Depression/Delirium/Dementia

Question 1

Depression characteristics

Answer 1

Often overlooked or misdiagnosed as dementia or cognitive impairment - “pseudodementia.”
Difficulty concentrating or problem solving, memory loss, irritability.

Question 2

Depression may correlate with…

Answer 2

Falls risk: fear of falling = less activity = greater risk.
Medications: side effects of pain meds, steroids.
Anti-depressants usually sedative, which further increases falls risk

Question 3

Most valid screening tools for depression

Answer 3

GDS
CES-D
(higher scores = more depressed)

Question 4

Consideration for administering the GDS

Answer 4

Verbally ask the questions - answer choices that indicate depression are bolded, may sway answer choices

Question 5

T/F: anti-depressants are the most effective intervention

Answer 5

FALSE!
Exercise is often just as effective as meds

Question 6

Considerations for interventions with depression

Answer 6

Pain reduction - esp if depression is due to chronic pain.
Falls prevention & fear of falling education.
Refer back to MD if high screening scores

Question 7

Normal cognitive changes with age

Answer 7

Decreased visual & verbal memory - difficulty naming/identifying objects.
Decreased visuospatial ability - e.g. moving around objects to avoid tripping.
Decreased immediate memory.

Question 8

Pathological cognitive changes (indicates dementia)

Answer 8

Inhibition of neural growth factors.
Loss of neural connections.
Brain tissue atrophy.
ACh deficiency.
Dopamine excess.
Increased amyloid plaque.
Increased neurofibrillary tangles.

Question 9

Criteria for dementia

Answer 9

Multiple cognitive deficits (including memory) AND at least one:
1. Aphasia - impaired speech
2. Apraxia - impaired motor
3. Agnosia - impaired processing/recognition
4. Executive dysfunction

Question 10

Early stages of dementia

Answer 10

Aware they’re having memory problems, pts will recognize/understand the impairment

Question 11

Cortical Dementia (2 types)

Answer 11

Alzheimer’s: most common.
Frontotemporal: word finding & recognition (temporal involvement); multitasking, impulsive, innapropriate (frontal involvement)

Question 12

Subcortical Dementia (2 types)

Answer 12

Lewy Body: fluctuations in alertness, hallucinations.
Parkinson’s: dementia may be associated with PD.

Question 13

Vascular Dementia

Answer 13

Due to infarct, gets progressively worse if multiple infarcts/strokes

Question 14

Alzheimer’s - early stage

Answer 14

Mild memory impairments.
Altered judgement, misplacing objects, losing words, difficulty recognizing people.
Difficulty learning novel/complex tasks.
Subtle personality changes.

Question 15

Alzheimer’s - middle stage

Answer 15

Memory/language worsen.
Difficulty performing IADLs (taking meds, paying bills, etc.)
Apraxia.
Disoriented to time/place.
Delusional or agitated.

Question 16

Alzheimer’s - late stage

Answer 16

Loss of mobility.
Bladder/bowel control issues.
24/7 care for ADLs.
Difficulty or unable to speak/swallow/cough (risk for pneumonia).
Unable to recognize family.
Significant personality changes.

Question 17

Alzheimer’s - terminal stage

Answer 17

Unaware of environment.
Total assist.
Mute, bedridden.
Primitive reflexes return.

Question 18

What are possible causes of Alzheimer’s?

Answer 18

50% genetic
50% environment

Question 19

Most common cause of death in Alzheimer’s pts

Answer 19

Aspiration pneumonia

Question 20

Dementia screening tools

Answer 20

6CIT
Trail-making test
Mini-Cog
ADAS (good but takes 30min to admin)

Question 21

Which dementia screening tools differentiate btwn domains (apraxia, aphasia, etc.)

Answer 21

MMSE
MoCA
SLUMS

Question 22

Screening for dementia should include…

Answer 22

At least 1 depression screen

Question 23

Dementia considerations with interventions

Answer 23

Resisted AND aerobic exercise (mod-high intensity).
Cognitive tasks early - build up reserve to slow progression.
Be mindful of sundowning & timing around meds.

Question 24

Key difference btwn dementia and delirium

Answer 24

Dementia: slow onset. Takes time to develop.
Delirium: acute. Can wake up randomly with delirium.

Question 25

Delirium prognosis

Answer 25

Good bc no tissue pathology. Delirium stops once trigger is removed (e.g., if caused by UTI, cognition returns once UTI resolves).

Question 26

Agitated/Hyperactive delirium

Answer 26

Restraining/sedation often makes it worse.
Sedation can risk aspiration.
BEST option = early mobilization!

Question 27

Quiet/Hypoactive delirium

Answer 27

Unresponsive, sluggish, confused, no command following.
More common than hyperactive - often misdx as dementia or depression.

Question 28

T/F: pt can have both types of delirium at once

Answer 28

TRUE!
May fluctuate btwn hyper/hypo at certain times of day.

Question 29

Delirium screening - 4 A’s

Answer 29

Alertness: falling back asleep >10sec after waking.
Abbreviated mental test: age, DOB, place, & year.
Attention: list months in reverse order, starting at Dec.
Acuteness: significant change in mental status in last 2wks, still persisting in last 24hrs.

Question 30

Confusion Assessment Method

Answer 30

Assesses 9 clinical features. Good for distinguishing delirium from dementia/depression.
Delirium = yes to items 1 AND 2, and either 3 or 4.
1. Acute changes from baseline.
2. Inattention.
3. Disorganized thinking.
4. Altered LOC.

Question 31

Delirium prevention

Answer 31

Reduce risk factors (nutrition education, meds, etc.)
Early identification of behavior changes.
Post-op: early mobility, get anesthesia OUT of system!

Question 32

Delirium: methods to help re-orient

Answer 32

Turn TV on (news is good!)
Open blinds, turn lights on.
Keep whiteboard accurately updated with dates.

Question 33

Hallucinations are common in what?

Answer 33

Delirium
Lewy Body dementia (hallucinations NOT common in all other types of dementia).

Question 34

Symptoms worse in the morning suggest:
a) Dementia
b) Delirium
c) Depression

Answer 34

c) Depression

Question 35

Symptoms worse in the evening/night suggest:
a) Dementia
b) Delirium
c) Depression

Answer 35

b) Delirium

Question 36

Symptoms with no pattern of worsening at certain times of day suggest:
a) Dementia
b) Delirium
c) Depression

Answer 36

a) Dementia

Question 37

___ is reversible:
a) Dementia
b) Delirium
c) Depression

Answer 37

b) Delirium
AND
c) Depression

Question 38

Signs of illness suggests:
a) Dementia
b) Delirium
c) Depression

Answer 38

b) Delirium