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cd 3303 > Dementia/ Delerium > Flashcards

Dementia/ Delerium Flashcards

1
Q

S&S of an acute confusional state

A 
Rapid change in mental state
Looking/acting confused
Altered/fluctuating consciousness
Inattentiveness
Agitation/lethargy
Hallucinations (visual or tactile)
Emotional changes (irritable, violent, euphoric, suspicious)
Autonomic changes (dilated pupils sweating, tachycardia)
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2
Q

3 Causes of acute confusional state/delirium

A

Underlying medical conditions

  1. Medication
  2. Drug withdrawal
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3
Q

Population MC affected by delirium

A

White, female, young OR >60yo

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4
Q

______% of hospitalized patients experience delirium while ___% of post-hip fracture patients experience delirium

A

10-30%; 50%

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5
Q

Name 7 patient characteristics which increase risk of delirium

A 
Hospitalization (esp in elderly)
Multiple medical conditions
Taking multiple medications
Terminally ill
Children
Sensory deprivation (hearing/visual)
Sleep deprivation
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6
Q

What medication conditions increase risk of delirium?

A 
Dementia
Post-surgical status
Transplant
Burn patient
Trauma patient
Drug/alcohol withdrawal
Malnourishment
Chronic hepatic disease
Dialysis
Parkinson's
HIV 
Post-stroke
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7
Q

Which of the following variations of delirium is least common?
A) Hyperactive (i.e. aggressive behaviours)
B) Hypoactive (i.e. deer in headlights)
C) Mixed (i.e. quick to be hyperactive when overstimulated but sedate/reclused when not overstimulated)

A

A (only 20% of cases)

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8
Q

What are the 3 most sensitive tests for delirium?

A

. Orientation (time, date, place)

  1. Recall memory (ID 3 objects)
  2. Serial 7’s (count backwards from 100 by increments of 7)
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9
Q

What are 4 key differences between dementia and delirium?

A
  1. Timeline: dementia is chronic, delirium is acute cognitive changes
  2. Fluctuation: dementia does not fluctuate, delirium does
  3. Alterness/attention: intact with dementia, waxes/wanes in delirium
  4. Speech/thinking: improverished in dementia, confused/disorganized in delirium
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10
Q

True or false: normal nervous system aging involves small, sluggish pupils, impaired upward gaze, and impaired convergence

A

True! Important to keep in mind when conducting CN exam on elderly individuals

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11
Q

Which reflex usually diminishes first in elderly individuals:
A) L4
B) L5
C) S1

A

S1

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12
Q

There is usually (increased/decreased) muscle tone in normal nervous system aging, as well as a return of ____________ reflexes

A

Increased; primitive (eg. sucking, glabellar, grasp)

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13
Q

What is aphasia?

A

Loss of power of expression

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14
Q

What is agnosia?

A

loss of ability to recognize objects, people, or sounds

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15
Q

What is apraxia?

A

Loss of ability to carry out purposeful motions

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16
Q

What is abulia?

A

Loss or impairment of the ability to make decisions or act independently.

17
Q

How does gait normally change in indivuals with dementia?

A

Reduced stride length and step gait
Slower pace, more cautious

(like the texting gait)

18
Q

What would you expect to find with a neuro exam in an individual with dementia?

A

Normal (might have increased motor tone)

19
Q

A focal lesion in which lobe of the brain is associated with incontinence?

A

Frontal

20
Q

A focal lesion in which lobe of the brain is associated with agnosia?

A

Parietal

21
Q

Impaired language is associated with which lobe of the brain?

A

Left temporal-frontal

22
Q

What are the 3 MC types of dementia?

A
  1. Alzheimers (60%)
  2. Vascular (15-20%)
  3. Lewy-Body (10%)
23
Q

It is expected that __________ dementia will be come the most common form of dementia throughout the world

A

Vascular

24
Q

Why are hemorrhagic strokes more common after falls in individuals with Alzheimers?

A

Predisposed to having small ruptures in diploic arteries (the arteries that go from the brain to the skull)

25
Q

What are 4 common features evidence on advanced imaging of an individual with Alzheimer’s?

A
  1. Brain atrophy
  2. Loss of function (hypoperfusion)
  3. Prominent sulci (i.e. central sulcus)
  4. Increased ventricular space
26
Q

What are some key clinical characteristics of vascular dementia?

A

Focal cognitive deficits
Stepwise progression with prolonged plateaus
Impaired exercutive function
Memory loss often not the first symptom

27
Q

What is another name for small-vessel vascular dementia?

A

Lacunar dementia

28
Q

What is strategic stroke?

A

Type of large-vessel vascular dementia developing after occlusion of a single large sized vessel in a functionally critical area

29
Q

6 Risk factors for post-stroke VD

A 
Older age
Lower education
Recurrent stroke
Left hemisphere stroke
Trouble swallowing 
Gait changes/urinary incontinence
Acute complciations of stroke (seizures, cardiac arrhythmias, aspiration pneumonia)
30
Q

What are the 4 categories of vascular dementia?

A

Large vessel
Small vessel
Ischemic-hypoxic
Hemorrhagic

31
Q

What strategies can be used to treat dementia?

A

Management of symptoms:

  • diversion therapy (eg. old movies, memorabilia)
  • fidget toys for restlessness
  • emphasize wellness to life, exercise, scheduled ADLs
  • depression treatments may be needed
32
Q

What kind of music was found to be helpful in the management of dementia symptoms?

A

Baroque - 60bpm

Caused 40% reduction in adverse behaviour

cd 3303 (24 decks)

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