Dementia

Question 1

Confusion in older adults?

Answer 1

delirium

dementia

Question 2

Delirium?

Answer 2

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

Question 2

Confusion in adults - cx?

Answer 2

CVA/stroke
subdural hematoma
anxiety
metabolic - hypoglycemia
low BP

Question 3

Dementia?

Answer 3

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

Question 4

Amnesia?

Answer 4

memory prob

Question 5

Aphasia?

Answer 5

language prob

Question 6

Aprxia?

Answer 6

prob using familiar objects

Question 7

Agnosia?

Answer 7

prob naming

Question 8

Major cx of dementia?

Answer 8

alzheimer’s dementia +/-vascular dementia

Question 9

What is alzheimer’s dementia?

Answer 9

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

Question 10

Impairment of Alzheimers dz?

Answer 10

hippocampus
parietal/temporal lobes
frontal lobe impairment

Question 11

Hippocampus cx?

Answer 11

cannot form new memories

Question 12

Parietal/temporal lobes?

Answer 12

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

Question 13

Dementia tx?

Answer 13

Memantine
cholinesterase inhibitors
valproate - anxiety, manic type

Question 14

Frontal lobe impairment?

Answer 14

complex cognition (exectuvie fxntioning)
insight (anosognosia)

Question 16

Frontal temporal lobe dementia?

Answer 16

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

Question 16

Lewy body dementia?

Answer 16

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

Question 17

Anosogosia?

Answer 17

lack of appreciation of significance of deficits

they do not know who they are but refuse to acknowledge they have memory probs

Question 18

Anosognosia - cx?

Answer 18

prob w/prefrontal cortex or the right parietal lobe

Question 19

Dementia dx?

Answer 19

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

Question 20

What to be aware from pt and family?

Answer 20

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

Question 21

Criteria for delirium?

Answer 21

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

Question 22

Delirium neurotransmitter deficit?

Answer 22

too much dopamine; too little Ach

Question 23

Delirium sx/PE?

Answer 23

sleeping disturbances
psychomotor agitation
depression
myoclonus
stupor, coma, seizures

Question 24

Cx of delirium?

Answer 24

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

Question 25

Delirium - RF?

Answer 25

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

Question 26

Delirium - precipitating factors?

Answer 26

foley use | more than 3 use of drugs

Question 27

Prevention of delirium?

Answer 27

``` get sleep cognitive impaired move them around fix visual fix hearing ```

Question 28

Tx delirium?

Answer 28

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

Question 30

Prevent delirium in geriatrics that are admitted to ICU?

Answer 30

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

Question 31

Wernicke's encephalopathy?

Answer 31

malnourished

Question 32

Wernicke's encephalopathy deficiency?

Answer 32

Vit B1/thiamine

Question 33

Wernicke's encephalopathy population?

Answer 33

alcoholics

Question 34

Korsakoff's syndrome?

Answer 34

irreversible dementia from B1 deficiency

Question 35

Alcohol withdrawal tx?

Answer 35

benzodiapine

Question 36

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

Answer 36

Korsakoff's syndrome

Question 37

Cretzfeldt-jakob?

Answer 37

prior dz accumulation of infectious proteins dementia anxiety

Question 38

AD first sx?

Answer 38

memory loss

Question 39

Vascular dementia first sx?

Answer 39

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