Dementia and Delirium Flashcards

1
Q

Characteristics of Dementia?

A
  • slow onset over yrs
  • sxs don’t rapidly fluctuate
  • memory impairment
  • at least one of the following:
    aphasia: unable to understand or express speech
    apraxia: inability to perfrom reqd movements
    agnosia: can’t recognize an object
  • neurocog disorder
  • sig cognitive decline that interferes w/ daily living
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2
Q

Characteristics of Delirium?

A
  • disturbance in consciousness w/ reduced ability to focus, to sustain focus, or shift attention
  • change in cognition
  • disturbance in consciousness that develops over a short period of time and fluctuates
  • may also have:
    disturbances in sleep-wake cycle
    disturbance in psychomotor behavior
    emotional disturbance
    rapid unpredictable shifts from one emotional state to another
  • acute changes
  • last days to weeks, but rarely months
  • usually completely reversible
  • disorientation early
  • prominent phsyiological changes due to underlying cause
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3
Q

Initial dx workup - Hx?

A

all medical hx:

  • underlying psychiatric disorder
  • hx of serious brain trauma or disease
  • cancer
  • infection
  • decreased CO: dehydration, acute blood loss, MI, CHF
  • all surgical hx
  • all meds take
  • ETOH
  • social hx
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4
Q

Intoxication of what drugs can cause delirium?

A

drug or ETOH abuse or poisons

  • anticholinergics
  • anticonvulsants
  • anticancer drugs
  • abx
  • marijuana
  • cocaine
  • inhalants
  • heavy metals
  • sedatives
  • NSAIDs
  • lithium
  • L-dopa
  • LSD
  • opiates
  • mushrooms
  • antidepressants
  • corticosteroids
  • cimetidine (H2 receptor antagonist)
  • ETOH
  • amphetamines
  • PCP
  • solvents (gas)
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5
Q

Other RFs for delirium?

A
- dietary difficulties:
poor nutrition
- in hosp
- dementia (harder to recognize and tx)
- family hx of mental illness
- acute stress: loss of spouse or changes in environment 
- vision/hearing difficulties
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6
Q

Initial dx workup for delirium - Physical and lab work?

A
  • vitals
  • changes due to underlying diseases
  • r/o stroke
  • blood and urine tests: check kidney and liver fxn
  • radiology
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7
Q

Initial intervention for changes in mental status: delirium?

A
  • recognize and tx underlying cause
  • reduce stimuli
  • simple, clear language
  • reassurance for person and family
  • be aware of increased risk for mortality
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8
Q

Initial intervention for changes in mental status: dementia?

A
- testing to ensure dx:
neuropsych testing, mental status assessment, neuro exam
- discuss long term care plans
- discuss advance directives
- refer to alzheimers assoc
- be present
- slow down
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9
Q

How common in AD? Pathogenesis of it?

A
  • 60% of all dementias
  • 1/9 people 65 and older have AD
  • 81% of people who have AD are 75 and older
  • 2/3 are women (women live longer, and assoc b/t gene APOE-e5 and estrogen
  • progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons and twisted strands of protein tau (tangles) inside neurons which damage and kill brain cells
  • not a normal part of aging, may occur in younger person w/ young onset AD
  • fatal
  • 6th leading COD in US
  • can’t be slowed down or cured
  • risk for getting disease can be modified
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10
Q

What are the stages of AD?

A

3 stages:

  • preclinical: measurable changes in brain and may be present 20 yrs b/f sxs
  • MCI due to ADL mild but measurable changes in thinking abilities that are noticeable but don’t affect daily activities: may be up to 10-20% of those over 64
  • dementia due to AD: quite noticeable memory, thinking and behavioral sxs that impair ability to fxn in daily life with a steady gradual progression over 10-15 yrs
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11
Q

Describe the mild (early stage) of active AD?

A
  • problem coming up w/ right word or name
  • trouble remembering names when introduced to new people
  • having greater difficulty performing tasks in social or work settings
  • forgetting material that one has just read
  • losing or misplacing a valuable object
  • increasing trouble w/ planning or organizing
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12
Q

Describe the moderate (middle stage) of active AD?

A
  • forgetfullness of events or about one’s own personal hx
  • feeling moody or withdrawn, esp in mentally challenging situations
  • being unable to recall address or phone number or schools attended
  • confusion about where they are or what day it is
  • needing help choosing proper clothing for day or season
  • trouble w/ bowel and bladder control
  • change in sleeping patterns
  • increased wandering and becoming lost
  • personality and behavioral changes
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13
Q

Describe the severe (late stage) of active AD?

A
  • reqr full time around clock assistance including personal care
  • lose awarenss of recent experiences as well as their surroundings
  • reqr high level of assistance w/ ADLs
  • experience changes in physical abilities: walk, sit, swallow
  • have increasing difficulty communicating
  • become vulnerable to infections, esp pneumonia (aspiration)
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14
Q

RFs for AD?

A
  • age
  • family hx
  • HTN, DM, high cholesterol
  • race: African American , Hispanic, Native American
  • female
  • level of education
  • socio-economic status
  • ETOH use
  • Down sydrome
  • head trauma
  • depression
  • exercise
  • obesity
  • smoking
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15
Q

What is vascular dementia?

A
  • 10% of all dementia cases
  • vascular changes present w/ other types of dementia in 50%
  • impaired judgement or impaired ability to make a decision initial sx
  • risk is high for those w/ HTN, DM, and high cholesterol
  • slow progression over yrs
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16
Q

What is dementia w/ lewy-bodies?

A
  • some sx similar to AD
  • early on: sleep disturbances, well-formed visual hallucinations***, gait imbalance and Parkinsonian movement features, may not have early memory impairment
  • lewy bodies: abnormal aggregations (or clumps) of protein alpha: synuclein that accumulates in neurons
  • may coexist in those w/ parkinson disease or alzheimers disease
  • progression: steady, gradual
17
Q

What is frontotemporal lobar degeneration?

A
  • includes: behavioral variant FTLD, primary progressive aphasia, Pick’s disease, corticobasal degeneration, and progressive supranuclear palsy
  • early sx: marked changes in personality and behavior and difficulty w/ producing or comprehending language, memory is spared
  • nerves in frontal and temporal lobes become shrunken
  • usually starts at 60
  • progression: steady and rapid
18
Q

What is mixed dementia?

A
  • alzheimers w/ another type: FTLD, lewy bodies
19
Q

What is Parkinson’s disease dementia?

A
  • problems w/ movement: slowness, rigidity, tremor, and changes in gait and speech, depression common
  • incidence about 1/10 of AD
  • progression: varied
20
Q

What is Creutzfeldt-Jakob disease?

A
  • very rare, but rapidly fatal disorder
  • impairs memory and coordination and causes behavioral changes
  • caused by prion (misfolded protein) that causes other proteins throughout brain to misfold and malfxn
  • may be called prion disease
  • may be inherited, sporadic or due to infection
21
Q

What is normal pressure hydrocephalus - relationship w/ dementia?

A
  • sx: difficulty walking, memory loss, inability to control urination
  • 5% of all dementias
  • those w/ hx of brain hemorrhage (subarachnoid bleed) and meningitis are at increased risk
  • insidious onset w/ varied progression which may be reversed w/ surgery
22
Q

HIV AIDS assoc w/ dementia?

A
  • HIV (dementia from opportunistic infections, encephalitis)
  • varied course occurring later in disease
  • nonspecific impairments of attention, executive fxn w/ variable memory changes but commonly depression
23
Q

What are the 10 warning signs of AD?

A
  • memory changes that disrupt daily life
  • difficulty completing familiar tasks
  • confusion w/ time or place
  • trouble understanding visual images, and spatial relationships
  • new problems w/ words in speaking or writing
  • misplacing things and losing ability to retrace steps
  • decreased or poor judgement
  • withdrawal from work or social activities
  • changes in mood or personality
24
Q

What does F/U include for pt w/ AD?

A
  • follw neurocog decline: mental status exam
  • follow other chronic diseases:
    know morbidity and mortality of AD: 60 yr old female is 2x as likely to develop AD than breast cancer in her lifetime
  • know whether to continue screening other diseases:
    mammogram
    HBA1C
  • ensure caregivers are doing ok - early mortality, support
  • risk of death for 70 yo w/in 10 yrs:
    w/ AD: 61%
    w/o AD: 30%
25
Q

Early dx advantages of AD?

A
  • ability to make plans
  • time for grief, denial, education, acceptance
  • time to create advance directives
26
Q

What are principal stressors and illnesses for caregivers?

A
  • financial/emotional and physical difficulties: 40% have depression
  • stress: lack of sleep, no time off
  • juggling job and caregiving
  • income status
  • continued worsening of own disease: many die b/f person w/ AD