Dementia & Delirium Flashcards by Alicia Daum

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

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Define Apraxia

Inability to perform required movements

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Define Agnosia

Cannot recognize an object

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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

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Other Risk Factors for Delirium

Dietary difficulties
In hospital
Dementia
Family history of mental illness
Acute stress
Vision or hearing difficulties (additive effect)

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Initial Diagnostic Workup: Physical & Labs

Vitals
Changes due to underlying diseases
Rule out stroke
CBC, CMP
U/A, culture &amp; sensitive
Radiology

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Initial Interventions for Delirium

Recognize &amp; treat underlying cause
Reduce stimuli
Simple, clear language
Reassurance for person &amp; family
Be aware of increased risk of mortality

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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

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Define Dementia

Neurocognitive disorder

Significant cognitive decline that interferes with daily living

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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

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Alzheimer’s Disease

Not part of normal aging
Fatal
Cannot be slowed down or cured
Risk of getting disease can be modified

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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

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Minimal Cognitive Impairment Due to Alzheimer’s Disease

Mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities

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Dementia Due to Alzheimer’s Disease

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Quite noticeable memory, thinking, & behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10-15 years

Stages of Active Alzheimer’s Disease

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Mild
Moderate
Severe

Mild Active Alzheimer’s Disease

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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

Moderate Active Alzheimer’s Disease

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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

Severe Active Alzheimer’s Disease

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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

Risk Factors for Alzheimer’s

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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

Vascular Dementia

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Impaired judgement or impaired ability to make a decision

Risk Factors for Vascular Dementia

HTN DM High cholesterol

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

Define Lewy Bodies

Abnormal aggregations of the protein alpha-synuclein that accumulates in neurons

Frontotemporal Lobar Degeneration Includes

``` Behavioral-varient frontotemporal lobar degeneration Primary progressive aphasia Pick's disease Corticobasal degeneration Progressive supranuclear palsy ```

Early Symptoms of Frontotemporal Lobar Degeneration

Marked changes in personality & behavior Difficulty with producing or comprehending language Memory is spared

Progression of Frontotemporal Lobar Degeneration

Steady, rapid

Progression of Vascular Dementia

Slow over many years

Progression of Dementia with Lewy Body

Steady, gradual

Define Mixed Dementia

Alzheimer's with another type of dementia

Parkinson's Disease Dementia

``` Slowness Rigidity Tremor Changes in gait & speech Depression ```

Progression of Parkinson's Disease Dementia

Varied

Creutzfeldt-Jacob Disease

``` Rare Rapidly fatal disorder Impairs memory & coordination & causes behavior changes Prion disease Inherited, sporadic, or due to infection ```

Symptoms of Normal Pressure Hydrocephalus

Difficulty walking Memory loss inability to control urination

Onset & Progression of Normal Pressure Hydrocephalus

Onset: insidious Progression: varied May be reversed with surgery

HIV AIDS

Nonspecific impairments of attention, executive function with variable memory changes but commonly depression

10 Warning Signs of Alzheimer's Dementia

Memory changes that disrupt daily life Challenges in planning or solving problems Difficulty completing familiar tasks Confusion with time or place Trouble understanding visual images & spatial relationships New problems with words in speaking or writing Misplacing things & losing ability to retrace steps Decreased or poor judgement Withdrawal from work or social activities Changes in mood or personality

Follow Up for Someone with Alzheimer's Disease

Follow neurocognitive decline: MMSE Follow other chronic diseases: mammogram, A1C, colonoscopy?? Ensure caregivers are doing OK

Early Diagnosis Advantages of Alzheimer's Disease

Ability to make plans Time for grief, denial, education, acceptance Time to create advance directives

Principal Stressors & Illnesses for Caregivers

``` Financial, emotional, & physical difficulties Stress: lack of sleep, no time off Juggling job & caregiving Income status Continued worsening of own disease ```

Dementia & Delirium Flashcards

(43 cards)