week 6- Dementia

Question 1

What are cognitive skills that may decline in an older adult?

Answer 1

verbal fluency,
logical analysis,
selective attention,
object naming,
complex visuospatial skills

Question 2

T/F- declines in cognitive skills are considered a normal part of aging?

Answer 2

FALSE- if therfe are changes in relation to cognitive functioning they should be investigated in relation to a neuro degenerative contition like dementia

Question 3

how can sensory changes effect or influence cognitive functioning?

Answer 3

-decreased visual acuity and accommodation, can result in decreased ability to process visual cues.
-Yellowing and flattening of the cornea can lead to difficulty distinguishing colors.
-Hearing loss affects what one hears in conversations

Question 4

Out of the following list, which is associated with dementia and which is associated with delerium?
______ a. Gradual and insidious onset

______ b. Hallucinations or delusions
______ c. A sudden, acute onset of symptoms

______ d. Progressive functional impairment

______ e. Personality changes with emotional lability

______ f. Incoherent interactions with others

______ g. Possible wandering behavior

______ h. Lucid at times, but often worsens at night

Answer 4

DM–a. Gradual and insidious onset


DL–b. Hallucinations or delusions


DL– c. A sudden, acute onset of symptoms


DM– d. Progressive functional impairment

DM– e. Personality changes with emotional lability


DL– f. Incoherent interactions with others

DM– g. Possible wandering behavior


DL– h. Lucid at times, but often worsens at night

Question 5

In dementia is onset usually sudden or gradual?

Answer 5

Gradual

Question 6

List 3 types of dementia:

Answer 6

(This is just a list of the dementias)
Alzheimer’s disease,
Diffuse Lewy body dementia,
Frontotemporal dementia (FTD)
Posterior Corticoid Atrophy (PCA)
Progressive primary aphasia (PPA)
Young onset Alzheimer’s disease (YOAD)
Vascular dementia

Question 7

What are 4 common cognitive assessments

Answer 7

-General Practitioner Assessment of -Cognition (GPCOG),
-Memory Impairment Screen,
-Mini-Cog, Mini-Mental State
-Examination (MMSE),
7-Minute Screen,
-Clinical Dementia Rating,
-Global Deterioration Scale,
-Brief Cognitive Rating Scale,
-MOCA- Montreal Cognitive
-Assessment
-CAM

Question 8

What dx testing should be used to help diagnose dementia?

Answer 8

Toxicology screen
✓ Electrocardiogram
✓ Electroencephalogram
✓
Complete metabolic panel
✓ Complete blood count with differential
✓
Thyroid function tests

✓
Rapid plasma reagin (RPR) test
✓ Serum B12and folate levels

✓
Liver function tests
✓
Vision and hearing evaluation
✓ Magnetic resonance imaging (MRI)
✓ Urinalysis

Question 9

What neuroanatomic changes are seen in person with AD?

Answer 9

Changes seen in the brain include destruction of the proteins of nerve cells of the cerebral cortex by diffuse infiltration with neurofibrillary tangles and plaques (nonfunctional tissue). These tangles and plaques are a result of the death of nerve cells within the brain.

Question 10

What is AD?

Answer 10

a progressive degenerative disorder of the brain leading to dementia

Question 11

what does AD cause?

Answer 11

irreversible loss of memory and loss of mental functions, particularly in tasks involving language, behavior and thinking

Question 12

how long does it take for a patient to become mentally or physiclly disabled or incapacitated for AD?

Answer 12

3-15 years

Question 13

What is developing Alzheimers disease a combination of?

Answer 13

Combination of genetic, lifestyle and environmental factors that affect brain over time

Question 14

Is alzheimers disease a natural part of aging?

Answer 14

No

Question 15

What is the most important factor to developing AD?

Answer 15

Age

Question 16

What are some support issues related to people living with AD?

Answer 16

-Exclusion
-Rushed and task based approaches
-Poor communication
-Uncertainty (care partners)
-Caregiver as “hostage” (care partners)
-Lack of support for care partners

Question 17

What is Donepezil?

Answer 17

Donepezil is indicated for the symptomatic treatment of mild to moderate Alzheimer’s disease. Donepezil may compensate for the loss of functioning cholinergic brain cells

Question 18

What three domains of AD does the research support donepezils effect on?

Answer 18

functional ability
behavior
cognition

Question 19

Why is donepezil a high risk medication for older adults?

Answer 19

increased rates of orthostatic hypotension and bradycardia within this population

Question 20

What do you need to teach K.B. and his family about donepezil? Select all that apply:

A)“The best time to take donepezil is in the morning.”

B)“Swallow each tablet whole. Drink a glass of water afterward.”
“Notify the provider if you have trouble urinating or muscle weakness.”

C)“You may have some nausea. Taking the medication with food may help.”

D)“Keep the tablet in the blister pack until you are ready to take the medicine.”

Answer 20

A, C, D, E

The tablet should not be swallowed whole but allowed to dissolve on the tongue. After it dissolves completely, the patient should drink a glass of water. Taking donepezil in the morning lessens the common side effect of insomnia (but remember discussion in class!!!)

Question 21

What are 6 things you should review with the patient and the family in regards to safety?

Answer 21

-Do not allow him to go out alone.
-Place locks on the doors and install a door alarm device that would provide warning if he opens the door.
-Register K.B. with a safe return program and obtain a wearable tracking device for K.B. to help with locating him if he wanders.
-Obtain a medical alert bracelet that has his name, address, and telephone number.
-Alert neighbors about K.B.’s wandering tendencies.
-He must stop driving.
-Do not allow him to do potentially dangerous activities, such as cooking, alone. Place locks on the stove dials.
-Ensure that the home has good lighting, install handrails in stairways and bathroom, and remove area rugs.