Week 3: Care of the Person with a Life Limiting Illness (Dementia) Flashcards

1
Q

What is dementia?

A

A variety of conditions with cognitive features caused by damage occurring in different parts of the brain

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2
Q

What are the signs and symptoms of dementia?

A

Decline in two or more mental abilities including memory, learning, orientation and attention
Deterioration in at least one intellectual skill, including abstraction, judgement, comprehension, language and calculation
Loosening emotional control or personality change
Difficulties in family, social and work functioning
Difficulty in self-care abilities associated with cognitive decline
Apathy or depression

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3
Q

How does dementia affect the frontal lobe?

A
Difficulties with: 
Planning
Organising
Problem solving 
Personality
Regulating social behaviour
Starting and stopping actions
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4
Q

How does dementia affect the parietal lobe?

A

Difficulties with:
Language and reading
Spatial perception (sense of
geography)
Touch and pressure, judgment of weight, texture, size and shape
Misidentification of facial images Not knowing dressing sequence

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5
Q

How does dementia affect the temporal lobe?

A

Difficulties storing new information, short term memory, long term memory
Distinguishing sounds and smells

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6
Q

How does dementia affect the occipital lobe?

A

Difficulties with recognition of shapes and colours, visual reception and depth perception

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7
Q

How does dementia affect the limbic system?

A

Problems with sleep and appetite.
Difficulty linking emotions, memories behaviours
Accentuation of libido; tied up with frontal lobe Aggressive emotional response if cautioned re inappropriate behaviour

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8
Q

What is the difference between dementia, delirium and depression?

A

Dementia is an umbrella term for chronic and progressive cognitive decline over months to years
Delirium: acute and sudden organic disturbance of higher cerebral functioning associated with environment
Depression: multifaceted syndrome, comprising a constellation of affective, cognitive, somatic and physiological manifestations in varying degrees

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9
Q

What are the causes of dementia?

A
Neurodegeneration
Cerebrovascular causes
Infection-related
Toxic and metabolic causes
Traumatic brain injury
Hereditary (uncommon)
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10
Q

What are the neurdegenerative causes of dementia?

A
Alzheimer’s Disease
Dementia with Lewy Bodies
Frontotemporal dementias
Parkinson’s Disease dementia
Huntington’s Disease
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11
Q

What are the cerebrovascular causes of dementia?

A

Vascular or Multi-Infarct dementia

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12
Q

What are the infection related causes of dementia?

A

Cruetzfeldt-Jabob disease and other Prion diseases

HIV-AIDS related dementia

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13
Q

What are the toxic and metabolic causes of dementia?

A

Wernicke-Korsakoff syndrome

Leukodystrophy

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14
Q

What are the hereditary causes of dementia?

A
One gene (Apolipoprotein E) is associated with an increased risk of Late Onset Alzheimer’s disease. 
Three genes (Amyloid Precursor Protein, Presenilin 1 and Presenilin 2) are associated with Younger Onset Alzheimer’s disease
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15
Q

How do you assess the presence of dementia?

A
Medical History
Physical Exam
Neurological Exams
Brain, Spinal cord and Neurons
   Coordination
   Reflexes
   Eye movements
   Speech
   Sensations (smell, touch, sound, etc.)
Mental Status Exam
Brain Imaging/Scans
Laboratory Exam
Determine blood count
Rule out vitamin or nutrient deficiency
Evaluate thyroid hormone levels (low levels may cause dementia symptoms) 
Rule out other diseases such as infections and diabetes
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16
Q

How do you assess the progressive decline in cognitive ability?

A
Judgement
Orientation
Emotions    
Memory
Thinking                                      
Communication
Function in ADLs                       
Sociability
17
Q

What are the tools used to assess dementia?

A
Mini Mental State Exam (MMSE)
Global Deterioration Scale (GDS)
GP –Cog
Functional Assessment Staging (FAST)
Clinical Dementia Rating (CDR)
18
Q

What is a stage 1 Functional Assessment Staging?

A

Normal adult: no functional decline

19
Q

What is a stage 2 Functional Assessment Staging?

A

Normal older adult: personal awareness of some functional decline

20
Q

What is a stage 3 Functional Assessment Staging?

A

Early Alzheimer’s Disease: noticeable deficits in demanding job situations

21
Q

What is a stage 4 Functional Assessment Staging?

A

Mild Alzheimer’s Disease: requires assistance with complicated tasks such as handling finances, planning parties

22
Q

What is a stage 5 Functional Assessment Staging?

A

Moderate Alzheimer’s Disease: requires assistance choosing proper clothing

23
Q

What is a stage 6 Functional Assessment Staging?

A

Moderately severe Alzheimer’s Disease: requires assistance dressing, bathing, and toileting. Experiences urinary and faecal incontinence

24
Q

What is a stage 7 Functional Assessment Staging?

A

Severe Alzheimer’s Disease: speech ability declines to about a half-dozen intelligible words. Progressive loss of abilities to walk, sit up, smile, and hold head up

25
Q

What are the main health issues for people with dementia?

A
• Cognitive ability and Emotional health
• Mobility, Vigour and Self-Care
• Continence
  Nutrition and hydration 
  Diminished senses
  Polypharmacy and psychotropic drugs
  Sensitivity to changes in environment
26
Q

What is the treatment for a person with dementia?

A

Medications to treat symptoms: cholinesterase inhibitors to slow progression of symptoms and improve brain function
Anxiolytics, SSRIs, sedatives and neuroleptic medications to control mood, psychosis and sleep problems
Assistance with ADLs
Psychosocial support
Adapting environment

27
Q

What is the disease trajectory of dementia?

A

Tier 1 –Early-stage disease
Tier 2 – Two-three comorbidities and moderate-stage disease
Tier 3 - Multiple comorbidities and severe-stage disease
Tier 4 - Complex needs and end-stage disease

28
Q

What are the care needs for an early stage dementia patient?

A
  • Self-managing, independent

- Carer / community services oversight

29
Q

What are the care needs for a dementia patient with two-three comorbidities and moderate-stage disease?

A

Optimally cared for in the community (general practice, community based services)

Self-management or support of carer to monitor and manage condition and risk factors

Requires care coordination

30
Q

What are the care needs for a dementia patient with multiple comorbidities and severe-stage disease?

A
  • Requires care coordination

- Requires ongoing disease /symptom management

31
Q

What are the care needs for an end stage dementia patient?

A

Complex needs
Frequently use hospitals for pneumonia
Residential/palliative care support/respite care
Requires ongoing care/case management / disease management / self-management support

32
Q

What is the model of care for a person with dementia?

A

Basic support: meals, home cleaning and modification, transport
Personal care: ADLs, hygiene and monitoring
Specialised care: symptoms, palliative, rehabilitation
Carer support: respite, counselling, education, advocacy

Special needs support through all levels: CALD, Indigenous, rural and remote, etc