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Flashcards in Dementia Deck (39):
0

Confusion in older adults?

delirium
dementia

2

Delirium?

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)
rapid onset
waxes and wanes
autonomic arousal
clouded consciousness
restless, agitated, lethargic
hallucination

2

Confusion in adults - cx?

CVA/stroke
subdural hematoma
anxiety
metabolic - hypoglycemia
low BP

3

Dementia?

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
insidous onset
progressive
NO autonomic arousal
conscious and alert
no hallucination

4

Amnesia?

memory prob

5

Aphasia?

language prob

6

Aprxia?

prob using familiar objects

7

Agnosia?

prob naming

8

Major cx of dementia?

alzheimer's dementia +/-vascular dementia

9

What is alzheimer's dementia?

frontal temporal lobe dementia/Pick's dz
Parkinson's dz dementia-spectrum illness
Lewy body dementia
Huntington's dz
dementia d/t alcohol
demential d/t head injury

10

Impairment of Alzheimers dz?

hippocampus
parietal/temporal lobes
frontal lobe impairment

11

Hippocampus cx?

cannot form new memories

12

Parietal/temporal lobes?

understanding and using languages, praxis, perception, visual-spatial skills

13

Dementia tx?

Memantine
cholinesterase inhibitors
valproate - anxiety, manic type

14

Frontal lobe impairment?

complex cognition (exectuvie fxntioning)
insight (anosognosia)

16

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

16

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

17

Anosogosia?

lack of appreciation of significance of deficits
they do not know who they are but refuse to acknowledge they have memory probs

18

Anosognosia - cx?

prob w/prefrontal cortex or the right parietal lobe

19

Dementia dx?

hx
MMSE; use SLUMS, MOCA
OT - functional assessments ( Allen cognitive; can they still pay bills, sewing, etc)
Neuropsychology: trails A & B

20

What to be aware from pt and family?

hx from multiple sources (we should avoid asking yes/no questions)
vague answers
good neurological examination

21

Criteria for delirium?

decreased awareness of environment - not able to focus, sustain or shift attention
memory, orientation, language, hallucination

22

Delirium neurotransmitter deficit?

too much dopamine; too little Ach

23

Delirium sx/PE?

sleeping disturbances
psychomotor agitation
depression
myoclonus
stupor, coma, seizures

24

Cx of delirium?

not working BBB****
hx of brain injury
infxn

25

Delirium - RF?

sensory deprivation (hearing/seeing)
young, old
male
severe illness
depressed

26

Delirium - precipitating factors?

foley use
more than 3 use of drugs

27

Prevention of delirium?

get sleep
cognitive impaired
move them around
fix visual
fix hearing

28

Tx delirium?

withdraw alcohol, benzo (avoid in older adults)
avoid restraints
family education
PT/OT
younger than 70? haloperidol
older than 70? riserpidone

30

Prevent delirium in geriatrics that are admitted to ICU?

sleep (10p-5a) - melatonin, mirtazapine
hydration
PO intake (warm food as warm, cold as cold)
moving/ambulatory
say no to Benzo and TCA

31

Wernicke's encephalopathy?

malnourished

32

Wernicke's encephalopathy deficiency?

Vit B1/thiamine

33

Wernicke's encephalopathy population?

alcoholics

34

Korsakoff's syndrome?

irreversible dementia from B1 deficiency

35

Alcohol withdrawal tx?

benzodiapine

36

What can happen if wernicke's encephalopathy get's bad?

Korsakoff's syndrome

37

Cretzfeldt-jakob?

prior dz
accumulation of infectious proteins
dementia
anxiety

38

AD first sx?

memory loss

39

Vascular dementia first sx?

apathy
falls
focal weakness
slowing of cognitive slowing
memory may be spared
motor slowing
spasticity