Topic 11: Dementia & Alzheimers

Question 1

Dementia

Answer 1

disorder characterized by a decline from previous level of function in 1 or more cognitive domains: complex attention, executive function, language, learning and memory, perceptual-motor, and social cognition. Problems ultimately disrupt individuals work, social responsibilities, family responsibilities, ability to perform ADLs

Question 2

Vascular dementia (VaD)

Answer 2

loss of cognitive function due to brain lesions caused by cardiovascular disease, the result of decreased blood supply from narrowing and blocking of arteries that supply the brain
· Can be caused by a single stroke or by multiple strokes

Question 3

Mixed dementia

Answer 3

2 or more types of dementia present at the same time

Question 4

hallmark of mixed dementia

Answer 4

· Hallmark abnormalities of Alzheimer’s disease + another type of dementia (usually vascular dementia)

Question 5

Dementia with Lewy Bodies (DLB):

Answer 5

characterized by presence of Lewy bodies (abnormal deposits of proteins) in brainstem and cortex
· Has features of both AD and PD, medication therapy may assist with symptoms

Question 6

Alzheimer’s Disease (AD):

Answer 6

chronic, progressive, neurodegenerative brain disease. The greatest risk factor is aging (most are >65), and family history of AD.

Question 7

Characteristic findings of AD

Answer 7

amyloid plaques, neurofibrillary tangles, loss of connection between neurons, and neuron death

Question 8

Sundowning

Answer 8

the patient becomes more confused and agitated in the late afternoon or evening (aggressive, agitated, wandering, resistance to redirection, increased verbal activity like yelling)

Question 9

Clinical Manifestations of dementia

Answer 9

· Gradual and progressive overtime
· Abrupt
o Vascular dementia tends to be abrupt or progress in a stepwise pattern

Question 10

EARLY Clinical manifestations of AD

Answer 10

o Memory loss that affects job skills
o Difficulty performing familiar tasks
o Problems with language (words or numbers)
o Disorientation to time and place
o Poor or decreased judgment
o Problems with abstract thinking
o Misplacing things
o Changes in mood, behavior, personality
o Loss of initiative

Question 11

As AD progresses clinical manifestations

Answer 11

o Personal hygiene deteriorated
o Agitation or aggression
o Some people develop delusions and hallucinations
o Dysphagia
o Apraxia
o Agnosia (visual, auditory, difficulty identifying family and friends)
o Dysgraphia
Retrogenesis

Question 12

Retrogenesis

Answer 12

decline in AD mirrors, in reverse order, brain development that occurs from birth (reverts to infantile reflexes)

Question 13

Behavior changes include

Answer 13

repetitiveness, delusions, hallucinations, agitation, aggression, altered sleeping patterns, wandering, hoarding, and resisting care

Question 14

definitive diagnosis of AD is

Answer 14

an exam of brain tissue at AUTOPSY and findings of neurofibrillary tangles and plaques

Question 15

diagnostic assessment

Answer 15

· Neuropsychologic testing, including Mini-Cog (clock drawing test)
· Mini-Mental State Exam (orientation to time, registration, naming, reading)
· Brain imaging tests: CT, MRI, PET
· CBC, ECG,
· Serum glucose, creatinine, BUN, vitamin B1, B6, B12
· Thyroid function tests
· Liver function test
Screening for depression

Question 16

preventing falls

Answer 16

· Have stairwells well lit
· Make sure the patient can grasp the handrails
· Tack down carpet edges
· Remove throw rugs and extension cords
· Use non-skid mats in tub or shower
· Install handrails in the bath and by the commode

Question 17

Vascular dementia management

Answer 17

Often prevented through treatment risk factors: HTN, diabetes, smoking, hypercholesterolemia, cardiac dysrhythmias

Question 18

Behavioral Interventions

Answer 18

· Assess for environmental changes that may be agitating patient (either move the patient or remove the stimulus)
· When patient resists or pulls tubes or dressings: cover with stretch tube gauze, remove them from visual field
· REASSURE you are there to keep patient safe
· Do Not ask challenging “why” questions
· REDIRECTION, DISTRACTION, REASSURANCE
· Repetitive activities like songs, music, massage or favorite objects can be soothing

Question 19

Nursing interventions for sundowning

Answer 19

· Create a quiet, calm environment
· Maximizing exposure to daylight by opening the. Blinds and turning on the lights during the day
· Evaluating medications to determine if any could cause sleep problems
· Limit naps and caffeine

Question 20

nursing interventions

Answer 20

· Assess patient’s memory and level of function
· Teach patients and caregivers about using memory enhancement aids such as calendars or notes
· Evaluate safety risk factors (MedicAlert bracelet/tracking devices)
· Determine possible precipitating factors for behavioral changes and develop strategies to address difficult behavior
· Assess family care giver’s stress level and coping strategies
· Make referrals for community services, such as adult day care and respite care
· Assess for signs of depression (antidepressants may be needed)

Question 21

feeding apraxia

Answer 21

inability to self-feed; Undernutrition is a problem

Question 22

patient may have hard time expressing pain BUT

Answer 22

still be recognized by changes in behavior; should still be treated

Question 23

Decreasing risk or cognitive decline interventions

Answer 23

· Avoid harmful substances (alcohol and smoking)
· Challenge your mind (read, crosswords)
· Exercise regularly
· Stay socially active
· Avoid trauma to the brain
· Take care of mental health (recognize and treat for depression early)
· Treat diabetes
· Take care of your heart
· Get enough sleep
Get the right fuel (healthy balanced diet low in fat and high in vegetables and fruit)

Question 24

drug therapy for AD

Answer 24

· Donepezil
· Rivastigmine
· Galantamine
Memantine: protects nerve cells against excess amounts of glutamate
Grandma Doesn’t Remember Me