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Flashcards in Dementia & Delirium Deck (43):
1

Clinical Features of Dementia

Slow onset over years
Symptoms do not rapidly fluctuate
Memory impairment
Aphasia, apraxia, or agnosia

2

Define Aphasia

Unable to understand or express speech

3

Define Apraxia

Inability to perform required movements

4

Define Agnosia

Cannot recognize an object

5

Clinical Features of Delirium

Disturbance in consciousness with reduced ability to focus, sustain focus, or shift attention
Change in cognition
Disturbance in consciousness that develops over a short period of time & fluctuates
May also have sleep, psychomotor behavior, or emotional disturbances, or rapid unpredictable shifts from one emotional state to another

6

Important History in the Initial Diagnostic Workup

All medical history
Underlying psychiatric disorder
Hx of serious brain trauma or disease
CA
Infection
Decreased cardiac output (dehydration, acute blood loss, MI, CHF)
All surgical history
All medications taken

7

Intoxication that May be Causing the Delirium

Drug or alcohol abuse or poisons
Anticholinergics
Sedatives
Antidepressants
Anticonvulsants
NSAIDs
Corticosteroids
Chemo
Lithium
Cimetidine
Antibiotics
L-dopa
Illicit drugs
Solvents
Heavy metals
Antihistamines

8

Other Risk Factors for Delirium

Dietary difficulties
In hospital
Dementia
Family history of mental illness
Acute stress
Vision or hearing difficulties (additive effect)

9

Initial Diagnostic Workup: Physical & Labs

Vitals
Changes due to underlying diseases
Rule out stroke
CBC, CMP
U/A, culture & sensitive
Radiology

10

Initial Interventions for Delirium

Recognize & treat underlying cause
Reduce stimuli
Simple, clear language
Reassurance for person & family
Be aware of increased risk of mortality

11

Initial Interventions for Dementia

Testing to ensure diagnosis: neuropsych, mental status, neurological exam, B12, hypothyroidism, Korsakoff syndrome, Normopressure hydrocephalus, uncontrolled DM
Discuss long term care plans
Discuss advanced directives
Refer to Alzheimer's Association
Be present
Slow down

12

Define Dementia

Neurocognitive disorder
Significant cognitive decline that interferes with daily living

13

Define Alzheimer's Disease

Progressive accumulation of protein fragment beta-amyloid (plaques) outside neurons & twisted strands of the protein tau (tangles) inside neurons which damage & kill brain cells

14

Alzheimer's Disease

Not part of normal aging
Fatal
Cannot be slowed down or cured
Risk of getting disease can be modified

15

3 Stages of Alzheimer's Disease

Preclinical
MCI due to Alzheimer's disease
Dementia due to Alzheimer's disease

16

Preclinical Stage of Alzheimer's Disease

Measurable changes in brain & may be present 20 years before symptoms

17

Minimal Cognitive Impairment Due to Alzheimer's Disease

Mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities

18

Dementia Due to Alzheimer's Disease

Quite noticeable memory, thinking, & behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10-15 years

19

Stages of Active Alzheimer's Disease

Mild
Moderate
Severe

20

Mild Active Alzheimer's Disease

Problems coming up with right word or name
Trouble remembering names to new people
Greater difficulty performing tasks in social or work settings
Forgetting material that one has just read
Losing or misplacing a valuable object
Increasing trouble with planning or organizing

21

Moderate Active Alzheimer's Disease

Forgetfulness of events or one's history
Feeling moody or withdrawn
Being unable to recall address or phone number or schools attended
Confusion on where they are & what day it is
Need help choosing clothing for day or season
Trouble with bowel & bladder control
Changes in sleep patterns
Increased wandering & becoming lost
Personality & behavioral changes

22

Severe Active Alzheimer's Disease

Require full time assistance including ADLs
Lose awareness of recent experiences as well as surroundings
Experience changes in physical abilities: walk, sit, swallow
Have increasing difficulty communicating
Become vulnerable to infections

23

Risk Factors for Alzheimer's

Age
Family history
HTN, DM, high cholesterol
Race: African or Native American
Female
Level of education
SES
Alcohol use
Down syndrome
Head trauma
Depression
Exercise
Obesity
Smoking

24

Vascular Dementia

Impaired judgement or impaired ability to make a decision

25

Risk Factors for Vascular Dementia

HTN
DM
High cholesterol

26

Symptoms of Dementia with Lewy-Body

Sleep disturbances
Well-formed visual hallucinations
Gait imbalance & Parkinsonian movement features
Early memory impairment
May coexist with Parkinson's or Alzheimer's disease

27

Define Lewy Bodies

Abnormal aggregations of the protein alpha-synuclein that accumulates in neurons

28

Frontotemporal Lobar Degeneration Includes

Behavioral-varient frontotemporal lobar degeneration
Primary progressive aphasia
Pick's disease
Corticobasal degeneration
Progressive supranuclear palsy

29

Early Symptoms of Frontotemporal Lobar Degeneration

Marked changes in personality & behavior
Difficulty with producing or comprehending language
Memory is spared

30

Progression of Frontotemporal Lobar Degeneration

Steady, rapid

31

Progression of Vascular Dementia

Slow over many years

32

Progression of Dementia with Lewy Body

Steady, gradual

33

Define Mixed Dementia

Alzheimer's with another type of dementia

34

Parkinson's Disease Dementia

Slowness
Rigidity
Tremor
Changes in gait & speech
Depression

35

Progression of Parkinson's Disease Dementia

Varied

36

Creutzfeldt-Jacob Disease

Rare
Rapidly fatal disorder
Impairs memory & coordination & causes behavior changes
Prion disease
Inherited, sporadic, or due to infection

37

Symptoms of Normal Pressure Hydrocephalus

Difficulty walking
Memory loss
inability to control urination

38

Onset & Progression of Normal Pressure Hydrocephalus

Onset: insidious
Progression: varied
May be reversed with surgery

39

HIV AIDS

Nonspecific impairments of attention, executive function with variable memory changes but commonly depression

40

10 Warning Signs of Alzheimer's Dementia

Memory changes that disrupt daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time or place
Trouble understanding visual images & spatial relationships
New problems with words in speaking or writing
Misplacing things & losing ability to retrace steps
Decreased or poor judgement
Withdrawal from work or social activities
Changes in mood or personality

41

Follow Up for Someone with Alzheimer's Disease

Follow neurocognitive decline: MMSE
Follow other chronic diseases: mammogram, A1C, colonoscopy??
Ensure caregivers are doing OK

42

Early Diagnosis Advantages of Alzheimer's Disease

Ability to make plans
Time for grief, denial, education, acceptance
Time to create advance directives

43

Principal Stressors & Illnesses for Caregivers

Financial, emotional, & physical difficulties
Stress: lack of sleep, no time off
Juggling job & caregiving
Income status
Continued worsening of own disease