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Adult Part II > Dementia > Flashcards

Dementia Flashcards

1
Q

Memory loss normal?

A

Not normal

But normal for information to take longer

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2
Q

Dementia

A

A progressive decline in cognitive function

A syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits

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3
Q

Criteria for dementia

A

Evidence of significant cognitive decline from a previous level of performance in one of more cognitive memory

  • learning and memory
  • language
  • executive function
  • complex attention
  • perceptual - motor
  • social cognition

Cognitive deficits interfere with independence in everyday activities. At minimum, assistance should be required with complex IADL’s

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4
Q

Aphasia

A

Difficulty verbalizing

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5
Q

Apraxia/dyspraxia

A

Difficulty doing known motor tasks

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6
Q

Agnosia

A

Difficulty recognizing familiar people or things

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7
Q

Frontal temporal

A

Personality changes

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8
Q

Delirium

A

A change in cognitive status, marked by in attention and an altered level of consciousness that develops acutely and fluctuates

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9
Q

Risks with delirium

A

Increased morbidity and mortality
Prolonged hospital stay, rehab days
Increased institutionalization, caregiver burden

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10
Q

Confusion Assessment Method CAM

A

Acute onset, fluctuating courses
Inattention
Disorganized thinking
Altered LOC

Dx of delirium requires features 1 & 2 along with either 3 or 4

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11
Q

DELIRIUM

A

Drugs, electrolyte imbalance, lack of sleep/drug compliance, infection, reduced sensory input, intracranial - CVA meningitis seizure, urinary retention fecal impaction, CHF arrhythmia hypoxia anemia

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12
Q

Focal signs of CVD or other brain injury

A

Neck auscultation for bruits, focal weakness, asymmetric reflexes, babinski sign, focal sensory loss, visual field deficits, in coordination

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13
Q

Signs of extrapyramidal disease

A

Rigidity, tremor, bradykinesia, gait disorder

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14
Q

Frontal release signs

A

primitive reflexes that suggest frontal lobe disorder

Snout, gasp, palmomental reflexes

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15
Q

Mental status exam

A

Areas of cognitive function to be tested include:

  • attention
  • recent and remote memory
  • language
  • praxis
  • visuospatial relationship
  • judgement
  • calculations
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16
Q

Mini Cog

A

90% both in sensitivity and specificity

  • 3 item recall and clock drawing
  • 3 min to administer
    0-2 = + dementia
    3-5 = no dementia
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17
Q

Clock drawing

A

Part of mini cog

Good screening tool for dementia and cognitive dysfunction

Evaluates for neglect and focal lesions

Normal score is 10

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18
Q

Folstein’s mini mental state test

A

80-90 % specific

1 point for ear correct answer

Asking about orientation
registration ( name 3 objects and have repeat)
Attention and calculation
- serial 7s, spell alternate backwards
Recall
Language

19
Q

Montreal Cognitive Assssment (MOCA

A

Designed as a rapid screen for mild cognitive impairment

Takes 10 min - above 26 = normal

Tackles : 
Visuspatial/ executive
Naming
Memory 
Attention 
Language
Abstraction
Delayed recall
Orientation
20
Q

Alzheimer’s disease

A

Progressive and fatal brain disease

Characterized by amyloid plaques and nuerofibrillary tangles in the brain

Brain atrophy of the cerebral cortex, most pronounced in the frontal, temporal and parietal lobes

21
Q

Frontal lobe

A

Problem solving , planning, word production, behavioral control, emotion

22
Q

Temporal lobe

A

Memory, emotion, word understanding

23
Q

Occipital lobe

A

Vision

24
Q

Mild cognitive impairment - preclinical

A

Preclinical MMSE 26-30

Reported by caregiver
Objective signs of memory impairment
Mild construction, language, or executive dysfunction
No function impairment

25
Q

Mild impairment

A

MMSE 21-25 ( 2-4 years from onset of symptoms)

Disoriented to date
Name difficulties as well as word findings
Problems managing finances
Getting lost, decrease insight 
Irritability, mood change 
Personality changes
26
Q

Middle, moderate impairment

A

MMSE 11-20

Can last from 2-10 years 
Disordered to date and place 
Aphasia
Impaired new learning 
Not cooking, shopping, paying bulls 
Restless, anxious, depressed
Delusions, agitation, aggression

Tough to manage at home

27
Q

Severe impairment

A

MMSE 0-10

Can last 1-3 yrs
Remote memory gone
Nearly unintelligible verbal output 
Unable to copy or write
Total care with ADL’s
Incontinent 
Motor or verbal agitation
28
Q

Vascular Dementia

A

2nd most common type of dementia

Characterized as multiple focal ischemic changes

Defining lesion is called a lacunar infarct , infarcts occur deep in the arteries of the brain

Risk factors : HTN, smoking, increased cholesterol, PVD, CVD, DM

Abrupt onset, stepwise deterioration, executive dysfunction, gait changes

29
Q

Frontetemporal dementia

A

Damage to brain cells especially in the frontal and temporal lobes

Behavioral issues, personality changes, language impairment

30
Q

Dementia w/ levy bodies

A

Pattern similar to alz , fluctuating presentation, visual hallucinations, muscle rigidity, myoclonic jerks,

31
Q

Normal pressure hydrocephalus

A

Caused by build up of fluid in teh brain, enlarged ventricles i CT scan

presents with Dips, Drips, Dementia

DX : Spinal tap, conditions can improve with a surgical shunt

32
Q

Creutzfeldt- Jacob

A

Rapidly fatal rare disease / “ mad cow dx”

33
Q

Negative behaviors related to

A

Occur in mid-late dementia

Physical pain or discomfort
Overstimulation 
Unfamiliar surroundings 
Complicated tasks
Frustrating interactions
34
Q

Environment

A

Therapeutic environment

  • decrease stimulation
  • environmental cues
  • sensory aides
  • safety
35
Q

Communication

A 
Good eye contact
Simple commands with cues
Approach from the front 
Watch body - language 
Avoid negative statements 
    - please sit back

Keep positive and calm

36
Q

Behavioral management

A 
Restrict 
Reassess
Reconsider
Rechannel 
Reassess 
Review
37
Q

Non pharmacological treatment

A

Music therapy
Social engagement
Distraction

38
Q

Pharmacologic treatment

A

TX depends on the stage of the disease and the type of dementia

39
Q

Cholinesterase inhibitors

A

Goal is not cure but to prevent deterioration and maintain function

Donepezil ( aricept )

40
Q

NMDA

A

Namenda for moderate to severe dementia

41
Q

Other pharmacologic treatment choices

A

To treat depression, anxiety, paranoia, agitation, disinhibition

42
Q

Health care proxy

A

Free and doesn’t need a lawyer

43
Q

Dementia hospice eligibility

A

Stage 7 or beyond on the FAST scale

+ one of criteria in the last year

Adult Part II (6 decks)

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