Week 5 : Cognition

Question 1

Nursing Process:
What are the 6 functions of clinical judgement?

Answer 1

1. Recognize Cues
2. Analyze Cues
3. Prioritize Hypotheses
4. Generate Solutions
5. Take Actions
6. Evaluate Outcomes

Question 2

What does AAPIE stands for ?

Answer 2

Assessment
Analyze
Planning
Implementation
Evaluation

Question 3

Definition of Cognition in the textbook

Answer 3

the mental action or the process of acquiring knowledge and understanding through thought, experience, and the senses.

Question 4

Continuum of Cognitive Functions : name examples that falls under the categories

Cognitive Impairment

Basic Cognitive Functioning

Higher order cognitive functioning

Answer 4

Basic = perception
patterns
recognition
attention

High= learning
comprehension
insight
problem solving
reasoning

Question 5

What does an intact cognition means ?

Answer 5

that the individual exhibits cognitive behaviours within the normal range for age and culture

Question 6

true or false. Level of cognition can change over time and if cognitive impairment is present, the degree of impairment can only be severe

Answer 6

false. it can be mild to severe

Question 7

In an individual with impaired cognition there may be deficiencies in any of the domains of cognitive function: name the 6 domains

Answer 7

1) perceptual motor function
2)language
3) learning and memory
4) social cognition
5) complex attention
6) executive function

Question 8

Cognition : Age related factors

Define if the statement is true :
Older adults experience physiological changes such as decrease in the size of the brain, number of neurons, and neurotransmitter efficiency

However, such physiological changes are not necessarily associated with loss of cognitive function

Answer 8

true

Question 9

true or false. cognitive impairment or intellectual loss is a part of the aging process. Though this can be indicative of disease process.

Answer 9

False! it is not part of the aging process but it is right that it is an indicative of disease process

Question 10

5 types of memories are what?

Answer 10

declarative episodic memory
declarative semantic memory
immediate working memory
working memory
procedural memory

Question 11

Cognitive Function : Memories ( where are the anatomic location)
declarative episodic memory
declarative semantic memory
immediate working memory
working memory
procedural memory

Answer 11

hippocampus
medial thalamus
temporoparietal association cortices
primary auditory or visual cortex
lateral frontal cortex
basal ganglia, association neocortices

Question 12

* Must know* ( on the midterm )

What are 7 types of dementia

Answer 12

1) Alzheimer’s disease ( AD)
2) Vascular dementia
3) Mixed dementia
4) Parkinson’s disease dementia
5) Dementia with Lewy bodies
6) Dementia due to Cretzfeldt-Jacob disease
7) Frontotemporal dementia

Question 13

this is the most common type of dementia ( accounting for 70-80% of cases)

Answer 13

Alzhemier’s disease

Question 14

Describe if the statement below is correct, if not why is it not correct? :

Alzhemeir’s disease abnormalities are deposits of lewy bodies and twisted strands of the protein tau which forms inside the nerve cells of the brain

Answer 14

false.

This is a false statement. abnormalities are deposits of the protein fragment beta amyloid ( plaques) and twisted strands of the protein tau ( tangles)

Question 15

Name early symptoms of Alzhemier’s disease

Answer 15

difficulty remembering names, and recent events, difficulty expressing oneself with words, spatial depression.
Language disturbance may also be presenting symptom

Question 16

What are the late symptoms of Alzheimer’s disease

Answer 16

impaired judgement, disorientation, behaviour changes, difficulty speaking, swallowing and walking

Question 17

What is the second most common type of dementia ?

Answer 17

vascular dementia

Question 18

true or false. vascular dementia: impairment is caused by an increased blood flow to parts of the brain due to cerebrovascular events ( stroke or transcient ischemic episodes)

Answer 18

false.

decreased blood flow ( not increased)

Question 19

True or false. Patients who suffer with vascular dementia symptoms often overlap with those of AD, although memory may not be as seriously affected.

Answer 19

true

Question 20

What are the characteristics of mixed dementia ?

Answer 20

Characterized by the hallmark abnormalities of AD and another type of dementia ( most commonly vascular dementia, but also other types such as dementia with lewy bodies)

Question 21

What is the characteristics of Parkinson’s disease dementia?

Answer 21

onset of dementia at least 1 year after onset of Parkinson’s disease symptoms

Question 22

this is the hallmark abnormality is lewy bodies ( abnormal deposits of the protein alpa-symuclein) that orms inside the nerve cells of the brain

Answer 22

this is called Dementia with lewy bodies

Question 23

true or false. Symptoms of dementia with lewy bodies is similar to AD, including problems with memory and judgement as we as behaviour changes.

Answer 23

true

Question 24

When dealing with a dementia patient with lewy bodies what should we avoid?

Answer 24

they have a severe sensitivity to neuroleptic drugs, and thus these mediations should be avoided

Question 25

What does the symptoms include in Dementia with lewy bodies ?

Answer 25

symptoms include fluctuating alertness, attention, and cognition, visual hallucinations, and Parkinsonism ( muscle rigidly and tremors )

Question 26

this involves brain atrophy, especially in the frontal and temporal lobes.

Answer 26

Frontotemperol dementia

Question 27

The Older Adult Experiencing Dementia: Responsive behaviours may include the following behaviours :

Answer 27

agitation/restlessness, physical aggression, vocalization, wandering, shadowing, hoarding, resistance to care, etc.

Question 28

Older adults with impaired cognition related to a disease process such as Dementia may demonstrate a responsive behaviour as a result of .....

Answer 28

physical condition not treated emotional needs not addressed sensory overload or deprivation disorder of vision or perception interplay between triggers and responses

Question 29

true or false. older adults cognition should be further investigated ( might be delirium or dementia ) have to take assessments

Answer 29

true

Question 30

The Older Adult Experiencing Dementia Tools to Assess Cognition In the Clinical setting, commonly used screening tools to access cognition include

Answer 30

MMSE MoCA ( montreal cognitive assessment tool)

Question 31

Older adult who is presenting with responsive behaviours may have an undiagnosed disease process such as

Answer 31

dementia , depression , or delirium

Question 32

The Older Adult Experiencing Dementia Tools to Assess Cognition: A change of cognition in an older adult may be followed by a more a

Answer 32

comprehensive assessment

Question 33

true or false. An older adult with a known disease process ( previously diagnosed) related to cognitive impairment, assessment tools can be used to motor disease progression

Answer 33

true

Question 34

The Older Adult Experiencing Dementia : Critical to include as a part of your clinical assessment: what question should you include?

Answer 34

what is the underlying reason the older adult with dementia demonstrating a responsive behaviour

Question 35

true or false. in order to reduce the underlying reason, the older adult with dementia demonstrating a responsive behaviour. you should talk to the family member, talk to the team.

Answer 35

true

Question 36

Think about it ** What can interdisciplinary team ( and the older adult's support persons ) can do to provide safe and compassionate care to older adult with a responsive behaviour ?

Question 37

The Older Adult Experiencing Dementia : Possible Underlying Reasons

Answer 37

Physical Condition not treated Emotional needs not addressed Sensory overload or deprivation Disorder of vision and perception Interplay between triggers and responses

Question 38

true or false. generate solutions/take action are these questions should be consider? 1) address physical and emotional needs. Is the older adult in pain? Is the older adult feeling isolated or depressed? 2) Is there too much/light or noise in the room 3) In the older adult able to see or hear properly ? Are their eyelashes clean? Are they wearing hearing aides?

Answer 38

all these questions should be consider when it comes to generating and taking actions

Question 39

Is delirium a medical emergenecy?

Answer 39

yes it is a medical emergency

Question 40

The Older Adult experiencing ______: serious, preventable, treatable , and often unrecognized condiiton

Answer 40

delirium

Question 41

The older adult experiencing delirium : changes in

Answer 41

attention, consciousness, and altered sleep wake patterns

Question 42

Risk Factors of delirium

Answer 42

advanced age, dementia, depression, functional dependency , medications, surgery, infections, serious illness , and physical restraints

Question 43

The Older Adult Experiencing Delirium : Functional consequences

Answer 43

longer hospital stays, increased mortality , increased dependency - delirium predicts development of dementia and acceleration of cognitive decline

Question 44

When assessing delirium, we have to use what ?

Answer 44

CAM AIDA acute onset, fluctuating on-course Inattention Disorganized Altered level of conciousness

Question 45

In this assessment: what is this describing ? Progressive decline in cognitive function, characterized by cognitive deficits in memory, understanding, judgement, decision-making, communication as well as changes in personality and behaviour

Answer 45

dementia

Question 46

True or false. Dementia : Assessment ( ongoing ) needs to be an interprofessional collaboration including the individual's support persons

Answer 46

true

Question 47

Identify if this is true when it comes to interventions in dementia : Person- centered care : Look beyond the disease and the takes we perform with the person within and our relationship with them. The focus is not on what we need to do for the person but rather on the person himself or herself and how to enhance well-being and quality of life

Answer 47

true

Question 48

Interventions with dementia patient : with responsive behaviours we need to address a potential underlying cause such as

Answer 48

poor physical health, problems in cognition, and communication emotional/spiritual vulnerability activities not reflective of the older adult's strengths unsettling environment previous trauma

Question 48

how may points do we have to distinguish to know that delirium is present ?

Answer 48

1 and 2

Question 48

how many points do we have to distinguish for CAM positive ?

Answer 48

three or four

Question 48

Interventions for delirium : immediate treatment o underlying cause of delirium: what are the examples of underlying causes we could look at ?

Answer 48

infection, pain, sleep deprivation, dehydration, adverse mediation effects, fluid and electrolyte imbalance, sensory impairment, and emotional/spiritual distress

Question 48

differentiating delirium, depression, and dementia : the onset course over 24 hours conciousness alertness

Answer 48

onset : delirium = sudden abrupt depression = recent, may relate to life change dementia = insidious, slo ( over years ), often unrecognized until deficits are obvious course over 24 hours : delirium = fluctuating, often worse at night depression= fairly stable, may be worse in the morning dementia= fairly stable = may change with stress conciousness : delirium= disturbed depression= clear dementia = clear alertness : delirium= increased, decreased, variable depression: normal dementia = generally normal Psychomotor activity : delirium = increased, decreased, or mixed depression = variable, agitated, or slowed down dementia= normal, may have apraxia or agnosia

Question 49

in the following : match the duration with delirium, depression, dementia a) variable, at least 2 weeks and may be chronic b) years c) hours to weeks

Answer 49

a= depression b= dementia c= delirium

Question 50

with the following characteristics name the following condition correlating with it : ( attention ) a= little impairment b= disordered fluctuates c= generally normal but may have trouble focusing

Answer 50

a= depression b=delirium c= dementia

Question 51

describe the characteristics describing these in differentiating delirium, depression, and dementia orientation thinking perception affect

Answer 51

orientation : delirium = usually imapired, fluctuates depression = usually normal : may answer " i dont know to questions, or may not answer dementia = often impaired thinking : delirium= disorganized , rambling, illogical, or incoherent depression = may be slow; hopelessness, helplessness dementia = difficulty finding words, preservation, impoverished thoughts, difficulty with abstraction, delusions in severe cases perception : delirium = disturbed; illusions, hallucinatins, misperceptions depression= misperception usually absent dementia= intact, hallucinations in severe cases affect : delirium = variable but may look disturbed, frightened depression= flat dementia = slowed response

Question 52

what is agnosia, aphasia and apraxia?

Answer 52

Agnosia: The inability to recognize common objects, familiar faces, or sounds, despite intact sensory abilities Aphasia: Loss of the ability to use and understand spoken and written language Expressive aphasia - speak Receptive aphasia - hear Apraxia: Impaired ability to manipulate objects or perform purposeful acts despite intact sensory abilities

Question 53

what is neuroplasticity?

Answer 53

the ability for brain to adapt to the needs of environment