Cognition Flashcards
(32 cards)
what is cognitive impairment? what does it include?
describes a range of disturbances of cognitive functioning including memory, orientation, attention, and concentration.
it includes delirium, depression, and dementia.
what are geriatric syndromes?
cognitive impairments is considered a geriatric giant, geriatric syndrome, or an indicator of frailty in the aging population.
three other geriatric syndromes include mobility, continence, and falls.
basically terms used to describe the significance of functional changes in older people. geriatric syndromes are interrelated and conditions that affect older people.
delirium, depression, dementia = how do they develop?
delirium = medical emergency, usually has rapid onset depression = can develop over time dementia = usually develops gradually over time
delirium: what is it? what is it caused by? signs & symptoms? assessment? how do we treat? interventions?
a medical emergency. it is most often caused from interrelated factors such as predisposing conditions (such as dementia), severe illness, sensory impairments, medications, etc.
any time an older person that is hospitalized exhibits “confusion”, they should be assessed for delirium. anytime any older person experiences sudden changes to their cognition, they should be assessed for delirium.
treat the cause!
intervention: identify an older person’s risk factors related to delirium, and always assess for delirium frequently.
people who have ______ are at an increased risk of developing ______.
people who have DEMENTIA are an increased risk of developing DELIRIUM.
what is delirium characterized by?
characterized by an acute and fluctuating onset of confusion, disturbances in attention, disorganized thinking and/or decline in level of consciousness.
what are the three types (clinical presentations) of delirium?
- HYPOACTIVE DELIRIUM: characterized by lethargy and decreased motor activity. hypoactive delirium can be overlooked because it may appear as if the older person is just sleepy.
- HYPERACTIVE DELIRIUM: characterized by agitation, vigilance, hallucinations, restlessness, and hyperactivity. most likely to be recognized due to the older person’s behaviours.
- MIXED DELIRIUM: characterized by alternating features of hypoactive and hyperactive delirium. studies suggest that 46% of delirium is mixed.
what are the two most common factors that could cause delirium?
MEDICATIONS: could be due to addition of a new medication or the withdrawal of a medication the older person has been taking for a long time. with older people, the golden rule related to introducing new medications is to start low (dose) and go slow (increasing the dose).
older people are particularly susceptible to delirium from the introduction of a group of medications called BENZODIAZEPINES (sedate)
INFECTIOUS PROCESSES: most commonly respiratory and urinary tract infections.
causes of delirium: I WATCH DEATH (acronym)
INFECTION
WITHDRAWAL ACUTE METABOLIC TOXINS, DRUGS CNS PATHOLOGY HYPOXIA
DEFICIENCIES ENDOCRINE ACUTE VASCULAR TRAUMA HEAVY METALS
delirium assessment and prevention:
- Determine the risks
- Hydration
- Nutrition
- Limiting tubes (Intravenous tubes and catheters) that hamper movement
- Hearing aids and eyeglasses on
- White orientation boards -where you write your name and the date
- Clocks
- Preventing constipation
- Use of bed alarms and chair alarms
- Active engagement of family members can help orientate and calm
- Non-pharmacological sleep protocol
- Early mobilization
Responding to possible unmet needs, such as hunger, thirst, pain, the need to use the toilet.
cause of depression in older people
complex; it is often an interaction between biological vulnerabilities, psychological vulnerabilities, and stressful events.
AFFECTIVE symptoms of depression:
sad, irritable mood, feelings of worthlessness or guilt, and or loss of pleasure
Cognitive symptoms: decreased concentration and/or suicidal thoughts or behaviours.
SOMATIC symptoms of depression:
fatigue, decreased energy, increased or decreased appetite, sleep disturbances and psychomotor agitation or retardation.
how does depression manifest in older people that makes it hard to recognize that it is depression?
somatizing complaints with the presence of a chronic condition.
why is depression often under-recognized in older people?
because it can be associated with confusion and believed to be dementia, and older people do not complain of depression, rather have physical complaints.
what is dementia? what does it affect?
an umbrella term used to describe a set of symptoms affecting brain function that are caused by neurodegenerative and vascular diseases or injuries.
it is a gradual and progressive decline in mental processing abilities, affecting short term memory, language, judgment, reasoning, communication, and abstract thinking.
what is dementia characterized by?
it is characterized by a decline in cognitive abilities.
is dementia a normal part of aging?
no. though, the prevalence of dementia increases with age, particularly over the age of 85.
what are the five main types of dementia?
Alzheimer’s disease Vascular dementia Lewy body disease Frontal temporal dementia Creutzfeldt-Jakob dementia
potential risk factors for dementia (particularly for Alzheimer’s Disease and vascular dementia)
vascular disorders or events (such as stroke, hypertension, head trauma)
explain Alzheimer’s Disease (progression, presentation, interventions)
most common – accounts for 50-60% of dementias.
course/progression: ranges from 1-20 years. characterized by a gradual decline over the years.
presentation: personality disintegration, amnesia, agnosia (ability to recognize people/objects), apraxia (loss of ability to perform familiar tasks), aphasia (loss of language skills)
interventions: directed at managing the symptoms and does not influence decline.
- cholinesterase inhibitors increase the amount of acetylcholine in the brain. acetylcholine helps cells communicate w/ one another.
- Memantine blocks the effects of abnormal glutamate activity that may lead to neuronal cell death and cognitive dysfunction.
explain vascular dementia (cause, progression, presentation, intervention)
cause: AKA multi-infarct, vascular dementia is caused by interruption of blood supply to areas of the brain by thromboembolism, hemorrhage or ischemia.
progression: can either be stepwise after an episode in the brain or a steady decline.
presentation: varies according to the type of brain affected.
interventions: same for alzheimer’s
risk factors of vascular dementia
HTN, cardiac disease, diabetes, smoking, alcoholism, dyslipidemia
screening tools for dementia
SLUMS and RUDAS
