Dementia, Delirium & Cognitive Decline Flashcards
What is dementia?
- Umbrella term (>100 different types)
- Progressive neurological disorder
- Group of symptoms caused by disorders affecting the brain
What are the common symptoms of dementia?
- Hard to make new memories
- Hard to communicate
- Confusion
What are some of the common types of dementia?
- 70% Alzheimer’s
- Lewy body
- Vascular
- Frontotemporal
- Mixed
What are some of the less common types of dementia?
- Korsakoff’s syndrome
- HIV associated
- Huntington’s disease
- Mild cognitive impairment (MCI)
What is a rare type of dementia?
Younger onset
What conditions may have similar symptoms to dementia (but are reversible & not degenerative)?
- Vitamin & hormone deficiencies
- Depression
- Medication interaction
- Polypharmacy
- Infection
- Brain tumours
- Delirium
- MCI
What is the pathology of Alzheimer’s?
- Abnormal plaques & tangles accumulate in the brain
- Plaques & tangles slowly destroy the hippocampus
- Slowly spreads to other parts of the brain (language, logic, emotion, sensory interpretation, long term memories)
- Finally compromises balance, coordination & autonomic function
What are the characteristics of Alzheimer’s?
- Gradual onset & progressive decline
- Short then long-term memory
- Decline in cognition & executive functioning
- Difficulties with language, spatial skills
- Mood swings
- Visual & hearing disturbances
- Loss of enthusiasm/ability to initiate
- Decline in physical function
When does the first lesion form in Alzheimer’s?
10-15 yrs before appearance of first symptoms
What is the pathology of vascular dementia?
- Damage to blood vessels
- Single stroke or multiple infarct
- Progressive & sudden changes
- Symptoms dependent on area of brain affected
- Some overlap with Alzheimer’s (mild memory loss, behaviour changes, speech & swallowing)
What are the characteristics of frontotemporal dementia?
- Atrophy/changes to frontal lobes
- Fixed mood & behaviour
- Loss of empathy
- Apathy or lack of motivation
- Loss of normal inhibitions
- Difficulty in reasoning, judgement, organisation & planning
- Distractibility & impulsiveness
- Changes in eating patterns
- Decline in self-care & personal hygiene
What is the pathology of Lewy body disease?
- Degeneration & death of nerve cells (Lewy bodies within cell)
- May be hard to distinguish from PD
What are the characteristics of Lewy body disease?
- Fluctuations in confusion & lucidity within short periods of time
- Parkinsonism (rigidity & balance difficulties)
- Visual hallucinations
- Visuospatial deficits (falls risk)
- Sleep disturbances
What functions of the brain are affected by dementia?
- Memory
- Orientation
- Judgement/decision making
- Multi stage tasks
- Language
- Cognition
- Personality & behaviour
- Initiative
- Confusion
What does dementia increase risk of?
- Falls
- Delirium
- Depression
- Difficult behaviour
- Poor nutritions & hydration
- Elder abuse
What are the common characteristics of confusion?
- Altered sense (vision, hearing, smell, touch, proprioception)
- Not knowing about self (e.g. thinking they are 35 not 70)
- Memory loss
What increases agitation & confusion?
- Confusing structures (noises & smells)
- Fatigue
- Change in routine
- Moving wards/beds
- Unmanaged pain
- Carer demands exceed capacity
What are the key issues with dementia in hospitals?
- 30-50% of inpatients have some cognitive impairment
- 50% of those with dementia are not diagnosed
- Dementia = 2x risk of delirium & 2x more likely to die in hospital
- Average length of stay double non-dementia patient
What are the strategies for reducing the impact of dementia in hospitals?
- Take time to find out what’s wrong
- Familiar objects
- Memory cues
- Good lighting
- Good signage
- Keeping noise level down
- Try to find out likes/dislikes & limit choices
- Planned admissions & discharges
What are 5 things hospital staff should ask carers?
- What things may cause distress?
- What helps settle them down (words, actions)?
- Are there set routines that reassure?
- Are there any repetitive questions/recurring issues that need specific answers? What is the preferred answer?
- Is there somebody they may call out for?
- Are there any signs that indicate they need to go to the toilet?
What is the treatment for dementia?
- Medication (slows progression for a short time only)
- Avoid psychotropic & anti-psychotic drugs (accelerate decline)
- Maintain a healthy heart
- Treat co-morbidities (diabetes, BP, cholesterol, limit alcohol)
- Exercise
How can a carer be affected by dementia?
- Stress
- Grief
- Loss of occupation
- Role change
- Changes to relationships
- Isolation
- Risk of depression
What are the risk factors for dementia?
- Getting older
- Family history
- High BP/cholesterol, diabetes, obesity, CVD
- Lifestyle factors (smoking, excessive drinking)
- Isolation
How can the risk of dementia be reduced?
- Reduce CV risk
- Physical activity
- Mental challenge
- Healthy diet
- Social engagement
- Avoiding head injuries
- Managing depression
