Week Six

Question 1

Hypercholesterolaemia

Answer 1

May increase risk for AD but no causal relationship established
Cholesterol does not enter the brain so uncertainty of link

Question 2

CAD

Answer 2

CAD is associated with increased risk of dementias in general but there are overlapping risk factors for both

Question 3

cognitive skills that may decline in an older adults?

Answer 3

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

Any decline should not be assumed to be a normal part of ageing but investigated in relation to a neuro-degenerative conditions such as dementias.

Question 4

Dementia

Answer 4

Dementia isan umbrella term that refers to the loss of cognitive functioning that interferes with daily life and activities.

Question 5

Physiologic age-related changes in an older adults can influence cognitive functioning. Explain one

Answer 5

Sensory changes

Eg 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 6

Delirium Behaviours

Answer 6

hallucinations or delusions
a sudden acute onset of symptoms
incoherent interactions with others
lucid at times, but often worsens at night

Question 7

dementia behaviours

Answer 7

gradual and insidious onset
progressive functional impairment
personality changes with emotional lability
possible wandering behaviours

Question 8

Dementia Types

Answer 8

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 9

How does health care determine the degree of cognitive impairment?

Answer 9

Neuropsychological testing in the major domains of thinking and memory, verbal and expressive abilities, constructional skills, and executive functions.
Can the patient continue to handle his or her own finances, to drive, or to perform instrumental activities of daily living.

Question 10

Rare and young onset dementias

Answer 10

Posterior cortical atrophy (PCA): mainly affecting visual and spatial perception

Frontotemporal dementia (FTD): mainly affects behaviour, personality and language

Familial AD: inherited – similar symptoms to late onset AD but can occur as young as 30

Primary progressive aphasia (PPA): predominately affects language skills

Lewy body dementia: Closely related to Parkinson’s Disease affecting movement and can cause hallucinations. May present with PCA

Young onset dementias (typically YOAD and FTD)

Question 11

Common Cognitive assessment tools

Answer 11

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 12

Diagnostic tests useful in diagnosing dementia

Answer 12

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 13

What are neuroanatomic changes seen in persons with AD?

Answer 13

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 14

How would you explain AD to family?

Answer 14

AD is a progressive, degenerative disorder of the brain leading to dementia
Causes irreversible loss of memory and loss of mental functions, particularly in tasks involving language, behavior, and thinking.
Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.
The rate of progression of AD varies from person to person.
Currently there is no known cure.
The time from the onset of symptoms until death ranges from 3 to 20 years, with an average of 8 years.
AD usually takes 3 to 15 years for a person to become mentally and physically disabled or incapacitated.

Question 15

How did he get AD?
How to respond

Answer 15

We do not for certain what causes or triggers AD
Combination of genetic, lifestyle and environmental factors that affect brain over time
AD is NOT a normal part of ageing but age is the most important risk factor for developing AD
There are familial forms of AD but there is evidence to suggest links to viruses, autoimmune disease, deficiencies in neurotransmitters

Question 16

Experiences and support needs from perspective of people aging 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 donezepil?

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.
There is strong evidence that donepezil has efficacy against the three major domains of Alzheimer’s disease symptoms, namely functional ability, behavior, and cognition. The strongest evidence is for improvement or less deterioration in global outcomes and cognition in the short to medium term.

Question 18

What do you need to teach K.B. and his family about donepezil? Select all that apply.
“The best time to take donepezil is in the morning.”
“Swallow each tablet whole. Drink a glass of water afterward.”
“Notify the provider if you have trouble urinating or muscle weakness.”
“You may have some nausea. Taking the medication with food may help.”
“Keep the tablet in the blister pack until you are ready to take the medicine.”

Answer 18

Correct answers are: 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 19

Safety is a Priority
Teaching ?

Answer 19

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.

Question 20

Advanced directives.
Why discuss this now?

Answer 20

People diagnosed with AD need to examine and update their financial and health care arrangements as soon as possible. Advanced planning can help them clarify their wishes and make informed decisions about health care and financial arrangements while they still have the capability to understand the aspects and consequences of legal decision making. Right now, K.B. is able to take part in meaningful discussions and think clearly enough to make decisions.

Question 21

Community Resources Available

Answer 21

Alzheimer peer support groups, Alzheimer Society, education programs, adult day care, home health assistants and home nursing, and various forms of assisted living, home and community care and long-term care facilities
Consider the inter/ multi-professional team