First Aid CH8 NCDs Flashcards
three main categories of NCDs
delirium, mild NCDs, major NCDs
define delirium
acute brain failure, disorder of orientation (attention, awareness) and language/vision, medical emergency that’s generally reversible but potentially deadly
onset time of delirium
hours to days, sxs worse at night (usually)
risk factors for delirium
polypharm, advanced age, immobility, pre-existing cog impairment, ETOH use, severe/terminal illness, malnutirtion
medications that can cause delirium
TCAs, Benzos
Anti-cholinergics, H2 blockers
Corticosteroids, Meperidine (opioid)
five categories of delirium
substance intoxication/withdrawal
medication-induced
delirium d/t medical condition/multiple etiologies
three types of delirium based on psychomotor activity (one of the five categories then gets sub-classed with one of these)
mixed: most common, normal psychomotor or fluctuating
hypoactive: most likely to go undetected, presents as drowsiness or lethargy
hyperactive: agitation, uncooperative, disruptive, MC in drug withdrawal/toxicity
CAM test
evaluation for suspected delirium
sxs of delirium
short attention span, disorientation, fluctuations in lvl of consciousness, visual hallucinations, poor short-term memory
MC precipitants of delirium in kids
febrile illness, meds
delirium does what on EEG?
background slowing of activity
- exception is delirium tremens (fast activity)
delirium tx
treat underlying cause, keep family member at bedside for redirection and reorientation
- Haloperidol for agitation
when are benzos appropriate in delirium tx?
if the pt is delirious d/t benzo or ETOH withdrawal
can folks with mild NCDs maintain independence? major NCDs?
yes (can perform activities of daily living)
no
what tests are typically included in initial eval of any psych illness?
thyroid function tests
- look for sx pattern (hypo vs hyper)
efficacy of mini mental state exam (MMSE)
sensitive for major NCDs
- dysfunction < 25
unreliable sensitivity for mild NCDs and early major NCDs
define Mini-Cog
3-item recall + drawing clock
define Alzheimer’s Dx
MC underlying etiology of major NCDs, d/t accumulation of beta-amyloid plaques and tau proteins, seen as gradual progressive decline in cog function that affects memory, learning, and language
- personality changes
- mood swings
- paranoia
what other dx state are the beta-amyloid plaques and tau proteins found?
down syndrome (T21), inc risk of early-onset Alzheimer's in these pts - can be seen with NORMAL aging
what’s the definitive diagnostic test for Alzheimer’s?
postmortem path studies of brain
genetics that inc risk for Alzheimer’s
autosomal dominant mutation
- presenilin 1 or 2
- episilon-4 variant of apolipoprotein gene
typical diagnostic age of Alzheimer’s
65 yo
tx for Alzheimer’s dx
no cure
- cholinesterase inh (donepezil/aricept, rivastigmine, galantamine) slows clinical deterioration by 6-12 months in 50% of pts with mild-mod dx
- NMDA R ant (memantine/Namenda)
- low-dose antipsychotics (inc mortality in pts w/ dementia)
- environmental interventions (puzzles, music, etc)
define vascular cognitive impairment (vascular dx)
2nd MC cause of major NCD (20% of cases), cog decline occurs in step-wise fashion d/t cortical strokes and microvascular dx in white matter
