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Clin Med- P > Geriatrics: depression, delirium, dementia > Flashcards

Geriatrics: depression, delirium, dementia Flashcards

1
Q

most common type of dementia?

A

alzheimers

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2
Q

how do most people die from alzheimer’s?

A

aspiration pneumonia: unable to swallow

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3
Q

define dementia

A

An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an ALERT patient

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4
Q

5 risk factors for alzheimers

A 
Age
Family history
Head injury
Fewer years of education
Female sex
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5
Q

what part of the brain gets attacked (and shut down) first in Alzheimer’s dz

A

hippocampus

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6
Q

what is “mild cognitive impairment” ?

A

Memory problem without deficits in other domains

No functional impairment

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7
Q

alzheimer’s Dz: onset, progression

A

Onset: gradual
Progression: gradual, over 8–10 yr on average

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8
Q

alzheimer’s Dz: cognitive and motor symptoms

A

Cognitive symptoms: primarily memory

Motor symptoms: rare early, apraxia later

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9
Q

alzheimer’s Dz: lab tests and imaging

A

Lab tests: normal

Imaging: possible global atrophy, small hippocampal volumes

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10
Q

alz. DSM IV

A

Development of cognitive deficits manifested by:
Impaired memory and
Aphasia, apraxia, agnosia, disturbed executive function

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11
Q

apraxia: what is it?

A
  • An inability to execute learned purposeful movements despite having the desire and physical capacity
  • Acquired disorder of motor planning
  • All of the muscles work but the region of the brain that plans and coordinates the movement of the muscles is impacted
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12
Q

Agnosia: what is it? where are the lesions?

A

The inability to recognize common objects, people, sounds, and places
Lesions on the parietal or temporal lobe
Semantic information and language

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13
Q

what is semantic memory?

A

long term memory or concepts not drawn from personal experience ( Letters, what is a cat…)

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14
Q

vascular dementia DSM IV

A

same as alzheimers but there are…

-Focal neurologic symptoms/signs or evidence of cerebrovascular disease

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15
Q

3 stages of progressive AD

A

mild, moderate and severe impairment

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16
Q

Vascular dementia: onset + progression

A

Onset: may be SUDDEN/ STEPWISE
Progression: stepwise with further ischemia

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17
Q

vascular dementia: cognitive and motor symptoms

A

Cognitive symptoms: depend on anatomy of ischemia

Motor symptoms: correlates with ischemia

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18
Q

vascular dementia: labs + imaging

A

Lab tests: normal

Imaging: cortical or subcortical changes on MRI

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19
Q

Lewy Body Dementia: cognitive + motor symptoms

and what is the major key for this Dx

A

Cognitive symptoms: memory, visuospatial, hallucinations, fluctuations
Motor symptoms: parkinsonism
key difference: *EARLY hallucinations

20
Q

Lewy Body Dementia: labs + imaging

A

Lab tests: normal

Imaging: possible global atrophy

21
Q

Fronto-temporal dementia and Lewy Body Dementia: onset + progression

A

Onset: gradual
Progression: gradual but faster than AD

22
Q

fronto-temporal dementia: cognitive + motor symptoms

A

Cognitive symptoms: executive: disinhibition, apathy, behavior changes
Motor symptoms: none

23
Q

fronto-temporal dementia: labs + imaging

A

Lab tests: normal

Imaging: atrophy in frontal and temporal lobes

24
Q

aggitation may be a sign of ____ in someone with dementia

A

depression

25
Q

primary goal of alzheimers txt

A

To enhance quality of life and maximize functional performance by improving cognition, mood, and behavior

26
Q

non-pharm txt of alzheimer’s dz (kinds weeds)

A 
Cognitive enhancement
Individual and group therapy
Regular appointments
Communication with family, caregivers
Environmental modification
Attention to safety
  • routines are importmant!
27
Q

pharm txt for alzheimer’s dz (kinda weeds)

A

Cholinesterase inhibitors: ***donepezil (Aricept)
+/- Memantine
(anti-chol may lower HR)
maybe: anti-depressants, pyschoactive meds

28
Q

symptom mgmt for alzheimers Dz

A 
Sundowning
Psychoses (delusions, hallucinations)
Sleep disturbances
Aggression, agitation
Hypersexuality
29
Q

what is “sundowning”

A

the closer to evening, the more agitated and confused the AD pt gets
(dont know why this happens)

30
Q

anti-pyschotic meds for alzheimer’s pts can cause what? how do we avoid this?

A

DEATH

start low, go slow!

31
Q

what are the distinguishing signs of delirium (from dementia)?

A

Acute onset, Cognitive fluctuations over hours or days
Impaired consciousness and attention
Altered sleep cycles
*can be under-alert or hyper-alert

32
Q

delirium DSM IV (3)

A
  1. Disturbance of consciousness with reduced ability to focus, sustain, or shift attention
  2. Change in cognition /perceptual disturbance
  3. Development over a short time (hours to days) and fluctuation during the day
33
Q

4 forms of delirium

A
  1. Hyperactive or agitated delirium = 25% of all cases
  2. Mixed
  3. Hypoactive delirium = ≥50% of all cases, but less recognized and appropriately treated
  4. Additional features include emotional lability, psychosis, hallucinations
34
Q

predisposing factors for delirium (kinda weeds)

A 
Advanced age, dementia 
male 
Functional impairment in ADLs
Medical comorbidity
History of alcohol abuse
Sensory impairment (↓ vision, ↓ hearing)
35
Q

how to prevent post-op delirium (3)

A

Limit sedation
Provide adequate analgesia
Transfuse high-risk patients

36
Q

3 ways to avoid complications of delirium

A

Remove indwelling devices ASAP
Prevent or treat constipation and urinary retention
Encourage proper sleep hygiene, avoid sedatives

37
Q

what 4 things are shared in dementia and depression

A

Impaired concentration
Lack of motivation, loss of interest, apathy
Psychomotor retardation
Sleep disturbance

38
Q

what 4 things differentiates depression from dementia

A

Demonstrate ↓ motivation during cognitive testing
Express cognitive complaints that exceed measured deficits
Maintain language and motor skills

39
Q

minor depression vs major depression vs bipolar in older people, what is common/uncommon?

A

minor: common
major: uncommon
bipolar: incidence declines with age

40
Q

major depression DSM IV: gateway symptoms?

A

Gateway symptoms (must have 1)

  • Depressed mood
  • Loss of interest or pleasure (anhedonia)
41
Q

depression : onset, cognitive deficit shown?, responses?

A 
Sudden onset.
Exposes cognitive deficit.
Often responds “I don’t know.”
Variability in cognitive ability.
Inconsistent effort.
42
Q

dementia : onset, cognitive deficit shown?, responses?

A 
Gradual onset.
Conceals deficit.
Tries to answers questions.
Stable or declining ability.
Consistent effort.
43
Q

how is bereavement different from depression ?

A

Most disturbing symptoms resolve in 2 months

Not associated with marked functional impairment

44
Q

3 steps in treating depression: acute, continues, prophylaxis/maintenance

A 
Acute — reverse current episode
Continuation — prevent a relapse
Continue for 6 months
Prophylaxis or maintenance — prevent future recurrence
Continue for 3 years or longer
45
Q

pharm txt for depression?

A

primary: SSRIs (celexa, zoloft)

46
Q

when would you use ECT for depression? (3)

A
  1. major depression & mania; response rates exceed 70% in older adults
  2. pts at serious risk for suicide, life-threatening poor intake of food
  3. psychotic depression in older pts

Clin Med- P (124 decks)

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