REVERSIBLE CAUSES OF DEMENTIA are?
D Drugs/medications E Emotional illness/depression M Metabolic/endocrine disorders E Eye/ear involvement/environmental N Nutritional/neurological T Tumors/trauma I Infection A Alcoholism/anemia/atherosclerosis
MODIFIABLE CAUSES OF DEMENTIA are?
- Normal pressure hydrocephalus
- Hepatic encephalopathy
- HIV encephalopathy (AIDS dementia complex)
IRREVERSIBLE CAUSES OF DEMENTIA are?
- Alzheimer disease
- Multi-infarct dementia
- Huntington chorea
No impairment (normal function)
STAGE 1 Alzheimers is?
Very mild cognitive decline (may be age-related changes or earliest signs of Alzheimer disease)
• Memory lapses, especially in forgetting familiar words or names or the location of everyday objects
• Symptoms not evident during a medical examination or apparent to friends, family, or co-workers
STAGE 2 Alzheimers is?
Mild cognitive decline
• Problems with memory or concentration; may be measurable in clinical testing or apparent during a detailed medical interview.
• Friends, family, or coworkers begin to notice deficiencies.
• Common difficulties include:
• Word or name finding problems noticeable to family or close associates
• Decreased ability to remember names when introduced to new people
• Performance issues in social or work settings
• Reading a passage and retaining little material
• Losing or misplacing a valuable object
• Decline in ability to plan or organize
STAGE 3 Alzheimers
Moderate cognitive decline (mild or early-stage Alzheimer disease)
• The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situationsClear cut deficiencies in the following areas:
• Decreased knowledge of recent occasions or current events
• Impaired ability to perform challenging mental arithmetic (e.g., counting backward from 100 in 7s)
• Decreased capacity to perform complex tasks, such as marketing, planning dinner for guests, or paying bills and managing finances • Reduced memory of personal history
STAGE 4 Alzheimers
Moderately severe cognitive decline (moderate or mid stage Alzheimer disease)
• Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities be¬ comes essential
• Individuals may:
• Be unable during a medical interview to recall such important details as their current address, their telephone number, or the name of the college or high school from which they graduated
• Become confused about where they are or about the date, day of the week, or season
• Have trouble with less challenging mental arithmetic (e.g., counting backward from 40 in 4s or from 20 in 2s)
• Need help choosing proper clothing for the season or the occasion
• Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
• Usually require no assistance with eating or using the toilet
STAGE 5 Alzheimers
Severe cognitive decline (moderately severe or midstage Alzheimer disease)
• Memory difficulties continue to worsen, significant personality changes may emerge, and affected individuals need extensive help with customary daily activities
• Individuals may:
• Lose most awareness of recent experiences and events as well as of their surroundings
• Recollect their personal history imperfectly, although generally able to recall their own name
• Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
• Need help getting dressed properly; without supervision, may make such errors as putting pajamas over daytime clothes or shoes on wrong feet • Experience disruption of their normal sleep-wake cycle
• Need help with handling details of toileting (flushing toilet, wiping, and disposing of tissue properly)
• Have increasing episodes of urinary or fecal incontinence
Experience significant personality changes and behavioral symptoms including suspiciousness and delusions, hallucinations, or compulsive, repetitive behaviors
• Tend to wander and become lost
STAGE 6 Alzheimers
Very severe cognitive decline
• This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak, and, ultimately, the ability to control movement.
• Lose capacity for recognizable speech, although words or phrases may occasionally be uttered
• Need help with eating and toileting and there is general incontinence of urine
• Lose the ability to walk without assistance and then the ability to sit without support, the ability to smile, and the ability to hold their head up
• Reflexes become abnormal and muscles grow rigid; swallowing is impaired
STAGE 7 Alzheimers
Onset abrupt; fluctuations over course of day common with lucid intervals during day and worst symptoms at night; lasts hours to weeks; unable to maintain attention to external stimuli; disorganized thinking, perceptual disturbances, disturbed sleep/wake cycle; hallucinations, usually visual, common
Physical finding with delirium are?
Decreased LOC, impaired arousal, decreased psychomotor activity; disoriented, most commonly to time; physical examination findings depend on underlying cause of delirium; patient often exhibits asterixis, tremor, and difficulty in motor relaxation; speech incoherent, hesitant, slow, or rapid
Diagnostic studies commonly seen with delirium are?
CBC, electrolytes, glucose, BUN, creatinine, LFTs, TFTs, serum Bi2, folate, serology for syphilis, ABGs, toxicology screen, blood alcohol level, U/A, ECG, EEG, chest radiograph, lumbar puncture, CT or MR I (when CVA or injury suspected)
Less abrupt, less severe than delirium; diurnal variation less severe than delirium; concentration impaired, easily distracted; errors in thinking common
Physical findings: Apathetic, drowsy; disoriented especially for time, but less for place, almost never for self; less severe disorientation, more sub¬ the motor signs than in delirium
Diagnostic studies for confusion are?
CBC, electrolytes, glucose, BUN, creatinine, LFTs, TFTs, serum Bi2, folate, serology for syphilis, ABGs, toxicology screen, blood alcohol level, U/A, ECG, EEG, chest radiograph, lumbar puncture, CT or MRI (when CVA or in¬ jury is suspected)
Onset insidious, course stable through day and night; present for months or years, with progressive deterioration; recent and remote memory impaired; hallucinations usually absent until late in course of disease; sleep often fragmented
Alert, attentive; orientation usually impaired; on mental status examination, patient tries hard, provides “near miss” answers; demonstrates one or more of following cognitive disturbances: aphasia (language disturbance); apraxia (impaired ability to carry out motor activities despite intact motor function); agnosia (failure to identify or recognize objects despite in¬ tact sensory function); disturbance in executive functioning (planning, organizing, sequencing, abstracting); physical findings often absent in Alzheimer type; olfactory sense can be impaired; speech usually unimpaired although difficulty with finding words; findings in multi¬ infarct dementia include focal neurological signs/symptoms: exaggerated DTRs, positive Babinski sign, gait abnormalities, hemiparesis
Labs for dementia?
CBC, electrolytes, glucose, BUN, creatinine, LFTs, TFTs, serum Bl2, folate, serology for syphilis, ABGs, toxicology screen, blood alcohol level, U/A, ECG, EEG, chest radiograph, lumbar puncture, CT or MRI (when CVA or in¬ jury suspected; does not yield useful information for dementia); PET scan