LO7 Flashcards
What is depression
A syndrome comprised of a combination of affective, cognitive, and
somatic or physiological manifestations in varying severity from mild to
severe.
● Depression is not an expected outcome of ageing.
● Symptoms of depression in the older adult are unique.
● Symptoms are typically somatic and physical rather than a depressed
mood.
● The most common affective or mood disorder of old age.
geriatric depression
Routine assessments for depression and risk of suicide should be
completed.
● Geriatric depression may easily be confused with dementia.
○ Cognitive impairment resulting from depression is related to apathy
rather than decline of brain function.
● Neglect of the treatment of depression can impede the physical recovery
of any medical illnesses.
● Two commonly used assessment tools are:
○ MMSE
○ Geriatric Depression Scale (GDS)
mini mental status examination
Measures cognitive functioning.
● Assesses the patient in many areas such as orientation, registration,
attention, calculation, recall, and language abilities.
● Total score is a maximum of 30 points.
● A score of 23 or lower is indicative of cognitive impairment.
○ Requires further evaluation
● Limitations of the test include:
○ Will not detect subtle memory loss in well-educated patients
○ Does not address language proficiency
geriatric depression scale
Self-reporting tool that can be completed in 5-10 minutes.
● Not a diagnostic tool – is used to monitor changes in a patient’s
emotional state of health.
● Patients are scored based on how many depressive answers they provide.
○ Less than or equal to 4 = no depression
○ 5-7 = borderline depression
○ Greater than 7 = probable depression
● Should be used as a supplement to the head-to-toe assessment and
provide guidance for further interventions.
delirium
Acute confusional state”
● Begins with confusion and progresses to disorientation.
● Common complication for the hospitalized older adult.
○ Occurs in up to 50% of hospitalized older people.
● Can be a life-threatening complication.
○ Due to the acute and unexpected onset of symptoms & underlying cause.
○ If unrecognized and underlying cause is not treated, irreversible brain
damage or death can follow.
signs of delirium
Altered level of consciousness:
○ Stupor to excessive activity
○ Combination of both
● Disorganized thinking
● Short attention span
● Hallucinations, & delusions
● Fear, anxiety & paranoia
● Those who are hyperalert/hyperactive are easier to diagnose.
recognition of delirium
Recognition can be complicated in patients with hypoactive or mixed disorders.
● Attentive clinical assessment is essential.
○ Aware of an individuals’ usual mental status.
● Often mistaken for dementia
● Delerium is usually abrupt in onset.
causes of delirium
Physical illness
Medication or alcohol toxicity
Dehydration
Fecal impaction
Malnutrition
Infection
Head trauma
Lack of environmental cues
Sensory deprivation or overload
dementia
Cognitive, functional, and behavioural changes that
eventually destroy a person’s ability to function.
* Symptom onset is subtle and progresses slowly.
* Marked by progressive deteriorations in intellectual
functioning, memory, and the ability to solve
problems and learn new skills.
* Two most common types of dementia:
* Alzheimer’s disease
* Vascular or Multi-infarct dementia
Alzeihmers disease
Progressive, irreversible, degenerative neurological disease that begins subtly
.
● Gradual loss of cognitive function & disturbances in behaviour and affect.
● Typically, uncommon in adults before the age of 65 years.
● Although it affects as many as 50% of those 85 years and older, this is not
and expected part of aging.
● The greatest risk factor for AD is increasing age.
● Other risk factors may include:
○ Environmental
○ Dietary
○ Inflammatory
Classified in two types:
○ Familial or early-onset AD (rare – accounts for less than 5% of all cases)
○ Sporadic or late-onset AD
● The cause is not well known but may be related to:
○ Degenerations of neurons
○ Family history
○ Genetic mutations
○ Repeated head trauma
○ Brain injuries
alzheimers pathophysiology
Many neuropathologic and biochemical changes are found in patients
with AD. For example:
○ Neurofibrillary tangles – tangled mass of nonfunctioning neurons
○ Senile or neuritic plaques – deposits of amyloid protein in the brain
● Neuron damage occurs in the cerebral cortex resulting in decreased brain
size.
● The enzyme responsible for producing acetylcholine (necessary for
memory processing), is decreased.
characteristic symptoms of AD
Amnesia: impaired memory.
○ Difficulty remembering recent events remote memory
● Apraxia: the loss of purposeful movement with no existing sensory or
motor impairment.
● Aphasia: the loss of language.
○ Begins with the loss of certain words, to minimal speech, to eventually
words are reduced to babbling or no communication at all.
● Agnosia: the loss of sensory ability to recognize objects.
○ Not limited to one specific sense.
○ Eventually loses ability to recognize loved ones faces
Vascular dementia
More abrupt onset than Alzheimer’s.
● An uneven, stepwise decline in mental function.
● Associated with a vascular incident such as: stroke or following cardiac
surgery.
● Clinical course is unpredictable.
● Risk factors include:
○ Hypertension
○ Cardiovascular disease
○ Hypercholesterolemia
○ Smoking history
○ Diabetes
montreal cognitive assessment
Rapid screening instrument for mild cognitive dysfunction.
● Assesses short term memory, language, ability to focus, delayed recall,
visuospatial ability by drawing, and ability to name pictures of common
items.
● Total time: approximately 10 minutes
● Total possible score: 30 points
● A score of 26 or greater is considered a normal score.
The 3 D’s
Delirium: characterized by acute and fluctuating onset of confusion,
disturbances in attention, disorganized thinking, and/or decline in
consciousness.
○ Can coexist with dementia those with dementia are at higher risk
or delirium.
● Dementia: a gradual and progressive decline in the mental processing
ability that affects short-term memory, language, judgement, reasoning,
and abstract thinking. Eventually affecting long-term memory and the
ability to perform familiar tasks.
● Depression: the presence of a cluster of depressive symptoms on most
days, most of the time, for at least 2 weeks. The intensity of those
symptoms is out of a person’s normal. Affects thoughts, feelings,
behaviours, and physical health.
