Dementia and Delirium Flashcards
1
Q
Characteristics of Dementia?
A
- slow onset over yrs
- sxs don’t rapidly fluctuate
- memory impairment
- at least one of the following:
aphasia: unable to understand or express speech
apraxia: inability to perfrom reqd movements
agnosia: can’t recognize an object - neurocog disorder
- sig cognitive decline that interferes w/ daily living
2
Q
Characteristics of Delirium?
A
- disturbance in consciousness w/ 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:
disturbances in sleep-wake cycle
disturbance in psychomotor behavior
emotional disturbance
rapid unpredictable shifts from one emotional state to another - acute changes
- last days to weeks, but rarely months
- usually completely reversible
- disorientation early
- prominent phsyiological changes due to underlying cause
3
Q
Initial dx workup - Hx?
A
all medical hx:
- underlying psychiatric disorder
- hx of serious brain trauma or disease
- cancer
- infection
- decreased CO: dehydration, acute blood loss, MI, CHF
- all surgical hx
- all meds take
- ETOH
- social hx
4
Q
Intoxication of what drugs can cause delirium?
A
drug or ETOH abuse or poisons
- anticholinergics
- anticonvulsants
- anticancer drugs
- abx
- marijuana
- cocaine
- inhalants
- heavy metals
- sedatives
- NSAIDs
- lithium
- L-dopa
- LSD
- opiates
- mushrooms
- antidepressants
- corticosteroids
- cimetidine (H2 receptor antagonist)
- ETOH
- amphetamines
- PCP
- solvents (gas)
5
Q
Other RFs for delirium?
A
- dietary difficulties: poor nutrition - in hosp - dementia (harder to recognize and tx) - family hx of mental illness - acute stress: loss of spouse or changes in environment - vision/hearing difficulties
6
Q
Initial dx workup for delirium - Physical and lab work?
A
- vitals
- changes due to underlying diseases
- r/o stroke
- blood and urine tests: check kidney and liver fxn
- radiology
7
Q
Initial intervention for changes in mental status: delirium?
A
- recognize and tx underlying cause
- reduce stimuli
- simple, clear language
- reassurance for person and family
- be aware of increased risk for mortality
8
Q
Initial intervention for changes in mental status: dementia?
A
- testing to ensure dx: neuropsych testing, mental status assessment, neuro exam - discuss long term care plans - discuss advance directives - refer to alzheimers assoc - be present - slow down
9
Q
How common in AD? Pathogenesis of it?
A
- 60% of all dementias
- 1/9 people 65 and older have AD
- 81% of people who have AD are 75 and older
- 2/3 are women (women live longer, and assoc b/t gene APOE-e5 and estrogen
- progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons and twisted strands of protein tau (tangles) inside neurons which damage and kill brain cells
- not a normal part of aging, may occur in younger person w/ young onset AD
- fatal
- 6th leading COD in US
- can’t be slowed down or cured
- risk for getting disease can be modified
10
Q
What are the stages of AD?
A
3 stages:
- preclinical: measurable changes in brain and may be present 20 yrs b/f sxs
- MCI due to ADL mild but measurable changes in thinking abilities that are noticeable but don’t affect daily activities: may be up to 10-20% of those over 64
- dementia due to AD: quite noticeable memory, thinking and behavioral sxs that impair ability to fxn in daily life with a steady gradual progression over 10-15 yrs
11
Q
Describe the mild (early stage) of active AD?
A
- problem coming up w/ 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 w/ planning or organizing
12
Q
Describe the moderate (middle stage) of active AD?
A
- forgetfullness of events or about one’s own personal hx
- feeling moody or withdrawn, esp 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 day or season
- trouble w/ bowel and bladder control
- change in sleeping patterns
- increased wandering and becoming lost
- personality and behavioral changes
13
Q
Describe the severe (late stage) of active AD?
A
- reqr full time around clock assistance including personal care
- lose awarenss of recent experiences as well as their surroundings
- reqr high level of assistance w/ ADLs
- experience changes in physical abilities: walk, sit, swallow
- have increasing difficulty communicating
- become vulnerable to infections, esp pneumonia (aspiration)
14
Q
RFs for AD?
A
- age
- family hx
- HTN, DM, high cholesterol
- race: African American , Hispanic, Native American
- female
- level of education
- socio-economic status
- ETOH use
- Down sydrome
- head trauma
- depression
- exercise
- obesity
- smoking
15
Q
What is vascular dementia?
A
- 10% of all dementia cases
- vascular changes present w/ other types of dementia in 50%
- impaired judgement or impaired ability to make a decision initial sx
- risk is high for those w/ HTN, DM, and high cholesterol
- slow progression over yrs
16
Q
What is dementia w/ lewy-bodies?
A
- some sx similar to AD
- 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 protein alpha: synuclein that accumulates in neurons
- may coexist in those w/ parkinson disease or alzheimers disease
- progression: steady, gradual
17
Q
What is frontotemporal lobar degeneration?
A
- includes: behavioral variant FTLD, primary progressive aphasia, Pick’s disease, corticobasal degeneration, and progressive supranuclear palsy
- early sx: marked changes in personality and behavior and difficulty w/ producing or comprehending language, memory is spared
- nerves in frontal and temporal lobes become shrunken
- usually starts at 60
- progression: steady and rapid
18
Q
What is mixed dementia?
A
- alzheimers w/ another type: FTLD, lewy bodies
19
Q
What is Parkinson’s disease dementia?
A
- problems w/ movement: slowness, rigidity, tremor, and changes in gait and speech, depression common
- incidence about 1/10 of AD
- progression: varied
20
Q
What is Creutzfeldt-Jakob disease?
A
- very rare, but rapidly fatal disorder
- impairs memory and coordination and causes behavioral changes
- caused by prion (misfolded protein) that causes other proteins throughout brain to misfold and malfxn
- may be called prion disease
- may be inherited, sporadic or due to infection
21
Q
What is normal pressure hydrocephalus - relationship w/ dementia?
A
- sx: difficulty walking, memory loss, inability to control urination
- 5% of all dementias
- those w/ hx of brain hemorrhage (subarachnoid bleed) and meningitis are at increased risk
- insidious onset w/ varied progression which may be reversed w/ surgery
22
Q
HIV AIDS assoc w/ dementia?
A
- HIV (dementia from opportunistic infections, encephalitis)
- varied course occurring later in disease
- nonspecific impairments of attention, executive fxn w/ variable memory changes but commonly depression
23
Q
What are the 10 warning signs of AD?
A
- memory changes that disrupt daily life
- difficulty completing familiar tasks
- confusion w/ time or place
- trouble understanding visual images, and spatial relationships
- new problems w/ words in speaking or writing
- misplacing things and losing ability to retrace steps
- decreased or poor judgement
- withdrawal from work or social activities
- changes in mood or personality
24
Q
What does F/U include for pt w/ AD?
A
- follw neurocog decline: mental status exam
- follow other chronic diseases:
know morbidity and mortality of AD: 60 yr old female is 2x as likely to develop AD than breast cancer in her lifetime - know whether to continue screening other diseases:
mammogram
HBA1C - ensure caregivers are doing ok - early mortality, support
- risk of death for 70 yo w/in 10 yrs:
w/ AD: 61%
w/o AD: 30%
25
Early dx advantages of AD?
- ability to make plans
- time for grief, denial, education, acceptance
- time to create advance directives
26
What are principal stressors and illnesses for caregivers?
- financial/emotional and physical difficulties: 40% have depression
- stress: lack of sleep, no time off
- juggling job and caregiving
- income status
- continued worsening of own disease: many die b/f person w/ AD
