Module 7 Flashcards
Aphasia
Loss of express/understand written or verbal language
Apraxia
Inability to carry out purposeful movement
Agnosia
Inability to recognize objects/people despite intact sensory skills
Ataxia
Disorders affecting coordination of voluntary muscle movements
affects balance, muscle coordination and speaking
Aphagia
Loss of ability to swallow
Types of Dementia
Alzheimers Vascular Lewy Body Frontotemporal Creutzfeld-Jakob (rare)
3 D’s
Dementia
Depression
Delirium
Delirium
temporary, impaired cognitive state
rapid onset
reversible
affects attention more than memory
Dementia
group of disorders that result in an overall decline in cognitive function: memory, abstract thinking, judgment, mood, disorientation, math ability, planning, ability to do ADL’s. may also result in personality, mood and behavioral changes
does not involve altered consciousness (LOC intact).
dementia is caused by neurodegeneration, vascular problems and repeat injury
gradual progressive disease. not curable.
Vascular Dementia
caused by impaired perfusion to areas of the brain
causes: thromboembolism, stroke, occluded arteries
Diagnosis of Dementia
no diagnostic test exists for dementia
diagnosis depends on ruling out other disorders (delirium) and thorough health assessment
information from secondary sources (friends, family, caregivers)
diagnosis can only be confirmed with a post-autopsy biopsy
Vascular Dementia Risk Factors
chronic conditions: hypertension, diabetes, cardiac disease, hyperlipidemia, atherosclerosis age gender (men at higher risk) stroke smoking alcoholism
*anything that would impair tissue perfusion
Definition of cognition
all mental processes related to human thought
observation, integration, application, memory
6 Domains of Cognition
Complex Attention Learning & Memory Perceptual Motor Function Social Cognition Executive Function Language
Types of Memory
Working Memory
Declarative Episodic (events that happened)
Declarative Semantic (words, knowledge, facts)
Immediate (very brief)
Working (small info that can be used in a short timeframe)
Procedural (long-term retention and retrieval)
Definition of perception
an individual’s perception of their environment
Declarative memory
the ability to consciously learn or recall information
Visuospatial cognition
capacity to comprehend, retain, use visual representations and their spatial relationships
Executive Function
higher level thinking
involved in consciousness, voluntary action, future-oriented
Scope of Cognition
Intact –> Impaired
Basic Cognitive Impairment
Perception
Pattern Recognition
Attention
Higher Order Impairment
Learning Comprehension Insight Problem-Solving Reasoning Decision-Making Creativity Metacognition (thinking about your thinking)
Brain Homeostasis
brain consumes about 20% of total blood oxygen –> requires adequate perfusion and oxygenation
fluid + electrolyte balances
Physiological Changes of Older Adults
reduced brain mass some loss of neurons atrophy of neurons loss in number and length of dendrites loss in number of axons increase in segmental demyelination reduced production of neurotransmitters loss of synapses
synaptic loss = key indicator of aging
effect: slower processing, may be slight changes in memory, changes in learning
Areas of the brain impacted with aging
Hippocampus
Corpus callosum
Prefrontal Lobe
Types of Cognitive Impairment
Dementia Delirium Depression Cognitive Impairment not Dementia Focal Cognitive Impairment (only specific cognitive domains affected) Intellectual Disability Learning Disability
Definition of Intellectual Disability
<70 IQ Score
diagnosed in adolescence (<18 years)
Consequences of Cognitive Impairment
reduced ability to do ADLs increased fall risk complicated disease management decreased independence higher incidence of hospitalization
Dementia Modifiable Risk Factors
Smoking Alcoholism Chronic conditions: hypertension, hyperlipidemia, diabetes, cardiac disease Hearing loss (use of hearing aids) Cognitive Engagement Activity levels Obesity Diet/nutrition History of head trauma Environmental Exposures (pollution, toxins)
Dementia Non-modifiable Risk Factors
Age (>65)
Gender (women higher risk)
Genetics (PS1, PS2, APP identified)
Congenital disorders - Down syndrome
Primary Prevention
Nutrition Exercise Social activity Regular medical care Prenatal care Reduce high-risk behavior Genetic Counseling (genetic testing, mature pregnancies) Use of hearing aids/glasses
Assessment tests
MOCA
MMSE (mini mental stimulation exam)
Mechanism of Vascular dementia
1) atherosclerosis of carotid/cerebral arteries –> impaired tissue perfusion to brain causing stroke
2) rarefaction/remodeling due to hypertension –> impaired tissue perfusion to brain
Delirium Risk Factors
urinary catheters side effects of medication use of restraints sensory deprivation (acute hospital setting) fluid & electrolyte imbalance - dehydration, respiratory acidosis pain sepsis fever
Signs of delirium
distractibility disorientation (time, place, person) hallucinations altered consciousness (LOC) disturbed sleep-wake cycle incoherent speech impaired short-term memory physical signs: dilated pupils, tachycardia, diaphoresis
Signs of Dementia
impaired memory (esp short term memory) disorientation (time, place, person) apathy, depression, anxiety reduced ability to do ADL's wandering reduced complex attention reduced abstract thought (planning, judgment) personality, mood, behavioral changes reduced math ability problems with language --> aphasia later stage: aphagia, ataxia, apraxia
Dementia Treatment
manage chronic conditions group therapy music therapy somatosensory therapy (massage) reorient to time, space, person --> mount a clock manage fall risk --> ensure patient safety involve client in ADL's as much as possible positive reinforcement/encouragement advance care planning, directives caregiver education exercise reminiscence simple communication, face-to-face
Acalculia
loss of ability to to math
Agraphia
loss of ability to write
MMSE Normal Score
26-30
MMSE Mild CI score
20–25
MMSE Moderate CI score
10-19
Severe CI Score
0-9
What is the MMSE
Mini Mental Status Exam
Screening tool used to assess cognitive impairment in individuals
Commonly used to assess severity of dementia in diagnosed patients
designed to be used in clinical/hospital settings
Normal MOCA Score
Above or equal to 26
