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.
Delirium prognosis
Good bc no tissue pathology. Delirium stops once trigger is removed (e.g., if caused by UTI, cognition returns once UTI resolves).
Agitated/Hyperactive delirium
Restraining/sedation often makes it worse.
Sedation can risk aspiration.
BEST option = early mobilization!
Quiet/Hypoactive delirium
Unresponsive, sluggish, confused, no command following.
More common than hyperactive - often misdx as dementia or depression.
T/F: pt can have both types of delirium at once
TRUE!
May fluctuate btwn hyper/hypo at certain times of day.
Delirium screening - 4 A’s
Alertness: falling back asleep >10sec after waking.
Abbreviated mental test: age, DOB, place, & year.
Attention: list months in reverse order, starting at Dec.
Acuteness: significant change in mental status in last 2wks, still persisting in last 24hrs.
Confusion Assessment Method
Assesses 9 clinical features. Good for distinguishing delirium from dementia/depression.
Delirium = yes to items 1 AND 2, and either 3 or 4.
1. Acute changes from baseline.
2. Inattention.
3. Disorganized thinking.
4. Altered LOC.
Delirium prevention
Reduce risk factors (nutrition education, meds, etc.)
Early identification of behavior changes.
Post-op: early mobility, get anesthesia OUT of system!
Delirium: methods to help re-orient
Turn TV on (news is good!)
Open blinds, turn lights on.
Keep whiteboard accurately updated with dates.
Hallucinations are common in what?
Delirium
Lewy Body dementia (hallucinations NOT common in all other types of dementia).
Symptoms worse in the morning suggest:
a) Dementia
b) Delirium
c) Depression
c) Depression
Symptoms worse in the evening/night suggest:
a) Dementia
b) Delirium
c) Depression
b) Delirium
Symptoms with no pattern of worsening at certain times of day suggest:
a) Dementia
b) Delirium
c) Depression
a) Dementia
___ is reversible:
a) Dementia
b) Delirium
c) Depression
b) Delirium
AND
c) Depression
Signs of illness suggests:
a) Dementia
b) Delirium
c) Depression
b) Delirium
