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Gero > Dementia Delirium Depression > Flashcards

Dementia Delirium Depression Flashcards

Exam 2

1
Q

Cognitive Status:

Cognition: What is it?

A

process by which information is learned, stored, retrieved, and used by the individual.

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2
Q

Cognitive Status:

Cognition: What kind of changes can occur with cognition?

A

Many age-related changes

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3
Q

Cognitive Status:

Memory: How is it long term?

A

Long-term remains relatively stable

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4
Q

Cognitive Status:

Memory: How is it short term?

A

Short-term exhibits more substantial changes

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5
Q

Cognitive Status:

What is the most important risk factor for developing dementia?

A

Age – most important risk factor for developing dementia

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6
Q

Cognitive Status:

What part of aging is dementia considered?

A

Dementia isn’t normal part of aging –it’s a Disease

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7
Q

Cognitive Status:

Senility: What kind of term is it?

A

Senility (old-fashioned term for dementia)

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8
Q

Cognitive Status:

Senility: Senility (old-fashioned term for dementia) using the two interchangeably implies what?

A

Senility (old-fashioned term for dementia) using the two interchangeably implies that characteristics of dementia are typical of advancing age — which is not true

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9
Q

Cognitive Status:

What does dementia involve?

A

Dementia itself involves significant cognitive decline that interferes with daily life and functioning.

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10
Q

Cognitive Status:

What kind of cognitive changes does aging do?

A

Normal aging may involve some cognitive changes, but these are generally mild and do not impede independence.

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11
Q

Cognitive Status

The normal cognitive changes associated with aging include what? How do they progress and effect daily living?

A

The normal cognitive changes associated with aging include mild memory and processing issues that generally do not progress over time nor interfere with daily functioning.

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12
Q

Cognitive Status

Mild cognitive impairment (MCI): What is it?

A

Mild cognitive impairment (MCI) is an intermediary diagnosis between normal cognition and dementia, in which a patient has demonstrable cognitive decline on examination, though not severe enough to affect independence in daily functioning.

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13
Q

Other Causes of Cognitive Changes

A

Parkinson’s disease

Chronic subdural hematoma

AIDS

Neurosyphillis

Liver Disease

Huntington’s disease

Brain Tumors

Hypothyroidism

Alcoholism

Medications

Vitamin deficiencies:

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14
Q

Other Causes of Cognitive Changes:

Medications like:

A

Narcotics,

hypnotics,

antiparkinsonian drugs,

antihistamines,

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15
Q

Other Causes of Cognitive Changes:

Vitamin deficiencies like:

A

VitaminB1,

Vitamin B12,

Folate

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16
Q

Cognitive Impairment:
What may it be associated with?

A

Cognitive impairment may be associated with psychosocial factors

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17
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors

A

Serious losses

Difficult relationships

Changes in social roles

Loneliness

Poverty

Unplanned moves

Relocation stress

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18
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like

Relocation stress: Causes and factors include

A

Relocation stress ( can be due to loss of familiar environment, loss of control, change in routine, health concerns, fear of the unknown)

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19
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: What is it often referred to as:

A

Relocation stress - often referred to as “transfer trauma” or “relocation syndrome,”

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20
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: When it is experienced?

A

is a phenomenon observed in older adults, particularly those in institutional settings, when they experience a move or transfer from one living environment to another.

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21
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: When it is experienced?

A

It is a multifaceted response to the anxiety and stress of such a move, especially when the older individual may not have had a say or active role in the decision-making process.

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22
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: Causes and factors include

Loss of Familiar Environment

A

A move can mean leaving behind a familiar and comforting environment which may have been their home for many years.

This can result in feelings of grief and loss.

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23
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: Causes and factors include

Loss of Control:

A

Older adults might feel they have little or no say in the decision to move, leading to feelings of powerlessness or lack of control over their own lives.

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24
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: Causes and factors include

Change in Routine:

A

Established routines can provide comfort and predictability. A move can disrupt these routines.

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25
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: Causes and factors include

Health Concerns:

A

Many older adults relocate due to health issues.

The combined stress of health problems and relocation can be overwhelming.

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26
Q

Cognitive Impairment:

Cognitive impairment may be associated with psychosocial factors like
Relocation stress: Causes and factors include

Fear of the Unknown:

A

Moving to a new place can be intimidating because of uncertainties about the new environment, caretakers, or neighbors.

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27
Q

Dementia:

What kind of diagnosis is it?

A

An “umbrella” diagnosis

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28
Q

Dementia:

What kind of medical term is it?

A

Dementia: medical term of group of brain disorders characterized by gradual decline in cognitive abilities and changes in personality and behavior

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29
Q

Dementia:

Dementia is NOT what? What does this mean?

A

Dementia is not a single disease, but a group of diseases, each type is associated with a different cause and unique combination of symptoms

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30
Q

Dementia:

How to determine the type of dementia?

A

Not always able to determine type of dementia

Can have more than one type

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31
Q

Dementia:

What does the DSM-5, 2021 emphasize?

A

The DSM-5, 2021 emphasizes that a diagnosis requires a significant decline in cognitive function that interferes with independence in everyday activities.

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32
Q

Dementia:

What kind of assessment tool is used?

A

**Assessment Tool on classes: Use of the Functional Activities Questionnaire in Older Adults with Dementia.

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33
Q

Dementia:

What is it a decline in?

A

Dementia is a decline in mental functioning, affecting memory, cognition, language, and/or personality.

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34
Q

Dementia

Cognitive impairment refers to what?

A

Cognitive impairment refers to a decline in at least one of the following cognitive domains:

language, executive function, complex attention, perceptual-motor function, social cognition, learning, and memory.

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35
Q

Dementia

Cognitive impairment refers to a decline in at least one of the following cognitive domains:

A

language,

executive function,

complex attention,

perceptual-motor function,

social cognition,

learning, and

memory.

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36
Q

Dementia

Cognitive impairment refers to a decline in at least one of the following cognitive domains:

How must the disturbance be?

A

The disturbance must interfere with independence in everyday activities and not be better explained by another neurocognitive disorder.

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37
Q

Slide 6: Functional Activities Questionnaire Administration

A
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38
Q

Dementia: How is the disease usually?

A

A long-term, usually irreversible condition involving degeneration in brain function

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39
Q

Dementia:

The brain function affected depends on what?

A

The brain function affected depends on the type of dementia

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40
Q

Dementia

Pathophysiology for Dementias in general :
includes what?

A

Neuronal Death:

Neurotransmitter Changes:

Structural Brain Changes:

Inflammation:

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41
Q

Dementia

Pathophysiology for Dementias in general :
Neuronal death: Most forms of dementia involve what?

A

Neuronal Death: Most forms of dementia involve the death of nerve cells (neurons) in the brain.

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42
Q

Dementia

Pathophysiology for Dementias in general :
Neurotransmitter Changes: What occurs with this?

A

The levels or functioning of chemicals that nerve cells use to communicate (neurotransmitters) may be altered.

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43
Q

Dementia

Pathophysiology for Dementias in general :
Structural Brain Changes: What occurs with this?

A

Over time, specific areas of the brain may shrink (atrophy) in some types of dementia.

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44
Q

Dementia

Pathophysiology for Dementias in general :
Inflammation: What occurs with this?

A

Some dementias, including AD, involve inflammatory processes in the brain.

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45
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

includes:

A

Amyloid Plaques:

Neurofibrillary Tangles:

Neurotransmitter Disruption:

Brain Atrophy:

Inflammation:

Oxidative Stress:

Vascular Factors:

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46
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Amyloid Plaques: What is the hall mark of AD? What do plaques do?

A

A hallmark of AD is the accumulation of beta-amyloid peptides, which clump together to form plaques in spaces between neurons.

These plaques are believed to block cell-to-cell signaling and trigger an immune response that can lead to inflammation and further damage.

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47
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Neurofibrillary Tangles: Inside neurons, what is a characteristic feature?

A

Inside the neurons, another characteristic feature of AD is the presence of neurofibrillary tangles.

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48
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Neurofibrillary Tangles: What are tangles made from?

A

These tangles are made of a protein called tau.

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49
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Neurofibrillary Tangles: In AD, what happens to Tau?

A

In AD, tau undergoes chemical changes that cause it to form twisted tangles, leading to transport problems inside the neurons and eventual neuron death.

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50
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Neurotransmitter Disruption: As AD progresses, what happens?

A

As AD progresses, there’s a decrease in the level of the neurotransmitter acetylcholine, which plays a vital role in memory and attention.

The neurons that produce acetylcholine are damaged and lost in AD.

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51
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Brain Atrophy: What happens with the damage in AD? What is the first region to be affected?

A

Over time, the damage in AD spreads, and there’s a marked shrinkage (atrophy) of brain tissue.

The hippocampus, crucial for memory formation, is usually the first region to be affected.

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52
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Inflammation: What becomes activated in AD? What do they release?

A

Glial cells, which support neuron function, become activated in AD and release inflammatory molecules that contribute to damage.

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53
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Oxidative Stress:

A

There’s evidence that oxidative stress plays a role in AD.

Reactive oxygen species (free radicals) can damage neurons and are found in higher levels in the brains of people with AD.

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54
Q

Dementia

Pathophysiology of Alzheimer’s Disease (AD):

Vascular factors: What may contribute to AD progression

A

Reduced blood flow, microbleeds, and other vascular changes may contribute to AD progression.

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55
Q

Dementia:

What are the types of dementia?

A
  1. Alzheimer’s Disease (AD)
  2. Vascular Dementia
  3. Lewy Body Dementia
  4. Frontotemporal Dementia
  5. Parkinson’s Disease Dementia
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56
Q

Dementia:

Alzheimer’s Disease (AD): Presentation

A

Patients often present with memory loss as an early symptom.

As AD progresses, other areas of the brain are affected leading to challenges in reasoning, visual spatial abilities, and eventually, speech and movement.

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57
Q

Dementia:

Alzheimer’s Disease (AD): Areas of the brain affected

A

Alzheimer’s primarily impacts the hippocampus, especially in the early stages.

The hippocampus is involved in memory formation.

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58
Q

Dementia:

Vascular Dementia: Areas of the Brain Affected

Why does this form of dementia arise?

A

This form of dementia arises due to reduced blood flow to various parts of the brain.

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59
Q

Dementia:

Vascular Dementia: Areas of the Brain Affected

A

The specific regions affected depend on the blood vessels that are blocked or damaged.

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60
Q

Dementia:

Vascular Dementia: Presentation

How do symptoms appear? What are they? How is progression?

A

Symptoms can be sudden if they are due to a stroke.

They might include confusion, difficulty speaking, or weakness on one side of the body.

The progression can be step-wise, with periods of stability followed by sudden declines.

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61
Q

Dementia:

Lewy Body Dementia (LBD): Areas of the Brain Affected

A

LBD is associated with abnormal protein deposits (Lewy bodies) that form in various parts of the brain, including the cortex and brainstem.

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62
Q

Dementia:

Lewy Body Dementia (LBD):
Presentation:

A

Beyond memory and cognitive challenges, LBD often involves visual hallucinations, Parkinsonian movement symptoms (like rigidity or shuffling walk), and fluctuations in alertness.

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63
Q

Dementia:

Frontotemporal Dementia (FTD):

Areas of the Brain Affected:

A

As the name suggests, FTD affects the frontal and temporal lobes of the brain.

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64
Q

Dementia:

Frontotemporal Dementia (FTD):

Areas of the Brain Affected: As the name suggests, FTD affects the frontal and temporal lobes of the brain.

These regions are associated with what?

A

These regions are associated with personality, behavior, and language.

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65
Q

Dementia:

Frontotemporal Dementia (FTD):

Presentation: How does it begin? How may patients act?

A

Presentation: Unlike other dementias that start with memory problems, FTD often begins with behavioral changes or language disturbances.

Patients might act inappropriately or impulsively, show apathy, or exhibit speech difficulties.

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66
Q

Dementia

Parkinson’s Disease Dementia (PDD)

Areas of the Brain Affected:

A

This type of dementia arises in the context of Parkinson’s disease, which primarily affects the basal ganglia and substantia nigra, regions associated with movement.

However, over time, other brain regions become involved.

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67
Q

Dementia

Parkinson’s Disease Dementia (PDD)

Presentation: When does it present? What symptoms?

A

This dementia typically occurs after a person has had Parkinson’s disease for some time.

Beyond the motor symptoms (like tremors, rigidity), individuals might show slowed thinking, difficulty concentrating, and visual hallucinations.

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68
Q

Dementia: 4 most common typesTable 15-2 :Distinguishing Features of Common Types of Dementia

What is the most common type of dementia? Who has a higher chance of developing this?

A

Alzheimer’s

Women have a higher chance of developing

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69
Q

Dementia: 4 most common typesTable 15-2 :Distinguishing Features of Common Types of Dementia

What is the second most common dementia? Who is at higher risk?

A

Lewy body dementia

Men at higher risk

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70
Q

Dementia: 4 most common typesTable 15-2 :Distinguishing Features of Common Types of Dementia

What is the Nursing Goal for dementia:

A

Identifying factors affecting the client’s functioning and quality of life.

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71
Q

Dementia: 4 most common typesTable 15-2 :Distinguishing Features of Common Types of Dementia

What is the most common dementia for people less than 60? What is it associated with?

A

Frontotemporal Dementia

( here gene mutation associated with it)

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72
Q

Dementia: 4 most common typesTable 15-2 :Distinguishing Features of Common Types of Dementia

–Mixed dementia

A
  • more than 50% of those whose brains met pathological criteria for Alzheimer had pathological evidence of one or more coexisting dimensions (NIA project)
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73
Q

Comments of slide 8

A
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74
Q

Which of the following is the best description of dementia?

A. Manifestation of a treatable condition
B. Syndrome of impaired cognition
C. Single disease
D. Complication of illness

A

B. Syndrome of impaired cognition

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75
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

A

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

memory impairment,

aphasia,

apraxia,

agnosia,

amnesia,

anomia and

impaired executive functions*

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76
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Amnesia: What does it refer to?

A

Memory loss

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77
Q

Dementia:

What is the most most easily visible and common sign of Alzheimer’s dementia?

A

Amnesia

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78
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Amnesia: How does it typically begin? How does it progress?

A

Memory loss in Alzheimer’s disease typically begins withshort-term memoryand progresses to a decline inlong-term memory.

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79
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as: Aphasia

A

Aphasia (Inability to express oneself through speech)

Aphasia is a term used to describe impaired communication

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80
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Aphasia: How may is be classified?

A

Aphasia may be classified asexpressive aphasia, where someone is unable to find the right words or may say them incorrectly, or

receptive aphasia, where the ability to understand, receive and interpret language is impaired.

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81
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Aphasia: What kind of aphasia is present in Alzheimer’s?

A

Alzheimer’s disease affects both expressive and receptive aphasia.

82
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Aphasia: In the early stages of Alzheimer’s what may occur? How does it progress?

A

In the early stages of Alzheimer’s, there might be some mild difficulty withfinding the right word.

As Alzheimer’s progresses into the later stages, speech may become nonsensical and impossible to understand, and it may be difficult to determine how much of what you say is being comprehended.

83
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Aphasia: What an important form of communication?

A

**non-verbal communication—which is an important aspect of interacting with each other when cognition is intact—becomes that much more important when interacting with someone who is living with dementia.

84
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Aphasia: What can it include? What is important?

A

This can include basic tactics such as remembering to smile to reassure the client that you are there to help them, as well as more advanced non-verbal approaches such as demonstrating a task you want to have them complete, instead of just verbally saying it.

Maintain good eye contact and use a relaxed and smiling approach is important.

85
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Aphasia: What else can it include?

A

Aphasia is commonly thought of as the impairment of speech and language, but it also can include the ability to read and write.

86
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as: Anomia

A

Anomia (problems finding the name of things)

87
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as: Apraxia

A

Apraxia (misuse of objects, because of failure to identify them)

88
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as: Agnosia

A

Agnosia (inability to recognize familiar objects, tastes ,sounds and other sensations)

89
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Agnosia: What kind of impairment is it?

A

Agnosia is the impairment of the ability to receive or correctly understand information from the senses of hearing, smell, taste, touch, and vision.

90
Q

Dementia:

It is a syndrome of impaired cognition caused by brain dysfunction and characterized by multiple cognitive deficits, such as:

Agnosia: What is an example?

A

For example :people with Alzheimer’s disease are often less able toidentify smellsor understand the feeling of a full bladder.

They also might not be able torecognize loved ones as the disease progresses.

Difficulty recognizing or interpreting visual shapes is frequently present in Alzheimer’s disease.

Agnosia may also be auditory, where the sense of hearing is intact but the ability to interpret what the sound means is impaired.

91
Q

Dementia:

The presence of what is often part of a cognitive assessment?

A

Agnosia

92
Q

Dementia:

What is one of the most common cognitive issues seen in dementia? What is it often associated with?

A

Apraxia

Apraxia is often associated with agnosia (loss of recognition) and/or aphasia (loss of language).

93
Q

Dementia:

What is one of the most common cognitive issues seen in dementia? What is it often associated with?

Apraxia: What is the person unable to do?

A

The person is unable to perform tasks or learned (familiar) purposeful movements on command even though they may understand the request or command.

94
Q

Dementia

Criteria: Decline in memory (Amnesia) PLUS decline in one or more of the following:

A

Ability to generate coherent speech or understand written or spoken language (Aphasia)

And with finding the right words ( Anomia)

Ability to recognize or identify objects (Agnosia)

Ability to execute motor activities (Apraxia)

Ability to think abstractly, make sound judgments and plan and carry out complex tasks

95
Q

Clinical Manifestations of Dementia

Early (Mild): includes

A

Forgetfulness

Short term memory impairment

Loss of initiative and interest

Decreased judgment

Geographic disorientation

Difficulty recognizing numbers

96
Q

Clinical Manifestations of Dementia

Middle (Moderate): includes

A

Impaired ability to recognize fam and friends

Agitation

Wandering, getting lost

Impaired comprehension

Delusions

Behavioral problems

97
Q

Clinical Manifestations of Dementia

Late (severe) : includes

A

Little memory, unable to process new info

Can’t understand words

Difficulty eating/swallowing

Unable to perform ADLs

Immobility

Incontinence

98
Q

Clinical Manifestations of Dementia

What does research show about people with dementia and awareness?

A

Research shows that people with dementia are acutely aware of the fact that they are experiencing a cognitive deficit.

99
Q

Clinical Manifestations of Dementia

Research shows that people with dementia are acutely aware of the fact that they are experiencing a cognitive deficit.

What is awareness associated with?

A

Awareness associated with higher levels of anxiety and depression.

100
Q

Alzheimer Disease

What are factors that increase the risk for AD?

A

Advanced age

Family history of people who have a first-degree relative with AD (i.e., parent or sibling)

Diabetes

Traumatic brain injury

Depression

Chronic diseases

Genetic factors

101
Q

Alzheimer Disease

Factors that increase the risk for AD:
Genetic factors?

A

Inheriting the APOE-E4 gene from one or both parents

102
Q

Alzheimer Disease

Factors that increase the risk for AD:
Chronic diseases like?

A

Risks for cardiovascular disease: smoking, obesity, diabetes, hypertension, hypercholesterolemia

103
Q

Alzheimer Disease

Factors that increase the risk for AD:

What does a simple blood test help with?

A

Simple blood test found to be up to 96% accurate in identifying elevated levels of beta amyloid and up to 97% accurate in identifying tau, even before symptoms begin to show, a new study suggests.

104
Q

Alzheimer Disease

Factors That Decrease the Risk for AD:

What does a simple blood test help with?

A

Physical activity

  • Diet that is low in saturated fats and rich in vegetables and vegetable-based oils
  • Higher levels of education, which help build a “cognitive reserve”
  • Engaging in social and cognitive activities
105
Q

Alzheimer Disease

What interacts to contribute to AD onset?

A

genetic, environmental, and lifestyle factors likely interact in complex ways to contribute to AD onset and progression.

106
Q

The effects of resistance exercise on cognitive function, amyloidogenesis, and neuroinflammation in Alzheimer’s disease

A

Slide 14 is time?

107
Q

Gradual progression of brain atrophy is correlated with what?

A

Gradual progression of brain atrophy is correlated with stages of Alzheimer’s

108
Q

Gradual progression of brain atrophy is correlated with stages of Alzheimer’s

What are the stages of Alzheimer’s?

A
  1. Mild Cognitive impairment
  2. Mild Alzheimer’s
  3. Moderate Alzheimer’s
  4. Severe impairment
109
Q

Gradual progression of brain atrophy is correlated with stages of Alzheimer’s

What types of neurons are especially susceptible to Alzheimer’s?

A

Neurons that use the neurotransmitter acetylcholine are especially susceptible to the disease.

110
Q

Gradual progression of brain atrophy is correlated with stages of Alzheimer’s

Cortical areas that are preferentially affected include the:

A

Cortical areas that are preferentially affected include the

hippocampus,

the amygdala,

the temporal cortex,

the olfactory system, and

intercortical connections.

111
Q

Treatment of AD:

Broadly, what is the goal of treatment?

A

Disease slowing and management of functional Consequences :

112
Q

Treatment of AD:

Disease slowing and management of functional Consequences :

A

Health promotion interventions:

Reassurance for anxiety and confusion

Redirection for unsafe or inappropriate behaviors

Management of BPSD

Medications

113
Q

Treatment of AD:

Disease slowing and management of functional Consequences :

Health promotion interventions include:

A

Exercise nutrition,

Cognitive engagement

114
Q

Treatment of AD:

Disease slowing and management of functional Consequences :

Medications: What do they do?

A

There is not currently a cure available for Alzheimer disease, but some drugs have been shown to slow the progression of the disease or help with symptoms/behaviors.

115
Q

Treatment of AD:

Disease slowing and management of functional Consequences :

BPSD: What is it?

A

BPSD (behavioral and psychological symptoms of dementia)

116
Q

Treatment of AD:

Disease slowing and management of functional Consequences :

What does treatment consist of?
How are treatment options?

A

Treatment for dementia consists of both pharmacological and nonpharmacological measures.

All treatment options are symptomatic in nature.

There are currently no disease-modifying agents to slow down or reverse the progression of neurodegenerative diseases.

117
Q

Specific medications for Dementia include?

A

Cholinesterase Inhibitors:

NMDA (N-methyl-D-aspartate) receptor antagonists.

Combination medication

118
Q

Cholinesterase Inhibitors:

A

Increase the concentration of acetylcholine and the duration of its action in synapses by inhibiting the degradation of acetylcholine

119
Q

Cholinesterase Inhibitors include:

A

Donepezil (aricept)

Rivastigmine (exelon)

Galantamine (razadyne)

120
Q

Cholinesterase Inhibitors include:

Donepezil (aricept)

A

Tx during all stages of disease

121
Q

Cholinesterase Inhibitors include:

Rivastigmine (exelon)

A

Tx during all stages of disease

122
Q

Cholinesterase Inhibitors include:

Rivastigmine (exelon): How does it differ from other drugs?

A

Exelon is less likely to interact with other drugs and may be safer and better tolerated in people.

123
Q

Cholinesterase Inhibitors include:

Galantamine (razadyne):

A

Tx for mild-moderate AD

Galantamine is effective with cognitive and behavioral symptoms.

124
Q

Cholinesterase Inhibitors:

What should not be done when taking these drugs?

A

No “drug holiday”

The effectiveness of cholinesterase inhibitors is diminished significantly if it is stopped and then restarted.

125
Q

NMDA (N-methyl-D-aspartate) receptor antagonists.

Include:

A

Memantine ( Namenda) Tx for moderate-advance AD

126
Q

NMDA (N-methyl-D-aspartate) receptor antagonists.

Memantine ( Namenda)

A

Tx for moderate-advance AD

Blocks excess of glutamate

127
Q

What is a combination treatment for AD?

A

Namzaric is a combination of Memantine and Donepezil also approved totreat moderate-to-advance AD.

128
Q

Slide 19

A
129
Q

Assessment Tools include:

A

MOCA (Montreal Cognitive Assessment)

Mini Mental Status Exam (MMSE)

Mini-Cog

130
Q

Assessment Tools include:

Mini Mental Status Exam (MMSE) purpose:

A

The MMSE is a widely used screening tool to assess general cognitive function, including orientation, registration, attention, calculation, recall, and language.

131
Q

Assessment Tools include:

Mini Mental Status Exam (MMSE): How is it scored?

A

The maximum score is 30, with a score of 24 or above typically considered normal.

It uses a simpler scoring system with equal weight assigned to each question.

132
Q

Assessment Tools include:

Montreal Cognitive Assessment (MoCA):
Purpose:

A

The MoCA is designed to detect mild cognitive impairment (MCI) and screen for various cognitive domains, including attention, memory, language, visuospatial abilities, executive functions, and orientation.

133
Q

Assessment Tools include:

Montreal Cognitive Assessment (MoCA):
Scoring:

A

The maximum score is 30, with a score of 26 or above generally considered normal.

It uses a weighted scoring system to provide a more comprehensive assessment.

134
Q

Assessment Tools include:

Montreal Cognitive Assessment (MoCA):
How does this test compare to the MMSE?

A

The MoCA is considered more sensitive in detecting MCI compared to the MMSE.

Length: The MoCA is longer and more extensive than the MMSE.

135
Q

Assessment Tools include:

Mini-Cog

Purpose:

A

The Mini-Cog is a brief screening tool for cognitive impairment that combines a three-item recall test with a clock-drawing task.

136
Q

Assessment Tools include:

Mini-Cog

Scoring:

A

It is scored based on the accuracy of recalling the three items and the quality of the clock drawing.

137
Q

Assessment Tools include:

Mini-Cog

How does this test compare to the MoCA and MMSE?

A

Length: The Mini-Cog is shorter and quicker to administer compared to the MoCA and MMSE.

138
Q

Behavioral and Psychological Symptoms of Dementia

include:

A

Aggression and agitation

Psychiatric symptoms (delusions)

Personality changes

Mood disturbances

Aberrant motor movements

Changes in sleep, eating, and appetite

Hypersexual behavior

Sundowning

Wandering

139
Q

Behavioral and Psychological Symptoms of Dementia

Agitation: What can be done about this?

A

(Adequate lighting at night can reduce agitation that can happen when surroundings are dark.

Regular daylight exposure address day and night reversal problems)

140
Q

Behavioral and Psychological Symptoms of Dementia

Sundowning:

A

(Fatigue, overstimulation,
fear of darkness, altered circadian rhythm)

141
Q

Behavioral and Psychological Symptoms of Dementia

What do dementia related behaviors reflect?

A

Dementia-related behaviors reflect an attempt to communicate needs that the person may not consciously recognize and cannot verbally express.

142
Q

Behavioral and Psychological Symptoms of Dementia

Addressing the needs of the person with dementia is best accomplished by:

A

Addressing the needs of the person with dementia is best accomplished by identifying the underlying causes of behavior.

143
Q

Common BPSD (behavioral and psychological symptoms of dementia):

A

Agitation:

Apathy:

Depression:

Anxiety:

Hallucinations:

Delusions:

Sleep Disturbances:

Wandering:

Sundowning:

Repetitive Behaviors:

Sexually Inappropriate Behaviors:

Physical Aggression:

Vocal Outbursts:

Hoarding:

Paranoia:

Catastrophic Reactions:

144
Q

Behavioral and Psychological Symptoms of Dementia - Nursing Care

Major nursing responsibility: What is it?

A

Look for contributing causes and implement strategies to prevent issues or minimize effects .

145
Q

Behavioral and Psychological Symptoms of Dementia - Nursing Care

Person-centered approach: What should be set up?

A

Setting up a daily routine wake/sleep/meals/snacks/rest etc.

146
Q

Behavioral and Psychological Symptoms of Dementia - Nursing Care

Person-centered approach: What should be implemented?

A

Implement regular rest periods (within the daily routine)

147
Q

Behavioral and Psychological Symptoms of Dementia - Nursing Care

Person-centered approach: How should the environment be?

A

Maintain a clutter-free environment.

Place pictures of familiar people in very visible places.

Lay out clothing in the order in which the items are to be donned.

pictures, signs, and color codes for identifying places

148
Q

Read slide 23

A
149
Q

Treatment of the Behavioral Manifestations of AD with medications

What are behavioral illnesses?

A

Depression

Insomnia

Severe agitation, aggression and associate psychosis-delusions.

Anxiety/panic disorders

150
Q

Treatment of the Behavioral Manifestations of AD with medications

Depression: What group of meds are used?

A

Selective serotonin reuptake inhibitor (SSRI) :

Tricyclic antidepressants

151
Q

Treatment of the Behavioral Manifestations of AD with medications

Depression:

Selective serotonin reuptake inhibitor (SSRI): What is included in this?

A

-citalopram (Celexa)

-escitalopram (Lexapro)

-sertraline (Zoloft)

152
Q

Treatment of the Behavioral Manifestations of AD with medications

Depression:

Tricyclic antidepressants: What kind of TCAs should be chosen?

A

Choose TCAs with a more favorable side effect profile, such as

153
Q

Treatment of the Behavioral Manifestations of AD with medications

Depression:

Tricyclic antidepressants: What are examples?

A

nortriptyline (Pamelor)

or desipramine (Norpramin)

154
Q

Treatment of the Behavioral Manifestations of AD with medications

Depression:

Tricyclic antidepressants: What kind of effects do nortriptyline (Pamelor) or desipramine (Norpramin) have compared to other TCAs?

A

Tend to have fewer anticholinergic and cardiovascular effects compared to other TCAs.

155
Q

Treatment of the Behavioral Manifestations of AD with medications

Depression:

When taking SSRIs or TCAs, what does nursing education include?

A

Nursing- pt. teaching maintain fluids

156
Q

Treatment of the Behavioral Manifestations of AD with medications

Insomnia: What is a med?

A

Melatonin with a darkened room

157
Q

Treatment of the Behavioral Manifestations of AD with medications

Sever Agitation, aggression and associate psychosis-delusions: What is a med group?

A

Antipsychotics

158
Q

Treatment of the Behavioral Manifestations of AD with medications

Sever Agitation, aggression and associate psychosis-delusions:

Antipsychotics like:

A

haloperidol (Haldol),

quetiapine (Seroquel)

risperidone (Risperdal)

olanzapine (Zyprexa)

aripiprazole (Abilify)

159
Q

Treatment of the Behavioral Manifestations of AD with medications

Sever Agitation, aggression and associate psychosis-delusions:

Antipsychotics: How do they differ? Which drug is most effective?

A

Each one has slightly different effects on the brain and has its own potential risks and side effects.

The drug with the most evidence to support its use in dementia isrisperidone.

160
Q

Treatment of the Behavioral Manifestations of AD with medications

Sever Agitation, aggression and associate psychosis-delusions:

Antipsychotics: Quetiapine?

A

Quetiapine (Seroquel)
has shown promise in thetreatment of psychosisin elderly patients with Alzheimer’s disease and Parkinson’s disease.

It improves psychosis in patients with Parkinson’s disease without exacerbating movement disorders

161
Q

Treatment of the Behavioral Manifestations of AD with medications

Anxiety/panic disorders: med groups used?

A

Benzodiazepines

Non-Benzodiazepine Anxiolytic

162
Q

Treatment of the Behavioral Manifestations of AD with medications

Anxiety/panic disorders:

Benzodiazepines: How is it used? Why?

A

(for short-term use due to addictive potential):

163
Q

Treatment of the Behavioral Manifestations of AD with medications

Anxiety/panic disorders:

Benzodiazepines: Include what drugs?

A

lorazepam (Ativan) Benzo *addictive

diazepam (Valium) Benzo *addictive

164
Q

Treatment of the Behavioral Manifestations of AD with medications

Anxiety/panic disorders:

Non-Benzodiazepines Anxiolytic: How is it used?

A

(a safer long-term option)

165
Q

Treatment of the Behavioral Manifestations of AD with medications

Anxiety/panic disorders:

Non-Benzodiazepines Anxiolytic: What meds are included?

A

buspirone (BuSpar) *not a sedative not addictive

166
Q

Treatment of the Behavioral Manifestations of AD with medications

How do benzos compare to non-benzos do?

A

While Benzos calms the body by binding with GABA receptors, buspirone (anxiolytics) acts on serotonin receptors.

Unlike Benzos buspirone is not addictive and causes less sedation than benzos.

167
Q

Slide 26

A
168
Q

Delirium:

According to the DSM-V Criteria, what is delirium?

A

DSM-V Criteria—it’s a syndrome

169
Q

Delirium:

What is it?

A

Disturbance of consciousness with reduced ability to focus, sustain or shift attention—change in mental status and cognition or development of a perceptual disturbance not better accounted for by pre-existing dementia

170
Q

Delirium:

How does disturbance develop?

A

Disturbance develops over a short period ( hours/days) fluctuate during the course of the day

171
Q

Delirium:

What is the disturbance caused by?

A

Evidence from history, physical or labs that the disturbance is caused by the direct physiological consequences of a general medical condition

172
Q

Occurrence of Delirium in Older Persons

Where does it mostly occur?

A

80%+ intensive care settings

173
Q

Assessment Tool: Confusion Assessment Method (CAM):

What is it? Who can do this assessment?

A

Nursing assessment of delirium

The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings.

174
Q

Assessment Tool: Confusion Assessment Method (CAM):

What is vital?

A

Frequent assessment vital

175
Q

Assessment Tool: Confusion Assessment Method (CAM):

What are the features?

A

Feature 1: Acute onset and fluctuating course

Feature 2: Inattention

Feature 3: Disorganized thinking

Feature 4: Altered level of consciousness

176
Q

Assessment Tool: Confusion Assessment Method (CAM):

Feature 1: Acute onset and fluctuating course

Who is this feature usually obtain from? What indicates this feature is present?

A

This feature is usually obtained from a family member or nurse and is shown by positive responses to the following questions:

Is there evidence of an acute change in mental status from the patient’s baseline?

Did the (abnormal) behavior fluctuate during the day, that is, tend to come and go, or increase and decrease in severity?

177
Q

Assessment Tool: Confusion Assessment Method (CAM):

Feature 2: Inattention

How is this feature positive?

A

This feature is shown by a positive response to the following question:

Did the patient have difficulty focusing attention, for example, being easily distractible, or having difficulty keeping track of what was being said?

178
Q

Assessment Tool: Confusion Assessment Method (CAM):

Feature 3: Disorganized thinking -

How is this feature positive?

A

This feature is shown by a positive response to the following question: Was the patient’s thinking disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?

179
Q

Assessment Tool: Confusion Assessment Method (CAM):

Feature 4: Altered Level of consciousness -

How is this feature positive?

A

This feature is shown by any answer other than “alert” to the following question: Overall, how would you rate this patient’s level of consciousness?

180
Q

Assessment Tool: Confusion Assessment Method (CAM):

Using the CAM tool, what would suggest a diagnosis of delirium?

A

Four-point algorithm; the presence of features 1 and 2 and either 3 or 4 are present (CAM +/positive), a diagnosis of delirium is suggested.

181
Q

Assessment Tool: Confusion Assessment Method (CAM)

What can improve outcomes in elderly with delirium?

A

Early recognition and treatment can improve outcomes.

182
Q

Assessment Tool: Confusion Assessment Method (CAM)

What is a key issue in recognizing delirium? What does this mean?

A

A key issue in recognizing delirium is understanding the older adult’s baseline and quickly identifying changes, which in the case of delirium can occur within hours.

Therefore, older adults should be assessed frequently

183
Q

Assessment Tool: Confusion Assessment Method (CAM)

What are other versions of this?

A

There is also a CAM-ICU version for use with non-verbal mechanically ventilated patients

The CAM-S is a companion tool to the CAM that can be used to assess the severity of delirium

184
Q

Assessment Tool: Confusion Assessment Method (CAM)

CAM-ICU: What does it take into account?

A

The CAM-ICU takes into account the unique challenges and characteristics of critically ill patients, such as the use of sedatives and mechanical ventilation.

185
Q

Prodromal symptoms of delirium
include:

A

Restlessness

Anxiety

Irritability

Sleep disturbance

186
Q

Prodromal symptoms of delirium may progress to delirium over how many days?

A

May Progress to full-blown delirium over 1 to 3 days ( Hours to days)

187
Q

Risk Factors for Delirium

A

History of dementia, depression or previous delirium

Sensory impairment

Multiple chronic conditions

Increasing severity of illness

Polypharmacy

Increasing age

Immobility and
functional dependency

Sleep deprivation

188
Q

Causes of delirium include:

A

Central Nervous System

Metabolic

Cardiopulmonary

Systemic illness

189
Q

Causes of delirium include:

Central Nervous System like:

A

Head trauma

190
Q

Causes of delirium include:

Metabolic like:

A

Acid base imbalance

191
Q

Causes of delirium include:

Cardiopulmonary like:

A

MI

CHF

192
Q

Causes of delirium include:

Systemic illness like:

A

Substance withdrawal

Infection

Sensory deprivation

Temperature dysregulation

Postoperative state

193
Q

Drugs that cause delirium include:

A

Anesthetics

Analgesics

Antihistamines

Antihypertensives

Muscle relaxants

Psychotropic medications

Cardiovascular medications

Corticosteroids

194
Q

Drugs that cause delirium:

When there is a change in cognition in a patient, what is the priority?

A

Nursing: Change in cognition in a patient –Priority is to assess their medications (after ABC and safety of course!)

195
Q

Delirium:

3 Variants- what are they?

A

Hypoactive delirium

Hyperactive delirium

Mixed delirium

196
Q

Delirium:

3 Variants-hypoactive delirium

A

This may include inactivity or reduced motor activity, sluggishness, abnormal drowsiness.

197
Q

Delirium:

3 Variants-hyperactive delirium

A

This may include restlessness, agitation, rapid mood changes or hallucinations

198
Q

Delirium:

3 Variants-Mixed delirium

A

Both hyperactive and hypoactive symptoms.

The person may quickly switch back from hypoactive and hyperactive states.

199
Q

Nursing Care Strategies to Manage a Patient with Delirium

Nursing Priority: What is it?

A

Nursing Priority: low-dose oxygenation and maintain their fluid and electrolyte balance.

200
Q

Nursing Care Strategies to Manage a Patient with Delirium

What should be done with meds?

A

Eliminate as many medications as you possibly can, since many medications are causative factors in delirium

201
Q

Nursing Care Strategies to Manage a Patient with Delirium

What are a few things that should be done?

A

Consistent caregivers-evidence

Sensory deficits

Environment:

Physical activity:

Fluid and electrolyte balance

202
Q

Strategies to Manage a Patient with Delirium

What are somethings that should be done?

A

Bowel and bladder

Safety

Psychological support

Sleep promotion

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