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Geriatrics > Dementia & Delirium > Flashcards

Dementia & Delirium Flashcards

1
Q

Clinical Features of Dementia

A

Slow onset over years
Symptoms do not rapidly fluctuate
Memory impairment
Aphasia, apraxia, or agnosia

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2
Q

Define Aphasia

A

Unable to understand or express speech

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3
Q

Define Apraxia

A

Inability to perform required movements

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4
Q

Define Agnosia

A

Cannot recognize an object

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5
Q

Clinical Features of Delirium

A

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

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6
Q

Important History in the Initial Diagnostic Workup

A 
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
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7
Q

Intoxication that May be Causing the Delirium

A 
Drug or alcohol abuse or poisons
Anticholinergics
Sedatives
Antidepressants
Anticonvulsants
NSAIDs
Corticosteroids
Chemo
Lithium
Cimetidine
Antibiotics
L-dopa
Illicit drugs
Solvents
Heavy metals
Antihistamines
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8
Q

Other Risk Factors for Delirium

A 
Dietary difficulties
In hospital
Dementia
Family history of mental illness
Acute stress
Vision or hearing difficulties (additive effect)
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9
Q

Initial Diagnostic Workup: Physical & Labs

A 
Vitals
Changes due to underlying diseases
Rule out stroke
CBC, CMP
U/A, culture & sensitive
Radiology
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10
Q

Initial Interventions for Delirium

A 
Recognize & treat underlying cause
Reduce stimuli
Simple, clear language
Reassurance for person & family
Be aware of increased risk of mortality
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11
Q

Initial Interventions for Dementia

A 
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
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12
Q

Define Dementia

A

Neurocognitive disorder

Significant cognitive decline that interferes with daily living

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13
Q

Define Alzheimer’s Disease

A

Progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons & twisted strands of the protein tau (tangles) inside neurons which damage & kill brain cells

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14
Q

Alzheimer’s Disease

A

Not part of normal aging
Fatal
Cannot be slowed down or cured
Risk of getting disease can be modified

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15
Q

3 Stages of Alzheimer’s Disease

A

Preclinical
MCI due to Alzheimer’s disease
Dementia due to Alzheimer’s disease

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16
Q

Preclinical Stage of Alzheimer’s Disease

A

Measurable changes in brain & may be present 20 years before symptoms

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17
Q

Minimal Cognitive Impairment Due to Alzheimer’s Disease

A

Mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities

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18
Q

Dementia Due to Alzheimer’s Disease

A

Quite noticeable memory, thinking, & behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10-15 years

19
Q

Stages of Active Alzheimer’s Disease

A

Mild
Moderate
Severe

20
Q

Mild Active Alzheimer’s Disease

A

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

21
Q

Moderate Active Alzheimer’s Disease

A

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

22
Q

Severe Active Alzheimer’s Disease

A

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

23
Q

Risk Factors for Alzheimer’s

A 
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
24
Q

Vascular Dementia

A

Impaired judgement or impaired ability to make a decision

25
Q

Risk Factors for Vascular Dementia

A

HTN
DM
High cholesterol

26
Q

Symptoms of Dementia with Lewy-Body

A

Sleep disturbances
Well-formed visual hallucinations
Gait imbalance & Parkinsonian movement features
Early memory impairment
May coexist with Parkinson’s or Alzheimer’s disease

27
Q

Define Lewy Bodies

A

Abnormal aggregations of the protein alpha-synuclein that accumulates in neurons

28
Q

Frontotemporal Lobar Degeneration Includes

A 
Behavioral-varient frontotemporal lobar degeneration
Primary progressive aphasia
Pick's disease
Corticobasal degeneration
Progressive supranuclear palsy
29
Q

Early Symptoms of Frontotemporal Lobar Degeneration

A

Marked changes in personality & behavior
Difficulty with producing or comprehending language
Memory is spared

30
Q

Progression of Frontotemporal Lobar Degeneration

A

Steady, rapid

31
Q

Progression of Vascular Dementia

A

Slow over many years

32
Q

Progression of Dementia with Lewy Body

A

Steady, gradual

33
Q

Define Mixed Dementia

A

Alzheimer’s with another type of dementia

34
Q

Parkinson’s Disease Dementia

A 
Slowness
Rigidity
Tremor
Changes in gait & speech
Depression
35
Q

Progression of Parkinson’s Disease Dementia

A

Varied

36
Q

Creutzfeldt-Jacob Disease

A 
Rare
Rapidly fatal disorder
Impairs memory & coordination & causes behavior changes
Prion disease
Inherited, sporadic, or due to infection
37
Q

Symptoms of Normal Pressure Hydrocephalus

A

Difficulty walking
Memory loss
inability to control urination

38
Q

Onset & Progression of Normal Pressure Hydrocephalus

A

Onset: insidious
Progression: varied
May be reversed with surgery

39
Q

HIV AIDS

A

Nonspecific impairments of attention, executive function with variable memory changes but commonly depression

40
Q

10 Warning Signs of Alzheimer’s Dementia

A

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

41
Q

Follow Up for Someone with Alzheimer’s Disease

A

Follow neurocognitive decline: MMSE
Follow other chronic diseases: mammogram, A1C, colonoscopy??
Ensure caregivers are doing OK

42
Q

Early Diagnosis Advantages of Alzheimer’s Disease

A

Ability to make plans
Time for grief, denial, education, acceptance
Time to create advance directives

43
Q

Principal Stressors & Illnesses for Caregivers

A 
Financial, emotional, & physical difficulties
Stress: lack of sleep, no time off
Juggling job & caregiving
Income status
Continued worsening of own disease

Geriatrics (15 decks)

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