Dementia and Delirium Flashcards
Dementia characteristics? 3
And at least one in the following? 3
- Slow onset over years
- Symptoms do not rapidly fluctuate
- Memory impairment
At least one of the following
- Aphasia: unable to understand or express speech
- Apraxia: inability to perform required movements
- Agnosia: cannot recognize an object
Characteristics of Delirium? 3
May also have what? 4
Delirium
- Disturbance in consciousness with reduced ability to focus, to sustain focus, or shift attention
- Change in cognition
- Disturbance in consciousness that develops over a short period of time and fluctuates
May also have
- Disturbance in sleep – wake cycle
- Disturbance in psychomotor behavior
- Emotional disturbance
- Rapid unpredictable shifts from one emotional state to another
Clinical Features of Delirium
- Changes occur how?
- Can last how long?
- What is an early finding?
- What is it due to?
- Reversible?
- Acute changes
- Last days to weeks, but rarely months
- Disorientation early
- Prominent physiological changes due to underlying cause
- Usually completely reversible
Delirium
Initial Diagnostic Workup: History
Causes to ask about?
9
- underlying psychiatric disorder
- history of serious brain trauma or disease
- cancer
- infection
- decreased cardiac output
- dehydration,
- acute blood loss,
- MI,
- CHF
Delirium Risk Factors
5
- Dietary difficulties -Poor nutrition
- In hospital
- Dementia
- Family history of mental illness
- Acute stress- loss spouse or change in environment
Delirium Initial Diagnostic Workup: Physical and Lab
5
- Vitals
- Changes due to underlying diseases
- Rule out stroke
- Blood and urine tests- check kidney and liver function
- Radiology
Initial Interventions for Changes in Mental Status: Delirium
5
- Recognize and treat underlying cause
- Reduce stimuli
- Simple, clear language
- Reassurance for person and family
- Be aware of increased risk for mortality
Initial Interventions for Changes in Mental Status: Dementia
6
- Testing to ensure diagnosis
- Discuss long term care plans
- Discuss advance directives
- Refer to Alzheimer’s Association
- Be present
- Slow down
What tests will help us ensure a diagnosis of Dementia?
3
- Neuropsych testing,
- mental status assessment,
- neurological exam
Dementia
- What kind of disorder?
- Significant cognitive decline that is characterized how?
- Neurocognitive disorder
2. Interferes with daily living
Alzheimer’s Disease == AD
1. PP?
2.___ % of all dementias
Why are 2/3 of alzheimer’s pts women? 2
- Progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons and twisted strands of the protein tau (tangles) inside neurons which damage and kill brain cells
- 60
- Women live longer
- Association between gene APOE-e4 and estrogen
Prognosis of AD?
Fatal and cannot be slowed down or cured
What are the three stages of AD?
- Preclinical
- MCI due to AD
- Dementia due to AD
Describe the followign stages of AD?
- measurable changes in brain and may be present 20 years before Sx
- mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities
- quite noticeable memory, thinking, and behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10 – 15 years
Mild (early stage) AD
What are some behaviors that might indicate this stage? 6
- Problem coming up with a right word or name
- Trouble remembering names when introduced to new people
- Having greater difficulty performing tasks in social or work settings
- Forgetting material that one has just read
- Losing or misplacing a valuable object
- Increasing trouble with planning or organizing
Moderate (middle stage) AD
What are some behaviors that might indicate this stage?
9
- Forgetfulness of events or about one’s own personal history
- Feeling moody or withdrawn, especially in mentally challenging situations
- Being unable to recall address or phone number or schools attended
- Confusion about where they are or what day it is
- Needing help choosing proper clothing for the day or season
- Trouble with bowel and bladder control
- Changes in sleep patterns
- Increased wandering and becoming lost
- Personality and behavioral changes
Severe (late stage) AD
What are some behaviors that might indicate this stage?
6
- Require full time around the clock assistance including personal care
- Lose awareness of recent experiences as well as their surroundings
- Require high level of assistance with ADLs
- Experience changes in physical abilities: walk, sit, swallow
- Have increasing difficulty communicating
- Become vulnerable to infections, especially pneumonia
Risk factors for AD?
14
- Age
- Family history
- Hypertension, diabetes mellitus, high cholesterol
- Race: African-American, Hispanic, Native American
- Female
- Level of education
- Socio-economic status
- Alcohol use
- Down’s syndrome
- Head trauma
- Depression
- Exercise
- Obesity
- Smoking
- What is vascular dementia?
- Risk is high for those with what? 3
- Progression?
- Vascular changes present with other types of dementia in 50%. Impaired judgment or impaired ability to make a decision initial Sx
- Risk is high for those with
- hypertension,
- diabetes mellitus, and
- high cholesterol - Slow progression over years
Dementia with Lewy-Body
1. Early on what will the symptoms be? 6
- What are lewy bodies?
- May coexist with what? 2
- Progression?
- Early on:
- sleep disturbances,
- well-formed visual hallucinations,
- gait imbalance and
- Parkinsonian movement features.
- May not have early memory impairment - Lewy bodies: abnormal aggregations (or clumps) of the protein alpha - synuclein that accumulates in neurons
- May coexist in those with Parkinson disease or Alzheimer’s disease
- Progression: steady, gradual
Frontotemporal Lobar Degeneration
1. Includes what? 5
- Early symptoms are marked by what?
- what is spared? - What becomes shrunken?
- Starts at what age?
- Progression?
- Includes:
- behavioral-variant FTLD,
- primary progressive aphasia,
- Pick’s disease,
- corticobasal degeneration,
- progressive supranuclear palsy - Early Sx: marked changes in personality and behavior and difficulty with producing or comprehending language.
- Memory is spared - Nerves in frontal and temporal lobes become shrunken
- Usually starts at age 60
- Progression: steady, rapid
What is mixed dementia defined as?
Alzheimer’s with another type
Parkinson’s Disease Dementia
Problems with what?
5
Problems with movement:
- slowness,
- rigidity,
- tremor, and
- changes in gait and speech,
- depression common
Creutzfeldt-Jakob Disease
- How common?
- Severity?
- What does it cause?
- What causes it?
- How is it contracted? 3
- Very rare
- Rapidly fatal disorder
- Impairs memory and coordination and causes behavior changes
- Caused by a prion (misfolded protein) that causes other proteins throughout the brain to misfold and malfunction
- May be
- inherited,
- sporadic or
- due to infection
Normal Pressure Hydrocephalus
- Symptoms? 3
- Who are at increased risk? 2
- Progression?
- Tx?
- Sx:
- difficulty walking,
- memory loss,
- inability to control urination - Those with history of
- brain hemorrhage (subarachnoid bleed) and
- meningitis are at increased risk - Insidious onset with varied progression
- which may be reversed with surgery
HIV AIDS
Varied course occurring later in disease
Nonspecific impairments such as?
3
- attention,
- executive function with variable memory changes but
- commonly depression
10 Warning Signs of Alzheimer’s Dementia
- Memory changes that disrupt daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words in speaking or writing
- Misplacing things and losing ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood or personality
Early AD dx advantages? 3
- Ability to make plans
- Time for grief, denial, education, acceptance
- Time to create advance directives