Module 9 - Cognitive Impairment and Neurological Disorders in the Older Adult Flashcards
What is dementia?
- An irreversible state that progresses over years
- Causes memory loss
- Behavior/personality changes
- Interferes with daily life
- Disturbances in functioning (planning, organizing, sequencing and abstract thinking)
- Alzheimer’s disease can cause dementia
What is delirium?
- Confused state of mind due to disturbances of the neurotransmitters in the brain
- Cognitive decline, behaviour/mood changes, memory loss, delusional thought and sleep disturbance
- Can be caused due to an infection (UTI)
- Affects more elderly people and has a rapid onset
What is depression?
- Mood disorder that causes a persistent feeling of sadness and loss of interest
- Onset is recent and may elate to life change
- Also known as a flat affect
Risk factors for delirium
- Age
- Medical illness (stroke, meningitis)
- Infection - UTI
- Pain
- Emotional stress
- Medication or substance effect
- Surgical procedures involving general anesthesia
- Inadequate education about delirium
- Lack of formal assessment methods
- Ageist attitudes
What assessments should you provide for delirium?
- Determine cognitive functioning
- Conduct a formal assessment to identify possible delirium cause - Infection
- Confusion Assessment Method (CAM)
Intervention and Care plan for delirium
- Intervene the risk factors and the root cause
- Resources for help - Hospital Elder Life Program (HELP)
- Pharmacological treatment of delirium is not recommended (unless it is an infection)
What is the Mini-Mental State Examination (MMSE)?
- Screening for cognitive function and Dementia
- Can measure changes in cognitive status that may benefit from intervention
What is the Montreal Cognitive Assessment (MoCA)?
- Rapid screening/in-depth for mild cognitive dysfunction
- Assesses different cognitive levels such as attention/concentration, functions, memory, language, conceptual thinking and calculation
What is the Cognitive Performance Scale (CPS) by interRAI ?
Combines information on memory impairment, LOC and functions
- Rates scores ranging from 0 (intact) to 6 (very severe impairment)
- Part of the MDS-RAI
What is the Confusion Assessment Method (CAM)?
- Delirium screening tool
- Can initiate interventions based on findings
- Looks at behavior, Inattention, disorganized thinking and altered LOC
What are the 3 types of dementia?
- Primary
- Secondary
- Mixed
Primary dementia
Dementia is the primary reason for neurological decline
- It is the main disease affected the individual
Secondary dementia
Dementia is a result from other conditions such as a pre-existing mental illness or physical condition
- Common development for Parkinson’s Disease
Mixed dementia
Combination of primary dementia and secondary causes such as vascular brain changes and pre-existing conditions
- Can be caused due to severe alcoholism
Vascular dementia
- Post- stroke dementia
- Caused by ischemia or hemorrhaging brain damage
Lewy-Body Dementia
Mixed dementia with Lewy bodies (DLB), and Parkinson’s disease dementia (PDD)
- Cognitive fluctuations and Hallucinations
Frontotemporal Dementia
- Shrinking of the anterior frontal and temporal lobes
- Changes in personality, cognition, memory, language and behaviour
Pathophysiology/Etiology - Alzheimer’s Disease
- A cerebral degenerative disorder of unknown origin
- Destroys proteins of nerve cells in the cerebral cortex causing brain cells to waste away
- Causes Dementia
Signs and Symptoms - Alzeheimers
- Memory loss
- Difficulty expressing
- Spatial cognition problems
- Impaired reasoning and judgement
- Depression
- Language issues
- Difficulty speaking
- Dysphagia
- Imbalance when walking
Treatment - Alzeheimers
- Depends on type of dementia - No Cure
- Lifestyle changes
- Manage Cardiovascular health
- Exercise
- Healthy diet
- Physiotherapy
- Counselling
- Medications to slow down progression
Pathophysiology/Etiology -Cerebrovascular disease
- Manifested from a stroke or a transient ischemic attack (TIA)
- Effects blood vessels and blood supply to the brain due to the rupture of blood vessels or vessel permeability
Signs and Symptoms Cerebrovascular disease
- Neurological deficits
- Severe headache
- Subarachnoid hemorrhages
- Nausea
- Vomiting
- Changes in motor, sensory, and visual function
- Decrease coordination, cognition and language (depends on the area)
Treatments - Cerebrovascular disease
- Prevention to reduce factors
- Life style changes (no smoking, limit alcohol)
- Healthy diet
- Exercise
- Follow ups with health professionals
- Medications (Anti-coagulants)
- Finding the source
Management and Assessments - Cerebrovascular disease
- Neurological assessments
- Nutrition
- Swallow test
- Bowel function
- PT/OT/SLP
- Ambulation
- Fall prevention
- Skin Assessment
- Compression stockings
What is the Progressively Lowered Stress Threshold model?
- Plan and evaluate care for dementia patients
- Social and physical environment and nursing care are structured to reduce stress
- Provides the person with a safe and predictable environment
- Establish a caring relationship with the patient
- Identify triggers related to discomfort or stress reactions
What is the Need-driven dementia-compromised behavior model?
- Maximize strengths and minimize the limitations
- Evaluates physiological needs, mood, physical environment, and social environment
What is the Recognition of retained abilities model?
- Focusing on abilities rather than disabilities
- Assessment and enhancements of the person’s abilities instead of focusing on lost abilities
- May prevent or reverse excess disability
What is the Relating well model?
- Promotion of care provider–resident relationships
- Focusing the care beyond the task
- Building relationships on promoting care to Dementia clients
Person centered care factors for dementia
- Meaningful relationships
- Structured activities to enhance abilities
- Social engagement
- Freedom of choice
- Self-expression
- Spirituality
- Creativity
- Supportive care
- Get to know the person
- Positive mood
What is the Gentle Persuasive Approach?
- Based on the the principles of person centered care and the Needs - Driven Dementia Compromised Model
- Educates caregivers on skills, knowledge and confidence to deliver person-centered care
- All behavior has meaning
- Negative behavioral responses are the result of unmet needs
