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Nayla Foundations Exam 4 > Dementia > Flashcards

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
Q

What is delerium

A

acute confused state triggered by unknown source

26
Q

Common Ddx for delerium include

A 
I watch death 
Infection 
Withdrawal 
Acute metabolic 
Trauma 
CNS lesion 
Hypoxia
Deficient ntr
Endocrine 
Acute vascular 
Toxins (antihistamine, BB, DM) 
Heavy metals
27
Q

Explain dementia vs delerium

A

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
Q

How is psychosis different from dementia

A

Symptoms of psychosis will improve with treatment

29
Q

How does dementia present

A 
short term memory loss 
hard to find words
apathy
apraxia
executive dysfunction
30
Q

What can help dementia patients

A

journaling to keep track of subtle changes

31
Q

What should the dementia work up include

A

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
Q

How can you treat dementia

A

45 min aerobic exercise
frequent mental stimulation
SSRI, trazodone (insomnia), Ritalin (apathy)

33
Q

What can help with lewy body dementia

A

memantine (increase mod cognition and behavior)

34
Q

What can help with alzheimers dementia

A

ACh-inhibitor

donepezil, rivastigmine (improve cognition)

35
Q

What do you AVOID in dementia patients

A

Paroxetine (anticholinergic)

Benzos

36
Q

What dementias are rapidly progressive

A

Jakob-Creutzfeldt (MCC mad cow dz)

FHx (prnp mutation)

37
Q

What should you stop doing if you have dementia

A

driving
admit if safety risk
refer all new cognitive declines

Nayla Foundations Exam 4 (15 decks)

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