Dementia & Mmt Disorders Flashcards
Cognitive Screens for Dementia
-mini mental status exam
-Montreal cognitive assessment
-referral of neurophysiological testing
Benefits:
-cueing, instructions, education, documentation
Limitations:
-can be demeaning, only a screen
Outcome Measures for Dementia
-TUG
-QoL
-Depression
-Anxiety
-caregiver burden
-Berg
-6MWT
Test Selection: Dementia
-should be obvious
-short instructions
-short duration
Tips:
-clear speech
-friendly facial expressions
-eye contact
-remove distractions
Aerobic Ex for Dementia
-lessens cognitive impairments and dementia risk
-neuroprotective
-reduces agitation
-moderations brain atrophy
Strength Training Recommendations @ Old Age
-2x week major muscle groups
-mod to high intensity
Balance Training @ Old Age
-3x week
-fall rpevention
Home Exercise Program (Dementia)
-practice
-clear language
-big print
-increase self efficacy
Maintaining Personhood
-person’s growth in coping skills
-focus on independence
-subjective experience of illness
Remaining Cognitive Strengths
-reading simple words
-emotional and procedural memory
-L/R orientation
tie in to movement/exercise
LEAD Rehabilitation Framework
Leveraging
Existing
Abilities In
Dementia
-developing an underlying knowledge
-integrate communication, cognition, coping
Communication Strategies
-approach from front on their level
-remove distractions
-eye contact
-smiling
-explain
-invite to participate; allow to time to respond w/ repetition
-K.I.S.S: keep it short and simple
-ask questions based on currrent, not short term memory
-cues
-narrow choices
Cognition/Education Strategies
Errorless learning
-with feedback
Modeling
- to utilize procedural memory (motor tasks, for language deficits)
Spaced Retreval
-builds on implicit or procedural memory
-retaining info by recalling
-learining without intention
External Memory Aids
-ABLED
-memory books
-planners/signs/calendars
Cognitive Task Analysis
-breaking down a task into simplest cognitive components
ABLED
-accessible: easily seen
-bright
-legible: large
-explicit: simple
-done: able to cross off
Coping Strategies
Reframing
-changing thinking and descalating
Re-Evaluating Expectation
-reasonable goals to the person
Substituting Behaviors
-replacing undesirable behaviors with others
Adjusting the Environment
Pearls of Wisdom
-patient centered care
-Match patient and appropriate clinician
-Have back up plans
-know how much communication
-be creative
Delirium
-acute confusional state
-short period of time
-worse at night
-80% of elderly in ICU
-15-50% of all hostpital pts
S/s:
-disrupted sleep
-disordered thinking
-delusion
-hallucinations
-restlessness
Causes:
-vascular
-Trauma/surgery
-Metabolic/infection
-Tumors/seizures
-Drugs
Treatment:
-reoreintation
-out of bed
-less noise at night
-solve underlying issues
Dementia
-progressive loss of congitive functions that interfere activites
S/s;
-Impaired learning and memoy (temporal)
-impaired complex tasking and reasoning (frontal)
-impaired orientation (pareital)
-aphasia (temportal and parietal)
-changes in social
-decline from previous
Causes:
-alzheimers
-vascular
-parkinsons
-huntingtons
-alcohol
-CTE
-HIV/infections
-Meds
Normal Pressure Hydrocephalus
-memory problems, gait (magnetic), incontinence
Imaging: large ventricles
Treatment: VP shunt
Evaluation of Dementia
HX:
-impairement
-onset
-progression
-prior level of function
Exam:
-observstion
-mental status
-neuro
Labs:
-HIV/syphilis
-thyroid/liver/kidney
-B12/folate
-Lupus test
Imaging:
-MRI
-PET/Amyloid PET (ARIA-E)
Mild Cognitive Impairement
-pre dementia
-impairement in 1 or more domain w/o dementia or ADL involvement
-12-18% of ppl >60
Predicitors:
-medial lobe attrophy
Tx:
-exercise (no drugs)