bodies, dendrites and axons
  • neuritic plaques: small areas of tissue degeneration
  • granulovacuolar degeneration: inside neurons of hippocampus. fluid filled spaces called vacuoles enlarge the cells body and cause it to malfunction
  • decrease in ACH level
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17
Q

What causes Alzheimer’s?

A

cause is unknown but may be related to genetic abnormality

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18
Q

Medical management for Alzheimer’s?

A
  • no real effective medical tx to slow down the disease or to cure it
  • but meds may help with cognition and reduce aggression and depression
  • nutrition needs to be monitered
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19
Q

1st stages/Early stages

Alzheimer’s in middle stages:

A
  • lapses of memory, problems with judgement and reasoning, disorientation, mood changes
  • language requirements are problematic, word finding, difficulty understanding complex material
  • talk long, become irrelevant, tangential
  • word finding problems worsen
  • patients begin to shorten their utterances and use sentences that aren’t grammatically correct
  • may get lost in simple conversations
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20
Q

Alzheimer’s in late stages

A
  • severely impaired communication
  • nonfunctional reading & writing abilities
  • comprehension of spoken material limited to simple familiar phrases
  • pts speech primarily consists of sentence fragments and words which may not make sense
  • syntax breaks down
  • neologistic utterance may occur
  • some become mute, other echolalic
  • death because of pneumonia
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21
Q

Pick’s Disease

A

Occurs between 40-60 years

no effective cure

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22
Q

Pick’s Disease

Characterized by 2 neuronal abnormalities

A

pick cells- enlarged neurons
pick bodies- globe like formations in the neuron

no effective cure- meds for symptoms

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23
Q

Pick’s in later stages

A

patient may become mute with motor rigidity

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24
Q

Difference between Alzheimer’s and Pick’s

A

memory and orientation last longer in Pick’s but Pick’s has more early language problems. Comprehension is problem in later stages as with Alz.

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25
Q

Identifying Cortical Dementia

A
  • in early stages may be difficult to identify whereas in late stages it is relatively easy to identify
  • to aid identify: use tests that investigate abstract reasoning, analysis, integration of information, reasoning and problem solving.
26
Q

Dementia can be differentiated from aphasia by

A

giving nonverbal tests of intelligence and problem-solving

27
Q

To aid in identifying dementia use tests that

A

investigate abstract thinking, analysis, integration of information, reasoning an and problem solving

28
Q

Dementia has __ onset and aphasia has ___ onset

A

gradual; sudden

29
Q

Standardized tests to use in early stages of dementia

A

Blessed Dementia Scale
Global Deterioration Scale
Clinical Dementia Rating Scale

30
Q

Comprehensive Batteries for assessing language and communication in AZ pts

A

Arizona Battery for Comm. Dis.
WAB, BDAE, CADL
PPVT- for receptive vocabulary

31
Q

Delayed story retelling can differentiate

A

AZ pts from normal elderly- normal elderly can recall and AD pts couldn’t (96% vs. 2%)

32
Q

Speech Production Assessment

A

Boston Naming Test
BDAE- cookie theft picture: see if they can pick out relevant information and say a cohesive narrative. look for word finding problems, tangential verbose characteristics, neologisms, irrelevant information

33
Q

What are the clinical objectives of intervention, dementia

A
  • minimize disruptive effects of dementia on pt and family
  • ensure pts safety
  • keep pt healthy
  • provide support and direction to pt and family
34
Q

Management issues in the early stages of dementia

A 
memory impairments 
anxiety and depression
behavior
pts denial
sleep disturbances
pts poor judgment with nutrition and hydration
35
Q

Memory Impairments in early stages of dementia

A

Problems with declarative memory (memory for past) and prospective memory (remembering to do things at certain times)
Procedural memory is usually ok
language and communication usually ok at this time but memory problems can affect language- some word finding
-anxious and depressed
-behavior begins to change: apathetic, pacing, asking questions over and over
-deny/minimize problem
-sleep disturbance
-poor judgement on nutrition and hydration

36
Q

Management issues in middle stages of dementia

A

memory and attention loss increase
troublesome behaviors increase (night walking, demanding, criticizing, physical violence)
orientation decreases
communication decreases- rarely initiates communication and responses become reduced

37
Q

Management issues in late stages of dementia

A

caregivers need to be helped to manage troublesome behaviors, sure pts safety, and involve pts participation in ADLs as much as possible

38
Q

Intervention in early stages of dementia

Memory

A

Portable memory aids, wallet size checklists, memory wallets, modify pts daily life to adhere to a schedule

39
Q

Intervention in early stages of dementia

Confusion

A

memory aids help in confusion

40
Q

Intervention in early stages of dementia

Impaired Communication

A
  • Pt is aware and wants strategies to help
  • Memory problems: portable memory aids are helpful, electronic organizers with alarms to keep appointments, wallet checklist with things to do, memory wallets with personal info, consistent schedule/structure, keep all items together (coffee mug, pot, coffee)
  • Confusion: memory aids help confusion

Impaired communication: repair strategies (speak slow, write out and ask questions)
teach semantic cueing like circumlocution
Group Treatment- helpful for social interaction and communication

41
Q

Intervention in middle stages of dementia

A

caregiver burden increases
maintaining environmental control is important
Pt becomes less independent and needs more supervision
managing troublesome behaviors and try to divert

42
Q

Intervention in middle stages of dementia

Managing troublesome behaviors

A

watch for warning signs and try to divert pt before the behavior occurs

43
Q

Intervention in middle stages of dementia

Communication

A
  • stereotypical and automatic utterance make up large part of communication
  • intervention concentrates on preserving pt’s residual communicative abilites
44
Q

Intervention in middle stages of dementia

group activities

A

helpful in maintaining orientation and to stimulate cognitive processes and to reinforce appropriate behaviors

45
Q

Intervention in late stages of dementia

A 
focuses on helping caregivers
provide familiar routines for ADLs
Use environmental cues
Institutionalization often occurs
Reality orientation
Milieu Therapy
Use Behavior Modification strategies- praise, food
46
Q

Milieu Therapy

A

makes pts environment more conducive to social interactions (provides drinks, eats, in activity periods)

47
Q

Korksakoff’s Syndrome

Amnesic Confabulatory Syndrome

A

neurological disorder caused by the lack of thiamine (B1) in the brain, its not strictly a dementia. Cerebral atrophy

48
Q

6 major Symptoms of Korksakoff’s Syndrome

A 
Anterograde amnesia
Retrograde amnesia
Confabulation
lack of insight
apathy
meager content in conversation
49
Q

Anterograde Amnesia

A

loss of ability to create new memories

50
Q

Retrograde Amnesia

A

unable to recall events that occurred before the development of the amnesia

51
Q

Other signs of Korksakoff’s Syndrome

A

Ataxia
Coma
Paralysis of muscles controlling the eye
Tremor

52
Q

Treatment for Korksakoff’s Syndrome

A

Replacement of thiamine by IV or IM together with proper nutrition and hydration but the brain damage caused may not be back to premorbid levels.
In some cases, drug therapy is recommended

53
Q

With treatment for Korksakoff’s Syndrome is successful, improvement will

A

become apparent within two years although recovery is slow and often incomplete

54
Q

Causes for Korksakoff’s Syndrome

A 
Chronic Alcoholism
Severe Malnutrition
Eating disorders- prolonged vomiting
Effects of Chemotherapy
Morning sickness in pregnant women (hyperemesis gravidarum)
Mercury Poisoning
Centipede (mukade) bites in Japan
55
Q

How does chronic alcoholism cause Korksakoff’s Syndrome?

A

usually an indicator of poor nutrition which in addition to inflammation of the stomach lining, causes thiamine defincieny

56
Q

Alzheimer’s in early stages

A
  • language requirements related to memory are problematic
  • circumloction
  • difficulty understanding complex material
  • may talk too long, become irrelevant and tangential
57
Q

Frontotemporal dementia

A

caused by pathological changes in the frontal and temporal lobes

58
Q

Normal Pressure hydrocephalus

A

CSF can’t be absorbed and builds up in the brain. results in dementia characteristics. can be improved with ventricular shunt

59
Q

Creutz-jakob Dz -

A

rare and Fata dz that causes rapidly progressing dementia and neuromuscular disorders.

60
Q

pseudo dementia

A

elderly individuals become depressed and might mimic dementia

Neuro Final Sarah (5 decks)

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