Dementia Flashcards

1
Q

What is a normal state of consciousness

A

wakefulness
awareness
alert when not asleep
if sleeping, readily awakened

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2
Q

What are arousal and cognition

A

arousal: alert- mediated by reticular activating system
cognition: oriented- properly working hemispheres

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3
Q

What is clouding of consciousness

A

mild AMS with inattention and reduced wakefulness (drunk)

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4
Q

What is confusional state

A

disoriented, bewildered, difficult to follow commands

hypoglycemia

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5
Q

What is lethargy

A

severely drowsy, aroused with moderate stimuli then drift back to sleep
(post-op)

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6
Q

What is obtudation

A

less interest
slower response
sleeps, more drowsy when awake

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7
Q

What is stupor

A

need vigorous repeat stimuli. If left alone, immediately relapse into sleep

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8
Q

What is a coma

A

unarousable, unresponsive

serious nervous system disorder

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9
Q

What are some things that can cause a coma

A
seizure
metabolic disturbance 
hypothermia 
lesions 
(need to hospitalize all and refer to neuro)
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10
Q

How should you evaluate an altered patient

A
Determine LOC (AVPU) 
Evaluate cause of coma 
look for + or - focality (level of dysfunction, cortical or brainstem involvement)
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11
Q

What is the Glasgow Coma scale

A

points 3-15 (<8 intubate)

points for motor, verbal, and eye opening

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12
Q

Who should you get an HPI from (if not the patient

A

Nursing home staff/medical professionals

only use family as last resort (and document)

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13
Q

What can cause an altered mental status

A
DM
HTN
thyroid/addisons
renal failure
CA
dementia 
CVD
seizure
psych
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14
Q

What is dementia

A

progressive intellectual decline NOT due to delerium or psych disorder

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15
Q

What are RF for dementia

A
60+ 
FHx 
Vascular disease 
DM
serious head injury
female
vitamin D deficiency 
chronic sleep deprivation
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16
Q

What can possible be protective against dementia

A

education

ongoing intellectual stimulation

17
Q

What are the types of dementia

A

Alzheimers dementia (MC)
Lewy body dementia
Vascular dementia

18
Q

What is Lewy body dementia

A

progressive dementia due to microscopic protein deposits that damage brain over time
**fluctuating cognition

19
Q

Lewy bodies are also found in these diseases

A

Parkinsons

Alzheimers

20
Q

Lewy body dementia is characterized by

A

plaques (beta amyloid protein)

tangles (Tau protein)

21
Q

Vascular dementia is caused by

A

impaired blood flow to brain (after CVA) with sudden onset Sx due to multifocal ischemic change

22
Q

RF for vascular dementia are

A

smoking
HTN
HLD

23
Q

What are cognitive symptoms of vascular dementia

A
recent memory loss
inattention 
difficulty planning or organizing 
confusion
poor judgement 
difficulty calculating or reasoning 
agitation, aggression, hallucinations, delusions, depression
24
Q

What did they make for people with vascular dementia

A

Wristbands; because they frequently get lost in familiar surroundings

25
What is delerium
acute confused state triggered by unknown source
26
Common Ddx for delerium include
``` I watch death Infection Withdrawal Acute metabolic Trauma CNS lesion Hypoxia Deficient ntr Endocrine Acute vascular Toxins (antihistamine, BB, DM) Heavy metals ```
27
Explain dementia vs delerium
pt with dementia is susceptible to delerium cant diagnose dementia until pt is not delerius or ill Dementia is usually diagnosed outpatient Delerium is usually diagnosed in the ED
28
How is psychosis different from dementia
Symptoms of psychosis will improve with treatment
29
How does dementia present
``` short term memory loss hard to find words apathy apraxia executive dysfunction ```
30
What can help dementia patients
journaling to keep track of subtle changes
31
What should the dementia work up include
Neuro MMSE ( 3 word recall) complete PE MRI w/ con for new progressive complaints (if + can do PET to see amyloid) Serum B12, T4, TSH, RPR, CBC, CMP, lipids ApoE (if +, increased risk for alzheimers)
32
How can you treat dementia
45 min aerobic exercise frequent mental stimulation SSRI, trazodone (insomnia), Ritalin (apathy)
33
What can help with lewy body dementia
memantine (increase mod cognition and behavior)
34
What can help with alzheimers dementia
ACh-inhibitor | donepezil, rivastigmine (improve cognition)
35
What do you AVOID in dementia patients
Paroxetine (anticholinergic) | Benzos
36
What dementias are rapidly progressive
Jakob-Creutzfeldt (MCC mad cow dz) | FHx (prnp mutation)
37
What should you stop doing if you have dementia
driving admit if safety risk refer all new cognitive declines