387: Week 3 - Mental Health in Older Adults

Question 1

Name some of the causes/risk factors of delirium

Answer 1

• Drug toxicity (MEDICATIONS)
• Dehydration
• Infection (UTI and upper respiratory)
• Electrolyte imbalance
• Hypoxia
• Metabolic disorders 9thyroid or blood glucose abnormality)
• Nutritional deficiencies
• Hepatic or renal disease

Question 2

How does delirium differ from dementia?

Answer 2

Delirium has:

• Sudden onset
• Rapid fluctuations in LOC (level of consciousness)
• Reversible causes (however if left untreated for too long it can have serious irreparable complications)

Question 3

What is “Dementia”?

Answer 3

• Gradual onset of multiple cognitive changes in memory, abstract thinking, judgment and perception which often results in a progressive decline in intellectual functioning and lowered capacity to perform daily activities
• Short term memory is the first to disappear

Question 4

Describe the process of assessing/screening for and diagnosing dementia.

Answer 4

• There is no one test to diagnose a dementia
• Diagnosis made on basis of clinical grounds… -Verification of diagnosis occurs upon autopsy with the identification of abnormal degenerative structures, neuritic plaques, and neurofibrillary tangles

Question 5

What are the risk factors for dementia?

Answer 5

• Age (risk increases w/ age)
• Familial tendency for AD (FAD less than 5%)
• Down’s syndrome (AD) -> tend to develop in late 40’s/early 50’s
• Multiple/repeated head traumas
• Low educational level (controversial)

Question 6

Discuss the “Neurotransmitter theory” regarding the development of dementia

Answer 6

Neurotransmitter:

• Acetylcholine involved in memory
• acetylcholine decreased in AD

Question 7

Signs and symptoms of dementia (Think of the 3 A’s ;)

Answer 7

Aphasia: difficulty with language
Apraxia: decreased ability to execute motor activities
Agnosia: inability to recognize or identify objects
Executive functioning decline: ability to think abstractly, plan, sequence etc. is impaired

Question 8

What are the signs of mild Alzheimer’s disease?

Answer 8

• Memory loss (mainly short term)
• Aphasia
• Mood swings
• Changes in personality
• Impairment of judgment
• Apathy (also a major indicator of depression)

Question 9

What are the signs of moderate Alzheimer’s disease?

Answer 9

• Inability to retain new information
• Continued personality/behavioral changes (possible increase in paranoia)
• Increased memory loss (severe short-term memory loss a impairment of long-term memory)
• Wandering/agitation/aggression and confusion
• Assistance required with ADLs

Question 10

What are the signs of severe (end stage) Alzheimer’s disease?

Answer 10

• Motor/gait disturbances
• Progressively becomes bedridden
• Inability to perform ADLs
• Incontinence
• Patient requires long term care
• Abilities to eat and swallow are often significantly compromised at this time

Question 11

What 3 categories of housing are available for older adults?

Answer 11

1. Independent (own home, apartment, low cost seniors housing)
2. Semi-independent (Assisted living)
3. Dependent (nursing homes, auxiliary hospitals, etc)

Question 12

What are some non-traditional housing options for older adults?

Answer 12

• Homeshare programs
• Intergenerational housing (grandparents live with adult children and grandchildren)
• WHO – Movement towards age-friendly cities

Question 13

Discuss the various “Genetic” theories regarding the development of AD.

Answer 13

• Various chromosomes have been considered to influence the development of AD:
• > 21 – Associated with Down’s Syndrome (Trisomy 21)
• > 14 – A locus is found on chromosome 14 in about 70% of individuals with FAD
• > 19 – Apolipoprotein (apoE) is a normal cholesterol carrying protein produced by Chr 19. One form of this protein protects against neurofibrillary tangles, but in AD, it appears to have failed to protect the individual from this

Question 14

Some theories suggest that 3 things may contribute in delaying the onset/progression of AD. What are they?

Answer 14

1. NSAIDS (may result in major GI bleeding)
2. Estrogen replacement therapy (cancerous in females and can result in DVT -> increase risk for major blood clotting)
3. Vitamin E

Question 15

What are the 4 types of primary dementia?

Answer 15

1. Alzheimer’s Disease -> presence of plaques and tangles in the brain
2. Vascular Dementia ->mini-strokes and other conditions block or reduce blood flow to brain cells
3. Dementia w/ Lewy Bodies (DLB) -> microscopic deposits that damage brain cells over time
4. Frontotemporal dementia (FTD) -> neurodegenerative disease characterized by progressive neuronal loss

Question 16

What are the 2 types of Alzheimer’s Disease?

Answer 16

1. Early-onset AD (dx 65 yrs or younger)

2. Late-onset AD (dx older than 65)