Flashcards in Dementia Deck (39):
Confusion in older adults?
disturbance of consciousness and change in cognition developing over a short pd of time; ATTENTION
problems attending (you cannot remember b/c you did not attend)
waxes and wanes
restless, agitated, lethargic
Confusion in adults - cx?
metabolic - hypoglycemia
a syndrome w/ progressive decline in daily living
cognitive deficits in two areas
1) memory impairment
2) amnesia, aphasia, apraxia, agnosia, anosognosia, executive functioning impairment
NOT d/t delirium or psychiatric dz
NO autonomic arousal
conscious and alert
prob using familiar objects
Major cx of dementia?
alzheimer's dementia +/-vascular dementia
What is alzheimer's dementia?
frontal temporal lobe dementia/Pick's dz
Parkinson's dz dementia-spectrum illness
Lewy body dementia
dementia d/t alcohol
demential d/t head injury
Impairment of Alzheimers dz?
frontal lobe impairment
cannot form new memories
understanding and using languages, praxis, perception, visual-spatial skills
valproate - anxiety, manic type
Frontal lobe impairment?
complex cognition (exectuvie fxntioning)
Frontal temporal lobe dementia?
1) behavioral variant- personality change; impulsive vs apathetic
2) semantic dementia- SPEECH is impaired NOT the memory
3) nonfluent progressive aphasia- stuttering, lose ability to write
Lewy body dementia?
read a contract and informed consent - able to form new memories
***visual hallucination or paranoia/delusion (sense are getting input but NOT getting input)
occipital lobe is VERY active
waxes and wanes w/in 24 hrs
overlaps w/ parkinsonism dementia
abnormal protein that develop in nerve cells of substantial nigra in PARKINSON'S DZ
lack of appreciation of significance of deficits
they do not know who they are but refuse to acknowledge they have memory probs
Anosognosia - cx?
prob w/prefrontal cortex or the right parietal lobe
MMSE; use SLUMS, MOCA
OT - functional assessments ( Allen cognitive; can they still pay bills, sewing, etc)
Neuropsychology: trails A & B
What to be aware from pt and family?
hx from multiple sources (we should avoid asking yes/no questions)
good neurological examination
Criteria for delirium?
decreased awareness of environment - not able to focus, sustain or shift attention
memory, orientation, language, hallucination
Delirium neurotransmitter deficit?
too much dopamine; too little Ach
stupor, coma, seizures
Cx of delirium?
not working BBB****
hx of brain injury
Delirium - RF?
sensory deprivation (hearing/seeing)
Delirium - precipitating factors?
more than 3 use of drugs
Prevention of delirium?
move them around
withdraw alcohol, benzo (avoid in older adults)
younger than 70? haloperidol
older than 70? riserpidone
Prevent delirium in geriatrics that are admitted to ICU?
sleep (10p-5a) - melatonin, mirtazapine
PO intake (warm food as warm, cold as cold)
say no to Benzo and TCA
Wernicke's encephalopathy deficiency?
Wernicke's encephalopathy population?
irreversible dementia from B1 deficiency
Alcohol withdrawal tx?
What can happen if wernicke's encephalopathy get's bad?
accumulation of infectious proteins
AD first sx?