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PT 742 Common Medical Conditions > Alzheimer-Dementia > Flashcards

Flashcards in Alzheimer-Dementia Deck (30)
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1

What is Dementia?

Characterized by loss of function in multiple cognitive domains
Has 1 or more of the following clinical manifestations
-General decrease in cognition
-Behavioral Disturbance
-Interference with daily function/independence

2

What is the prevalence of Dementia?

5% under 65
35-50% over 85%

3

What else comes with dementia?

Aphasia-A language disorder that affects a person's ability to communicate
Apraxia- difficulty with motor planning
Agnosia- inability to process sensory information
Disturbance of executive functions

4

What are some things pt with dementia will have?

Difficulty learning & retaining new info (remembering events)
Handling complex tasks (balancing a checkbook)
Reasoning (unable to cope with unexpected events)
Spatial ability and orientation (Getting lost in familiar places)
Language
Behavior

5

What are some different versions of dementia?

Alzheimers-60-80%
Vascular (multi-infarct)-10-20%
Parkinsons disease and related demtias - 5%
Frontal Lobe dementia
Reversible dementia's

6

What is delirium?

Disturbance of consciousness
-reduced clarity of awareness of environment
-w/ reduce ability to focus, sustain or shift attention
Change in cognition
-memor deficit, disorientation, language disturbance

7

How does delirium work?

The disturbance develops over short period of time and fluctuates during the course of the day.
Differentiated by etiology (due to general medical condition, substance induced, multiple etiology, not otherwise specified)

8

What is the prevalence of Delirium?

10-30% in hospitalized medically ill
10-40% of hospitalized elderly
Up to 51% of post-operative patients

9

How can you differentiate between delirium and dementia?

Delirium fluctuates with time of day, differentiated by variations in alertness/orientation.
Dementia residents usually are alert, and mental status does not change during the day

10

How many pt with delirium fully recover?

40%

11

What's the most common form of dementia?

Alzheimers-60-70%

12

What is Alzheimers?

Acquired syndrome of decline in memory and at least one other cognitive domain sufficient to interfere with social or occupational functioning in an alert person

13

What are some risk factors for Alzheimers?

Age
History of depression
Femaile
Low education level
Family history
Diabetes
Hypercholesterolemia
Blood Pressure
Genetics

14

How can Alzheimers disease be diagnosed

only at an autopsy

15

What are some signs and symptoms of Alzheimers?

memory loss
personality change
global cognitive dysfunction,
functional impairments
Loss of short term memory

16

What is the 1st Stage of Alzheimers?

Stage 1-Mild
-Defective memory difficulty learning new info, language and visuospacial skills decline
-Personality changes occur, but motor abilities remain intact
First 1-3 years

17

What is the 2nd stage of Alzheimers?

Moderate
-recent and remote memory severely impaired, recall of previously learned info difficult
-language, visuospatial skills and personality changes worsen
-Psychiatric features and acalculia are noted
-Neuroimaging and EEG changes begin
-Lasts 2-10 years

18

What is the 3rd stage of Alzheimers?

Severe
-Intellectual function markedly worsens
-Echolalia, palilalia, aphasia, loss of motor function, falls, loss of sphincter control, personality changes
-Bedridden
-Neuroimaging studies demonstrate atrophy
-EEG shows diffuse slowing
-Lasts 1-3 years

19

What is Vascular dementia?

Clinical presentation varies with location of infarcts.
-Lacunar Dementia-no stroke history; progressive dementia, focal deficits, frontal lobe-like syndrome
-Binswanger's disease-Apathy, agitation, bilateral corticospinal or bulbar signs

20

What is Post-stroke Dementia?

New dementia at 3 months after acute stroke
6-32% prevalence

21

What's mixed dementia?

Features vascular (lacunar) and Alzheimer

22

What are some examples of reversible dementias?

Medication-induced
Alcohol-related (Withdrawal, intoxication)
Metabolic disorders
Depression

23

What is the 1-minute mental status exam?

Category fluency-name as many animals as they can
Phonemic fluency test-Name as many words as possible in a minute
Test of recall-3 unrelated objects and see if the pt can remember

24

What is sundowning?

Occurs late in day, and extends into the night
Etiology unknown
May be aggravated by
-fatigue
-low lighting
-increased shadows
-disruption of internal clock
Sleep disturbance

25

What are some treatment tips with these disorders?

Speak slowly
limit distractions
don't argue
comfort and assurance
Encourage nonverbal communication (point/gesture)

26

What are the 7 modifiable factors that help prevent these disorders?

Diabetes
High BP
Obesity
Smoking
Depression
Cognitive inactivity
Physical inactivity

27

What are some other interventions with these disorders?

low lighting levels, music, simulated nature sounds
Walking and other forms of light exercise
Simulated presence therapy (videotaped family)
Massage, pet therapy, bright light, cognitive remediation

28

Why do driving skills deteriorate?

Decreased sensory response
Reaction times
Visual Acuity changes
ROM decreased

29

What are some signs of unsafe driving?

Difficulty locating familiar places
Failure to observe traffic signals
Slow or poor decision making
Driving inappropriate speeds
Become angry or confused when driving

30

What kind of scores on the Clinical Dementia Rating (CDR) implicate unsafe driving conditions?

As low as .5, and should not be driving with a score of 1 or higher.
Need to reassess every 6 months of .5