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Flashcards in Dementia and Delirium Deck (28):
1

Dementia characteristics? 3

And at least one in the following? 3

1. Slow onset over years
2. Symptoms do not rapidly fluctuate
3. Memory impairment

At least one of the following
1. Aphasia: unable to understand or express speech
2. Apraxia: inability to perform required movements
3. Agnosia: cannot recognize an object

2

Characteristics of Delirium? 3

May also have what? 4

Delirium
1. Disturbance in consciousness with reduced ability to focus, to sustain focus, or shift attention
2. Change in cognition
3. Disturbance in consciousness that develops over a short period of time and fluctuates

May also have
1. Disturbance in sleep – wake cycle
2. Disturbance in psychomotor behavior
3. Emotional disturbance
4. Rapid unpredictable shifts from one emotional state to another

3

Clinical Features of Delirium
1. Changes occur how?
2. Can last how long?
3. What is an early finding?
4. What is it due to?
5. Reversible?

1. Acute changes
2. Last days to weeks, but rarely months
3. Disorientation early
4. Prominent physiological changes due to underlying cause
5. Usually completely reversible

4

Delirium
Initial Diagnostic Workup: History
Causes to ask about?
9

1. underlying psychiatric disorder
2. history of serious brain trauma or disease
3. cancer
4. infection
5. decreased cardiac output
6. dehydration,
7. acute blood loss,
8. MI,
9. CHF

5

Delirium Risk Factors
5

1. Dietary difficulties -Poor nutrition
2. In hospital
3. Dementia
4. Family history of mental illness
5. Acute stress- loss spouse or change in environment

6

Delirium Initial Diagnostic Workup: Physical and Lab
5

1. Vitals
2. Changes due to underlying diseases
3. Rule out stroke
4. Blood and urine tests- check kidney and liver function
5. Radiology

7

Initial Interventions for Changes in Mental Status: Delirium
5

1. Recognize and treat underlying cause
2. Reduce stimuli
3. Simple, clear language
4. Reassurance for person and family
5. Be aware of increased risk for mortality

8

Initial Interventions for Changes in Mental Status: Dementia
6

1. Testing to ensure diagnosis
2. Discuss long term care plans
3. Discuss advance directives
4. Refer to Alzheimer’s Association
5. Be present
6. Slow down

9

What tests will help us ensure a diagnosis of Dementia?
3

1. Neuropsych testing,
2. mental status assessment,
3. neurological exam

10

Dementia
1. What kind of disorder?
2. Significant cognitive decline that is characterized how?

1. Neurocognitive disorder

2. Interferes with daily living

11

Alzheimer’s Disease == AD
1. PP?

2.___ % of all dementias


Why are 2/3 of alzheimer's pts women? 2

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

2. 60

3.
-Women live longer
-Association between gene APOE-e4 and estrogen

12

Prognosis of AD?

Fatal and cannot be slowed down or cured

13

What are the three stages of AD?

1. Preclinical
2. MCI due to AD
3. Dementia due to AD

14

Describe the followign stages of AD?

1. measurable changes in brain and may be present 20 years before Sx

2. mild but measurable changes in thinking abilities that are noticeable but do not affect daily activities

3. quite noticeable memory, thinking, and behavioral symptoms that impair ability to function in daily life with a steady gradual progression over 10 – 15 years

15

Mild (early stage) AD
What are some behaviors that might indicate this stage? 6

1. Problem coming up with a right word or name

2. Trouble remembering names when introduced to new people

3. Having greater difficulty performing tasks in social or work settings

4. Forgetting material that one has just read

5. Losing or misplacing a valuable object

6. Increasing trouble with planning or organizing

16

Moderate (middle stage) AD
What are some behaviors that might indicate this stage?
9

1. Forgetfulness of events or about one’s own personal history

2. Feeling moody or withdrawn, especially in mentally challenging situations

3. Being unable to recall address or phone number or schools attended

4. Confusion about where they are or what day it is

5. Needing help choosing proper clothing for the day or season

6. Trouble with bowel and bladder control

7. Changes in sleep patterns

8. Increased wandering and becoming lost

9. Personality and behavioral changes

17

Severe (late stage) AD
What are some behaviors that might indicate this stage?
6

1. Require full time around the clock assistance including personal care

2. Lose awareness of recent experiences as well as their surroundings

3. Require high level of assistance with ADLs

4. Experience changes in physical abilities: walk, sit, swallow

5. Have increasing difficulty communicating

6. Become vulnerable to infections, especially pneumonia

18

Risk factors for AD?
14

1. Age
2. Family history
3. Hypertension, diabetes mellitus, high cholesterol
4. Race: African-American, Hispanic, Native American
5. Female
6. Level of education
7. Socio-economic status
8. Alcohol use
9. Down’s syndrome
10. Head trauma
11. Depression
12. Exercise
13. Obesity
14. Smoking

19

1. What is vascular dementia?

2. Risk is high for those with what? 3

3. Progression?

1. Vascular changes present with other types of dementia in 50%. Impaired judgment or impaired ability to make a decision initial Sx

2. Risk is high for those with
-hypertension,
-diabetes mellitus, and
-high cholesterol

3. Slow progression over years

20

Dementia with Lewy-Body
1. Early on what will the symptoms be? 6

2. What are lewy bodies?

3. May coexist with what? 2

4. Progression?

1. Early on:
-sleep disturbances,
-well-formed visual hallucinations,
-gait imbalance and
-Parkinsonian movement features.
-May not have early memory impairment

2. Lewy bodies: abnormal aggregations (or clumps) of the protein alpha - synuclein that accumulates in neurons

3. May coexist in those with Parkinson disease or Alzheimer’s disease

4. Progression: steady, gradual

21

Frontotemporal Lobar Degeneration
1. Includes what? 5

2. Early symptoms are marked by what?
-what is spared?

3. What becomes shrunken?

4. Starts at what age?
-Progression?

1. Includes:
-behavioral-variant FTLD,
-primary progressive aphasia,
-Pick’s disease,
-corticobasal degeneration,
-progressive supranuclear palsy

2. Early Sx: marked changes in personality and behavior and difficulty with producing or comprehending language.
-Memory is spared

3. Nerves in frontal and temporal lobes become shrunken

4. Usually starts at age 60
-Progression: steady, rapid

22

What is mixed dementia defined as?

Alzheimer’s with another type

23

Parkinson’s Disease Dementia
Problems with what?
5

Problems with movement:
1. slowness,
2. rigidity,
3. tremor, and
4. changes in gait and speech,
5. depression common

24

Creutzfeldt-Jakob Disease
1. How common?
2. Severity?
3. What does it cause?
4. What causes it?
5. How is it contracted? 3

1. Very rare
2. Rapidly fatal disorder
3. Impairs memory and coordination and causes behavior changes
4. Caused by a prion (misfolded protein) that causes other proteins throughout the brain to misfold and malfunction

5. May be
-inherited,
-sporadic or
-due to infection

25

Normal Pressure Hydrocephalus
1. Symptoms? 3
2. Who are at increased risk? 2
3. Progression?
4. Tx?

1. Sx:
-difficulty walking,
-memory loss,
-inability to control urination

2. Those with history of
-brain hemorrhage (subarachnoid bleed) and
-meningitis are at increased risk

3. Insidious onset with varied progression

4. which may be reversed with surgery

26

HIV AIDS
Varied course occurring later in disease
Nonspecific impairments such as?

3

1. attention,
2. executive function with variable memory changes but
3. commonly depression

27

10 Warning Signs of Alzheimer’s Dementia

1. Memory changes that disrupt daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words in speaking or writing
7. Misplacing things and losing ability to retrace steps
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood or personality

28

Early AD dx advantages? 3

1. Ability to make plans
2. Time for grief, denial, education, acceptance
3. Time to create advance directives