Dementia & Delirium Flashcards
Clinical Features of Dementia
Slow onset over years
Symptoms do not rapidly fluctuate
Memory impairment
Aphasia, apraxia, or agnosia
Define Aphasia
Unable to understand or express speech
Define Apraxia
Inability to perform required movements
Define Agnosia
Cannot recognize an object
Clinical Features of Delirium
Disturbance in consciousness with reduced ability to focus, sustain focus, or shift attention
Change in cognition
Disturbance in consciousness that develops over a short period of time & fluctuates
May also have sleep, psychomotor behavior, or emotional disturbances, or rapid unpredictable shifts from one emotional state to another
Important History in the Initial Diagnostic Workup
All medical history Underlying psychiatric disorder Hx of serious brain trauma or disease CA Infection Decreased cardiac output (dehydration, acute blood loss, MI, CHF) All surgical history All medications taken
Intoxication that May be Causing the Delirium
Drug or alcohol abuse or poisons Anticholinergics Sedatives Antidepressants Anticonvulsants NSAIDs Corticosteroids Chemo Lithium Cimetidine Antibiotics L-dopa Illicit drugs Solvents Heavy metals Antihistamines
Other Risk Factors for Delirium
Dietary difficulties In hospital Dementia Family history of mental illness Acute stress Vision or hearing difficulties (additive effect)
Initial Diagnostic Workup: Physical & Labs
Vitals Changes due to underlying diseases Rule out stroke CBC, CMP U/A, culture & sensitive Radiology
Initial Interventions for Delirium
Recognize & treat underlying cause Reduce stimuli Simple, clear language Reassurance for person & family Be aware of increased risk of mortality
Initial Interventions for Dementia
Testing to ensure diagnosis: neuropsych, mental status, neurological exam, B12, hypothyroidism, Korsakoff syndrome, Normopressure hydrocephalus, uncontrolled DM Discuss long term care plans Discuss advanced directives Refer to Alzheimer's Association Be present Slow down
Define Dementia
Neurocognitive disorder
Significant cognitive decline that interferes with daily living
Define Alzheimer’s Disease
Progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons & twisted strands of the protein tau (tangles) inside neurons which damage & kill brain cells
Alzheimer’s Disease
Not part of normal aging
Fatal
Cannot be slowed down or cured
Risk of getting disease can be modified
3 Stages of Alzheimer’s Disease
Preclinical
MCI due to Alzheimer’s disease
Dementia due to Alzheimer’s disease
Preclinical Stage of Alzheimer’s Disease
Measurable changes in brain & may be present 20 years before symptoms
Minimal Cognitive Impairment Due to Alzheimer’s Disease
Mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities
Dementia Due to Alzheimer’s Disease
Quite noticeable memory, thinking, & behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10-15 years
Stages of Active Alzheimer’s Disease
Mild
Moderate
Severe
Mild Active Alzheimer’s Disease
Problems coming up with right word or name
Trouble remembering names to new people
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 Active Alzheimer’s Disease
Forgetfulness of events or one’s history
Feeling moody or withdrawn
Being unable to recall address or phone number or schools attended
Confusion on where they are & what day it is
Need help choosing clothing for day or season
Trouble with bowel & bladder control
Changes in sleep patterns
Increased wandering & becoming lost
Personality & behavioral changes
Severe Active Alzheimer’s Disease
Require full time assistance including ADLs
Lose awareness of recent experiences as well as surroundings
Experience changes in physical abilities: walk, sit, swallow
Have increasing difficulty communicating
Become vulnerable to infections
Risk Factors for Alzheimer’s
Age Family history HTN, DM, high cholesterol Race: African or Native American Female Level of education SES Alcohol use Down syndrome Head trauma Depression Exercise Obesity Smoking
Vascular Dementia
Impaired judgement or impaired ability to make a decision
Risk Factors for Vascular Dementia
HTN
DM
High cholesterol
Symptoms of Dementia with Lewy-Body
Sleep disturbances
Well-formed visual hallucinations
Gait imbalance & Parkinsonian movement features
Early memory impairment
May coexist with Parkinson’s or Alzheimer’s disease
Define Lewy Bodies
Abnormal aggregations of the protein alpha-synuclein that accumulates in neurons
Frontotemporal Lobar Degeneration Includes
Behavioral-varient frontotemporal lobar degeneration Primary progressive aphasia Pick's disease Corticobasal degeneration Progressive supranuclear palsy
Early Symptoms of Frontotemporal Lobar Degeneration
Marked changes in personality & behavior
Difficulty with producing or comprehending language
Memory is spared
Progression of Frontotemporal Lobar Degeneration
Steady, rapid
Progression of Vascular Dementia
Slow over many years
Progression of Dementia with Lewy Body
Steady, gradual
Define Mixed Dementia
Alzheimer’s with another type of dementia
Parkinson’s Disease Dementia
Slowness Rigidity Tremor Changes in gait & speech Depression
Progression of Parkinson’s Disease Dementia
Varied
Creutzfeldt-Jacob Disease
Rare Rapidly fatal disorder Impairs memory & coordination & causes behavior changes Prion disease Inherited, sporadic, or due to infection
Symptoms of Normal Pressure Hydrocephalus
Difficulty walking
Memory loss
inability to control urination
Onset & Progression of Normal Pressure Hydrocephalus
Onset: insidious
Progression: varied
May be reversed with surgery
HIV AIDS
Nonspecific impairments of 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 & spatial relationships
New problems with words in speaking or writing
Misplacing things & losing ability to retrace steps
Decreased or poor judgement
Withdrawal from work or social activities
Changes in mood or personality
Follow Up for Someone with Alzheimer’s Disease
Follow neurocognitive decline: MMSE
Follow other chronic diseases: mammogram, A1C, colonoscopy??
Ensure caregivers are doing OK
Early Diagnosis Advantages of Alzheimer’s Disease
Ability to make plans
Time for grief, denial, education, acceptance
Time to create advance directives
Principal Stressors & Illnesses for Caregivers
Financial, emotional, & physical difficulties Stress: lack of sleep, no time off Juggling job & caregiving Income status Continued worsening of own disease
