Depression/Delirium/Dementia Flashcards
Depression characteristics
Often overlooked or misdiagnosed as dementia or cognitive impairment - “pseudodementia.”
Difficulty concentrating or problem solving, memory loss, irritability.
Depression may correlate with…
Falls risk: fear of falling = less activity = greater risk.
Medications: side effects of pain meds, steroids.
Anti-depressants usually sedative, which further increases falls risk
Most valid screening tools for depression
GDS
CES-D
(higher scores = more depressed)
Consideration for administering the GDS
Verbally ask the questions - answer choices that indicate depression are bolded, may sway answer choices
T/F: anti-depressants are the most effective intervention
FALSE!
Exercise is often just as effective as meds
Considerations for interventions with depression
Pain reduction - esp if depression is due to chronic pain.
Falls prevention & fear of falling education.
Refer back to MD if high screening scores
Normal cognitive changes with age
Decreased visual & verbal memory - difficulty naming/identifying objects.
Decreased visuospatial ability - e.g. moving around objects to avoid tripping.
Decreased immediate memory.
Pathological cognitive changes (indicates dementia)
Inhibition of neural growth factors.
Loss of neural connections.
Brain tissue atrophy.
ACh deficiency.
Dopamine excess.
Increased amyloid plaque.
Increased neurofibrillary tangles.
Criteria for dementia
Multiple cognitive deficits (including memory) AND at least one:
1. Aphasia - impaired speech
2. Apraxia - impaired motor
3. Agnosia - impaired processing/recognition
4. Executive dysfunction
Early stages of dementia
Aware they’re having memory problems, pts will recognize/understand the impairment
Cortical Dementia (2 types)
Alzheimer’s: most common.
Frontotemporal: word finding & recognition (temporal involvement); multitasking, impulsive, innapropriate (frontal involvement)
Subcortical Dementia (2 types)
Lewy Body: fluctuations in alertness, hallucinations.
Parkinson’s: dementia may be associated with PD.
Vascular Dementia
Due to infarct, gets progressively worse if multiple infarcts/strokes
Alzheimer’s - early stage
Mild memory impairments.
Altered judgement, misplacing objects, losing words, difficulty recognizing people.
Difficulty learning novel/complex tasks.
Subtle personality changes.
Alzheimer’s - middle stage
Memory/language worsen.
Difficulty performing IADLs (taking meds, paying bills, etc.)
Apraxia.
Disoriented to time/place.
Delusional or agitated.
Alzheimer’s - late stage
Loss of mobility.
Bladder/bowel control issues.
24/7 care for ADLs.
Difficulty or unable to speak/swallow/cough (risk for pneumonia).
Unable to recognize family.
Significant personality changes.
Alzheimer’s - terminal stage
Unaware of environment.
Total assist.
Mute, bedridden.
Primitive reflexes return.
What are possible causes of Alzheimer’s?
50% genetic
50% environment
Most common cause of death in Alzheimer’s pts
Aspiration pneumonia
Dementia screening tools
6CIT
Trail-making test
Mini-Cog
ADAS (good but takes 30min to admin)
Which dementia screening tools differentiate btwn domains (apraxia, aphasia, etc.)
MMSE
MoCA
SLUMS
Screening for dementia should include…
At least 1 depression screen
Dementia considerations with interventions
Resisted AND aerobic exercise (mod-high intensity).
Cognitive tasks early - build up reserve to slow progression.
Be mindful of sundowning & timing around meds.
Key difference btwn dementia and delirium
Dementia: slow onset. Takes time to develop.
Delirium: acute. Can wake up randomly with delirium.
