Class 6: Dementia and Hypoxia Flashcards
What is hypoxia?
Deficient amount of oxygen to tissues of the body
(in our case the brain tissue)
Altered / not sufficient cardiac or respiratory function.
Diffuse effect neurocognitively.
Ex. near drowning, cardiac arrest, massive blood loss, car accident with multiple internal injuries with massive bleeding.
What is hypoxemia?
Deficient amount of oxygen in the blood
What are traditional causes of hypoxia?
COPD Obstructive sleep apnea (OSA) Acute respiratory distress syndrome (ARDS) High altitude COVID
What can influence the lung and how the individual is oxygenating with COPD?
Inflammation of airways that obstruct the airways, mucous, further on out into lungs more narrow airways get. Alveoli can lose shape and flexibility.
How can COPD affect cognition?
Encoding/retrieval memory; problem solving, verbal fluency, working memory, psychomotor speed, simple motor skills
Exercise can positively impact this
How can sleep apnea affect cognition over a period of time?
Sustained/selective attention
Psychomotor speed, fine motor coordination
Planning, initiation, mental flexibility, working memory, verbal fluency
Learning and memory
What does neuroimaging show for involvement of deficits for sleep apnea?
Reductions in prefrontal cortex, subcortical gray matter, hippocampus, white matter
What are neurologic manifestations of COVID?
Olfactory and gustatory
Cognition (Brain fog)
Dizziness, headaches
1/3 of patients on discharge exhibited cognitive and motor deficits
What are neurologic consequences of COVID?
Mild but real brain damage
Encephalitis
Acute inflammation of the brain
Cause viral infections
Brain swelling
Strokes
Increase risk for people over 70 and in the young (7x more likely)
Damage to white matter connections
Small vessel disease, lacunar infarcts, “mini strokes”
Systemic Inflammation
Associated with cognitive decline with ongoing / lasting effects
Increase in proinflammatory cytokines (found in severe sepsis) associated with hippocampal atrophy
What is the most common type of dementia?
Alzheimer’s
What is dementia?
An acquired, progressive impairment of several cognitive domains in an alert individual
NOT delirium or psychiatric disorder
Influences social interactions, work, and ability to perform ADLs
Secondary to a disease of the brain (e.g., AD, PD) that are typically chronic in nature.
What can dementia impair?
Memory Reasoning Orientation Calculation Learning capacity Language Judgment Deterioration in emotional control, social behavior or motivation
What can dementia impair?
Memory Reasoning Orientation Calculation Learning capacity Language Judgment Deterioration in emotional control, social behavior or motivation
What is the DSM 5?
Diagnostic and Statistical Manual of Mental Disorders
Published by the American Psychiatric Association to relay a common language and classification system for mental disorders
What are the classifications of disorders in the DSM 5?
Major Neurocognitive and Mild Neurocognitive Disorder
What is a mild neurocognitive disorder?
Evidence of modest cognitive decline from a previous level of performance in one or more domain based on the concerns of the individual, a knowledgeable informant, or the clinician
Measurable memory impairment on standardized testing; outside range of expected for age / education matched healthy older adults
Cognitive deficits are INSUFFICIENT to interfere with independence (e.g., instrumental activities of daily living – paying bills, managing meds) but greater effort, compensatory strategies or accommodation may be required to maintain independence.
NOT secondary to delirium or another mental disorder (DSM 5)
What is delirium?
Disturbance in attention and orientation to the environment; confusion.
Disturbance develops over a short period of time (hours to days) and represents and acute change from baseline that is not solely attributable to another neurocognitive disorder.
Fluctuates in severity during the course of the day
Not related to neurocognitive dysfunction!
What causes delirium?
Medications (especially anti depressants, antipsychotics) Most common Infections Metabolic disorders Surgery, anesthesia Substance withdrawal Kidney or liver disease Toxins
What is major neurocognitive disorder?
Evidence of substantial cognitive decline from a previous level of performance in one or more of cognitive domains based on the concerns of the individual, a knowledgeable informant, or the clinician.
Test performance in the range of 2 or more SD below appropriate norms
Cognitive deficits are SUFFICIENT to interfere with independence (i.e., requires min assist with instrumental ADLS)
Not secondary to delirium or another mental disorder
What requirements must major neurocognitive impairment meet?
Symptoms must be insidious in onset
Must not be accounted for by delirium, schizophrenia or major depression
Must be acquired
Must be persistent (does not vary like delirium)
Must cross several areas of cognitive function
Must be severe enough to interfere with work, social activities and relationships with others
What are risk factors of MCI to turn into AD?
Age APOE carrier status (APOE e4). Found on chromosome 19 Can be inherited by mother, father or both Present in 25 to 30% of the population and 40% of people with late onset AD RISK FACTOR…not a cause. DM HTN Increased Cholesterol
What can prevent AD?
Absence of APOE 4 variant Lifetime of exercise (physical and mental) Youth Social stimulation Controlled cardiovascular risk Non-smoking
Examples of changes of memory in normal aging?
Forget appointment
Forget a neighbors name
Forget a birthday or anniversary
What are examples of changes in memory in dementia and major CI?
May not remember making an appointment
May not recognize a neighbor or family member
My not recognize that their spouse’s birthday is February 4
Examples of disorientation in normal aging?
Forgets day of week, gets lost
Examples of disorientation in dementia or major CI
Routinely do not know what day it is
May not recognize if it is morning, noon or night
May get lost in their own neighborhood or home
