Dementia Flashcards
dementia
irreversible
onset gradual
lifetime duration
slow progressive decline of mental and functional capacity
SHORT-term memory loss is an EARLY sign
EPISODIC memory affected first ( memory of recent events)
most common cause : alzhiemiers , CVA, parkinsons, AIDS
delirium
reversible ( remove cause) rapid onset brief duration incoherent and confused agitation, excitement, disoreintation, delusions
causes :fever, infections, shock, drugs, alcohol, dehydration
Sundowning Phenomenom
seen in both dementia and delerium
- observe and minimize triggers, maintain routines
- simplify surroundings
- watch TV, take a walk, conversation
- adjust light exposure, play music
use essential oils
What are examples of antocholinergics + S/e and contraindications
Ipratriopium - tx copd
Bently - tx IBS
Ditropan - tx urge incontinence
Atropine
( antihistamines, TCA’s, decongestants, antispasmodics, urinary incontinence )
se: confusion, agiatation, disoreintation, memory problems, ataxia, tachy, diplopoia Dry as a bone red as a beet mad as a hatter hot as a hare cant see cant pee cant spit cant shit
contra: glaucoma, bladder outlet obstruction ( may cause urinary retention)
Folstein Mini-Mental State Exam (MMSE)
for dementia
30 is MAX score
involves orientation, short term memory, attention and calculation, recall, write a sentance, copy a design
Scores : 0-10 = severe, 10-20 = moderate 25-30 = mild/ questionable
Mini-cog test
3 min tool to screen for cognitive impairment
high sensitivity and specificity
invovles : three word recognition, clock drawing, three word recall
SCORE : 0-3
0-2 = dementia
3-5 = no dementia
Alzheimer disease
1 most common cause of dementia. Insiduous onset,
due to a build up of plaque, amyloid and nuerofibrillary tangles on the brain
unusal to occur prior to 60
impaired memory of RECENT EVENTS ( episodic memory) is most common initial symptom
lifespan 3-11 years after dx
Cognitive impairment dx
at least two or more
- impaired ability to remember recent information
- impaired reasoning and poor judgement ( executive functioning)
- impaired language functions ( word finding problems)
- changes in personality or behavior
- impaired visuospatial abilities
AD work up and labs
r/o all other causes and get : TSH, vit B12, nuerosyphilius, HIV, CBC, CMP
obtain hx from a family / close contacts , refer to nuero no brain biopsy
AD tx
lifestyle : establish a routine, write down lists, adult day care, avoid falls
Mild cognitive dysfunction : 1 st line Aricept
moderate - can add Nemenda
psychosis and agitation: seroquel ( black box for decreasing life span) and abilify , resperidal, zyprexa
what drugs rec for elderly depression, aggression, resltess, anxiety
SSRI’s ( celexa, Zoloft, Cymbalta)
SNRI ; Wellbutrin
what medication for depression and appetite for elderly
remeron
what meds for sleep problems in elderly
ambien, lunesta, sonata
Vascular DM
2 cause of dementia. ischemic damage to brain from CVA and TIA’s. Athersclerotic plaques, bleeding, and or blood clots
risk factors: HTN and DM
symptoms: memory loss, impaired EF, impaired judgement, apathy, location on infarct determines symptoms, falls, focal weakness, disorientation, anxiety/depression
Lewy body Dementia
caused by alpha synuclein protein. Initally severe sleep distubrance w/ vivid hallucinatiosn , muscle rigity and parkinson like movement disorder
