- An inability to execute learned purposeful movements despite having the desire and physical capacity - Acquired disorder of motor planning - All of the muscles work but the region of the brain that plans and coordinates the movement of the muscles is impacted

Geriatrics: depression, delirium, dementia Flashcards by Jacqui Joseph

most common type of dementia?

alzheimers

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how do most people die from alzheimer’s?

aspiration pneumonia: unable to swallow

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define dementia

An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an ALERT patient

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5 risk factors for alzheimers

Age
Family history
Head injury
Fewer years of education
Female sex

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what part of the brain gets attacked (and shut down) first in Alzheimer’s dz

hippocampus

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what is “mild cognitive impairment” ?

Memory problem without deficits in other domains

No functional impairment

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alzheimer’s Dz: onset, progression

Onset: gradual
Progression: gradual, over 8–10 yr on average

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alzheimer’s Dz: cognitive and motor symptoms

Cognitive symptoms: primarily memory

Motor symptoms: rare early, apraxia later

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alzheimer’s Dz: lab tests and imaging

Lab tests: normal

Imaging: possible global atrophy, small hippocampal volumes

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alz. DSM IV

Development of cognitive deficits manifested by:
Impaired memory and
Aphasia, apraxia, agnosia, disturbed executive function

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apraxia: what is it?

An inability to execute learned purposeful movements despite having the desire and physical capacity
Acquired disorder of motor planning
All of the muscles work but the region of the brain that plans and coordinates the movement of the muscles is impacted

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Agnosia: what is it? where are the lesions?

The inability to recognize common objects, people, sounds, and places
Lesions on the parietal or temporal lobe
Semantic information and language

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what is semantic memory?

long term memory or concepts not drawn from personal experience ( Letters, what is a cat…)

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vascular dementia DSM IV

same as alzheimers but there are…

-Focal neurologic symptoms/signs or evidence of cerebrovascular disease

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3 stages of progressive AD

mild, moderate and severe impairment

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Vascular dementia: onset + progression

Onset: may be SUDDEN/ STEPWISE
Progression: stepwise with further ischemia

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vascular dementia: cognitive and motor symptoms

Cognitive symptoms: depend on anatomy of ischemia

Motor symptoms: correlates with ischemia

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vascular dementia: labs + imaging

Lab tests: normal

Imaging: cortical or subcortical changes on MRI

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Lewy Body Dementia: cognitive + motor symptoms

and what is the major key for this Dx

Cognitive symptoms: memory, visuospatial, hallucinations, fluctuations
Motor symptoms: parkinsonism
key difference: *EARLY hallucinations

Lewy Body Dementia: labs + imaging

Lab tests: normal

Imaging: possible global atrophy

Fronto-temporal dementia and Lewy Body Dementia: onset + progression

Onset: gradual
Progression: gradual but faster than AD

fronto-temporal dementia: cognitive + motor symptoms

Cognitive symptoms: executive: disinhibition, apathy, behavior changes
Motor symptoms: none

fronto-temporal dementia: labs + imaging

Lab tests: normal

Imaging: atrophy in frontal and temporal lobes

aggitation may be a sign of ____ in someone with dementia

depression

primary goal of alzheimers txt

To enhance quality of life and maximize functional performance by improving cognition, mood, and behavior

non-pharm txt of alzheimer's dz (kinds weeds)

``` Cognitive enhancement Individual and group therapy Regular appointments Communication with family, caregivers Environmental modification Attention to safety ``` * routines are importmant!

pharm txt for alzheimer's dz (kinda weeds)

Cholinesterase inhibitors: ***donepezil (Aricept) +/- Memantine (anti-chol may lower HR) maybe: anti-depressants, pyschoactive meds

symptom mgmt for alzheimers Dz

``` Sundowning Psychoses (delusions, hallucinations) Sleep disturbances Aggression, agitation Hypersexuality ```

what is "sundowning"

the closer to evening, the more agitated and confused the AD pt gets (dont know why this happens)

anti-pyschotic meds for alzheimer's pts can cause what? how do we avoid this?

DEATH | start low, go slow!

what are the distinguishing signs of delirium (from dementia)?

Acute onset, Cognitive fluctuations over hours or days Impaired consciousness and attention Altered sleep cycles *can be under-alert or hyper-alert

delirium DSM IV (3)

1. Disturbance of consciousness with reduced ability to focus, sustain, or shift attention 2. Change in cognition /perceptual disturbance 3. Development over a short time (hours to days) and fluctuation during the day

4 forms of delirium

1. Hyperactive or agitated delirium = 25% of all cases 2. Mixed 3. Hypoactive delirium = ≥50% of all cases, but less recognized and appropriately treated 4. Additional features include emotional lability, psychosis, hallucinations

predisposing factors for delirium (kinda weeds)

``` Advanced age, dementia male Functional impairment in ADLs Medical comorbidity History of alcohol abuse Sensory impairment (↓ vision, ↓ hearing) ```

how to prevent post-op delirium (3)

Limit sedation Provide adequate analgesia Transfuse high-risk patients

3 ways to avoid complications of delirium

Remove indwelling devices ASAP Prevent or treat constipation and urinary retention Encourage proper sleep hygiene, avoid sedatives

what 4 things are shared in dementia and depression

Impaired concentration Lack of motivation, loss of interest, apathy Psychomotor retardation Sleep disturbance

what 4 things differentiates depression from dementia

Demonstrate ↓ motivation during cognitive testing Express cognitive complaints that exceed measured deficits Maintain language and motor skills

minor depression vs major depression vs bipolar in older people, what is common/uncommon?

minor: common major: uncommon bipolar: incidence declines with age

major depression DSM IV: gateway symptoms?

Gateway symptoms (must have 1) - Depressed mood - Loss of interest or pleasure (anhedonia)

depression : onset, cognitive deficit shown?, responses?

``` Sudden onset. Exposes cognitive deficit. Often responds “I don’t know.” Variability in cognitive ability. Inconsistent effort. ```

dementia : onset, cognitive deficit shown?, responses?

``` Gradual onset. Conceals deficit. Tries to answers questions. Stable or declining ability. Consistent effort. ```

how is bereavement different from depression ?

Most disturbing symptoms resolve in 2 months | Not associated with marked functional impairment

3 steps in treating depression: acute, continues, prophylaxis/maintenance

``` Acute — reverse current episode Continuation — prevent a relapse Continue for 6 months Prophylaxis or maintenance — prevent future recurrence Continue for 3 years or longer ```

pharm txt for depression?

primary: SSRIs (celexa, zoloft)

when would you use ECT for depression? (3)

1. major depression & mania; response rates exceed 70% in older adults 2. pts at serious risk for suicide, life-threatening poor intake of food 3. psychotic depression in older pts