Flashcards in Dementia & Delirium Deck (43)
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1
Clinical Features of Dementia
Slow onset over years
Symptoms do not rapidly fluctuate
Memory impairment
Aphasia, apraxia, or agnosia
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Define Aphasia
Unable to understand or express speech
3
Define Apraxia
Inability to perform required movements
4
Define Agnosia
Cannot recognize an object
5
Clinical Features of Delirium
Disturbance in consciousness with reduced ability to focus, sustain focus, or shift attention
Change in cognition
Disturbance in consciousness that develops over a short period of time & fluctuates
May also have sleep, psychomotor behavior, or emotional disturbances, or rapid unpredictable shifts from one emotional state to another
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Important History in the Initial Diagnostic Workup
All medical history
Underlying psychiatric disorder
Hx of serious brain trauma or disease
CA
Infection
Decreased cardiac output (dehydration, acute blood loss, MI, CHF)
All surgical history
All medications taken
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Intoxication that May be Causing the Delirium
Drug or alcohol abuse or poisons
Anticholinergics
Sedatives
Antidepressants
Anticonvulsants
NSAIDs
Corticosteroids
Chemo
Lithium
Cimetidine
Antibiotics
L-dopa
Illicit drugs
Solvents
Heavy metals
Antihistamines
8
Other Risk Factors for Delirium
Dietary difficulties
In hospital
Dementia
Family history of mental illness
Acute stress
Vision or hearing difficulties (additive effect)
9
Initial Diagnostic Workup: Physical & Labs
Vitals
Changes due to underlying diseases
Rule out stroke
CBC, CMP
U/A, culture & sensitive
Radiology
10
Initial Interventions for Delirium
Recognize & treat underlying cause
Reduce stimuli
Simple, clear language
Reassurance for person & family
Be aware of increased risk of mortality
11
Initial Interventions for Dementia
Testing to ensure diagnosis: neuropsych, mental status, neurological exam, B12, hypothyroidism, Korsakoff syndrome, Normopressure hydrocephalus, uncontrolled DM
Discuss long term care plans
Discuss advanced directives
Refer to Alzheimer's Association
Be present
Slow down
12
Define Dementia
Neurocognitive disorder
Significant cognitive decline that interferes with daily living
13
Define Alzheimer's Disease
Progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons & twisted strands of the protein tau (tangles) inside neurons which damage & kill brain cells
14
Alzheimer's Disease
Not part of normal aging
Fatal
Cannot be slowed down or cured
Risk of getting disease can be modified
15
3 Stages of Alzheimer's Disease
Preclinical
MCI due to Alzheimer's disease
Dementia due to Alzheimer's disease
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Preclinical Stage of Alzheimer's Disease
Measurable changes in brain & may be present 20 years before symptoms
17
Minimal Cognitive Impairment Due to Alzheimer's Disease
Mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities
18
Dementia Due to Alzheimer's Disease
Quite noticeable memory, thinking, & behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10-15 years
19
Stages of Active Alzheimer's Disease
Mild
Moderate
Severe
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Mild Active Alzheimer's Disease
Problems coming up with right word or name
Trouble remembering names to new people
Greater difficulty performing tasks in social or work settings
Forgetting material that one has just read
Losing or misplacing a valuable object
Increasing trouble with planning or organizing
21
Moderate Active Alzheimer's Disease
Forgetfulness of events or one's history
Feeling moody or withdrawn
Being unable to recall address or phone number or schools attended
Confusion on where they are & what day it is
Need help choosing clothing for day or season
Trouble with bowel & bladder control
Changes in sleep patterns
Increased wandering & becoming lost
Personality & behavioral changes
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Severe Active Alzheimer's Disease
Require full time assistance including ADLs
Lose awareness of recent experiences as well as surroundings
Experience changes in physical abilities: walk, sit, swallow
Have increasing difficulty communicating
Become vulnerable to infections
23
Risk Factors for Alzheimer's
Age
Family history
HTN, DM, high cholesterol
Race: African or Native American
Female
Level of education
SES
Alcohol use
Down syndrome
Head trauma
Depression
Exercise
Obesity
Smoking
24
Vascular Dementia
Impaired judgement or impaired ability to make a decision
25
Risk Factors for Vascular Dementia
HTN
DM
High cholesterol
26
Symptoms of Dementia with Lewy-Body
Sleep disturbances
Well-formed visual hallucinations
Gait imbalance & Parkinsonian movement features
Early memory impairment
May coexist with Parkinson's or Alzheimer's disease
27
Define Lewy Bodies
Abnormal aggregations of the protein alpha-synuclein that accumulates in neurons
28
Frontotemporal Lobar Degeneration Includes
Behavioral-varient frontotemporal lobar degeneration
Primary progressive aphasia
Pick's disease
Corticobasal degeneration
Progressive supranuclear palsy
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Early Symptoms of Frontotemporal Lobar Degeneration
Marked changes in personality & behavior
Difficulty with producing or comprehending language
Memory is spared
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