FINAL EXAM - Dementia Flashcards Preview

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Flashcards in FINAL EXAM - Dementia Deck (53)
1

Dementia

group of conditions that all gradually destroy brain cells and lead to progressive decline in mental function

2

Progressive disorders impact (6)

1.memory
2.learning
3.reasoning
4.judgement
5.communication
6.which all impact completion of daily activities

3

Global Deterioration Scale (GDS)

primary degenerative dementia assessment tool what is broken down into 7 stages that occur over an 8-10yr period
#1 is Normal, #7 Very severe

4

Allen Cognitive Model

dementia assessment tool that has a hierarchy of 6 cognitive levels that focus on how information if processed during normal life activities
#6 Planned activities (highest), #1 Automatic actions (lowest; baby like stage)

5

GDS - Stage 1: No Cognitive Decline (2)

no memory deficit on clinical interview
cognitive processing drives the bus for treatment planning

6

GDS - Stage 2: Very Mild Cognitive Decline (6)

1. Subj. complaints of memory deficits, though no deficit on clinical interview
2. appropriate concern with respect to symptomatology
3. no deficits in ADL, social, or employment situations
4. Start doubting self
5. masking the dementia
6. forgetting medication

7

GDS Stage 3- Mild Cognitive Decline (8)

1. observe deficits with concentration with clinical testing, and memory only with intensive interview
2. denial begins; mild anxiety
3. lost traveling to unfamiliar locations
4. functional issues with demanding work and social situations - banking, bus routes are issues
5. Word and name finding deficits (masking)
6. Still driving
7. Family starts noticing deficits
8. errorless learning - put them in a situation where they will be successful.

8

GDS Stage 3 - Caregiver approach (4)

1. Simplify - do complex things together or for them
2. help to see the whole picture - pros and cons
3. monitor, limit or restrict hazards
4. plan for progressive disability - Can still learn new info to carry on before level 4

9

GDS Stage 4 - Moderate Cognitive Decline - Memory/ General Symptoms (4)

1. Duration approx. two years
2. thinking like that of an 8 yr old to an adolescent
3. clear cut deficits on clinical interview - concentration, decreased knowledge of current/recent events, personal history
4. Personal Hx is meaningful to them

10

GDS Stage 4 - Moderate Cognitive Decline - Behavior (5)

1. Denial - you are the problem
2. Flattened expression - feel hopeless
3. very focused
4. anxious, angry, and wants autonomy - told cant' drive anymore
5. Depression

11

GDS Stage 4 - Mild Cognitive Decline - ADL Status (7)

1. rigid with daily routine
2. requires daily contact an support
3. able to complete self care ADLs
4. Understands Beginning/Middle/End of activity
5. Able to complete 4-5 familiar steps to an activity
6. Needs help with higher level tasks - money
7. Difficulty with traveling to familiar locations

12

GDS Stage 4 Mild Cognitive Decline - Communication (3)

1. able to make needs known but difficulty naming things being looked for
2. communication may be self centered
3. limited reading comprehension - medications

13

GDS Stage 4 - Mild Cognitive Decline - Motor Skills (7)

1. able to walk and fn when standing and during ambulation
2. able to visually scan environment
3. recognizes highly visible cues in environment
4. beginning safety issues
5. compensation for attention and or physical deficits
6. may require us of adaptive equipment
7. Minimal Stimulation during Fn. tasks

14

GDS - Stage 4 - Mild Cognitive Decline - Caregiver Approaches (4)

1. Provide highly visible external cues for orientation
2. Encourage to ask for assistance with solving problems
3. participates best in highly valued activities
4. able to follow calendar/schedule
5. Assess for safety issues/ restrict hazards
6. establish structured schedule and ADL routine - supplies set-up or removed
7. Cue for Word finding deficits
8. Expect misinterpretation - avoid reasoning and reassure

15

GDS - Stage 5 - Moderately Severe Cognitive Decline - Memory - General Symptoms (9)

1. can't survive without assistance
2. duration approx 1.5yrs
3. unable to recall aspects of current lives
4. still knows spouse's and children's names
5. frequent disorientation to time or place
6. difficulty counting backwards from 40 to 4
7. Can follow some directions but does not retain out of context
8. lives in the immediate situation
9. Everyday is a new day

16

GDS - Stage 5 - Moderately Severe Cognitive Decline - Behavior (8)

1. delusion is their perception of reality
2. perceive that they are 20-40 yrs old
3. will search a way out; on a mission
4. impatient, paranoid, suspicious
5. afraid to be alone
6. sexual acting out - don't get angry
7. depression
8. Music of time brings awareness

17

GDS - Stage 5 - Moderately Severe Cognitive Decline - ADL (10)

1. assist with toileting
2. structure to bathe or change clothes
3. can do routine tasks, folding laundry, simple meal task, simple board game or puzzle
4. able to learn 2 or 3 procedures with concrete results
5. performs best with activities that are error proof or support social skills
6. difficulty with common objects
7. senses completion of tasks/activity
8. unable to notice mistakes or solve problems
9. does not anticipate safety hazards
10. may begin to reverse day and night

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GDS - Stage 5 - Moderately Severe Cognitive Decline - Communication (4)

1. difficulty being understood; often repeats self
2. complex language is hard to understand
3. not able to answer detailed questions
4. able to name familiar objects

19

GDS - Stage 5 - Moderately Severe Cognitive Decline - motor skills (3)

1. tunnel vision 14" in front (carry through last stage )
2. uses hands to manipulate objects - different grasps for different objects
3. sustains actions for at least a minute

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GDS - Stage 5 - Moderately Severe Cognitive Decline - Caregiver approaches (12)

1. environmental assessment for hazards and safety
2. determine interventions and cueing to maximize ADL function
3. Additional time to perform tasks - maintain fn ability
4. expect inattention to quality
5. interpret behaviors with daily routine
6. adapt activities for poor attention and direction following
7. Avoid correcting
8. simplify communication - Yes/No or no more than 2 choices
9. structure hydration and approaches for meal intake
10. determine strategies for memory loss
11. facilitate group interaction - maintain social skills
12. Determine activities that match interest and cognitive skills - provide objects, repetitive activity

21

GDS - Stage 6 - Severe Cognitive Decline - Memory/General Symptoms (7)

1. duration 2-2.5yrs
2. abilities mimic that of a 2 to 5 yr old
3. almost always knows own name, though may forget name of spouse
4. sketchy knowledge of past life
5. largely unaware of current events
6. able to distinguish familiar from unfamiliar persons in their environment
7. tunnel vision

22

GDS - Stage 6 - Severe Cognitive Decline -Behavior (8)

1. personality and emotional changes
2. 20-50%have delusions and hallucinations
3. obsessive symptoms, anxiety, agitation, violent episodes, loss of will power
4. resists unfamiliar, searches out familiar
5. lost sense of self
6. wanders: no boundaries - everything is mine
7. being cold or experiencing discomfort can facilitate hostility
8. get into their reality

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GDS - Stage 6 - Severe Cognitive Decline - ADL (7)

1. may become incontinent
2. performs mechanics of toileting with structure
3. days and nights mixed up
4. difficulty sitting for meals
5. unable to recognize everyday objects
6. unable to sequence dressing or do fine manipulation
7. May disrobe, poor tolerance of bras, dentures, hearing aids, eyeglasses, socks, shoes

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GDS - Stage 6 - Severe Cognitive Decline -Communication (5)

1. connects with others through touching, verbalizations, and shadowing - body language and tone of voice is key
2. responds only to those directly in front; loss of peripheral vision
3. aphasic (word salad)
4. needs assist to interpret issues of pain, anxiety illness hunger thirst
5. Sings with sense of intonation

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GDS - Stage 6 - Severe Cognitive Decline -Motor Skills (6)

1. Able to sit and stand against gravity
2. shuffling gait
3. tends to bend forward or lean backward: may lean to one side
4. able to use grab bars
5. risk for falls
6. responds to music and repetitive rhythmical movements

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GDS - Stage 6 - Severe Cognitive Decline -Caregiver approaches (12)

1. anticipate all needs
2. assure consistent caregivers
3. understand childhood or traumatic events
4. team up with stage 5 "buddy"
5. determine sleeping patterns
6. find effective ways to redirect
7. Focus safety issues with mobility, fall prevention
8. positioning needs - in/out of bed
9. closely monitor weight and watch for dysphagia issues
10. provide props that support identity, items with high tactile stimulation
11. establish ADL routine (self care and Meal)
12. Establish best method of communication

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GDS - stage 7 - very severe cognitive decline (10)

1. automatic action level
2. dependent on other to survive
3. no functional ability to verbalize or manage physical needs
4. May you respond with facial change, oral motor change, some repetitive words and; many expressed self with yelling or grunting
5. May respond to stimulus of high contrast may turn had too track; may pinch or hit
6. incontinent
7. dependent in all adl, including self feeding
8. dependent in functional mobility: may have some trunk movement in bed (rolling) and/or may be able to raise body parts against gravity
9. dysphagia issues
10. risk for skin breakdown, contractures, and loss of swallowing fn.

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GDS - stage 7 - very severe cognitive decline - Caregiver approaches (4)

1. requires total care-comfort
2. provide sensory stimulation
3. diligent about falls prevention, skin management, positioning, contractures
4. monitor swallowing fn and weight/hydration

29

OT and Dementia (6)

1. compensatory strategies - early stages
2. environmental modifications
3. strengthening and balance - Level 3 and 4 build reserve so they have in later stages
4. adaptive equipment and assistive devices
5. behavior management
6. caregiver education

30

Alzheimer's Disease (AD)

Progressive impairment of memory, executive fn., attention, language, visual processing, and praxis; behavioral disturbances are common

31

Mild Cognitive Impairment (MCI)

clinical state of individuals who are memory impaired but are functioning well and do not meet the criteria for dementia

32

MCI includes 5 criteria

1. complains of memory problems
2. memory loss is abnormal for the person's age
3. ADLs are NOT affected
4. Other cognitive abilities are intact
5. There is no dementia

33

Early Stage of AD

Usually lasts 2-3 years
Cognitive changes in memory, language, and visuospatial

34

Early stage of AD Memory changes (5)

1. Short-Term memory impaired
2. Long-term memory begins to be impaired
3. Procedural memory remains intact
4. personal episodic memory (where and when they ate breakfast) begins to show deficits
5. semantic memory (remembering name of general object) begins showing deficits

35

Early stage of AD Language Changes (4)

1. aphasia appears
2. paraphasia begins (substitute wrong word or word that sounds familiar)
3. Anomia (saying thing a ma jing or gives up searching for word)
4. Circumlocution - tries t express an idea by talking around the intended word

36

Early stage of AD Visuospatial Skills decline (3)

1. lost in a familiar area
2. Does not recognize familiar places (intersection)
3. disorientation within the home

37

Early stage of AD Executive Fn (5)

1. difficulty with IADLs (bills)
2. More rigid and irritable
3. Problems with planning organizing and sequencing
4. Depression
5. Confusion and anxiety lead to withdrawal from social activity

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Middle Stage of AD

1. last for 2-10 years
2. continued decline in memory, visuospatial skills, & language
3. all areas of performance skills begin to show deficits
4. psychiatric symptoms increase
5. behavior disturbances arise

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Middle Stage of AD Memory (7)

1. Remote memory worsens (think in early stages of life and focus on worries of that time)
2. No longer bothered by memory loss
3. disorientation to time and place
4. may not recognize own face
5. New information not retained for more than a few moments
6. Difficulty organizing thoughts and thinking logically
7. thinking is concrete

40

Middle Stage of AD Language (5)

1. Aphasia worsens
2. limited to concerns of the moments or reminiscing about the past
3. diminished verbal responsiveness
4. difficulty understanding simple questions or instructions
5. lose of rational planning and problem solving

41

Middle Stage of AD Visuospatial Skills (6)

1. visual inattention begins to seriously limit fn
2. lost in familiar environment and can't orient self to new environments
3. constructional skill are compromised (arms and legs on clothing)
4. loss of ability to judge depth and distance
5. leads to falls
6. judging direction and distance is problematic

42

Middle Stage of AD Psychiatric Symptoms (5)

1. Depression and anxiety worsen
2. Depression is associated with increased mortality
3. loses control over emotions - outburst of fear and anger
4. visual/auditory hallucinations
5. Sleep pattern is off - increased naps, wakeful at night

43

Middle Stage of AD Behavior Disturbances (5)

1. Increased likelihood of nursing home placement
2. Wandering and agitation
3. paces w/o goal or destination
4. loss of impulse control
5. loss of filter

44

Late Stage of AD (4)

lasts for 8-12 years
fully dependent
motor skills affected
immobile and incontinent

45

Late Stage of AD Memory (4)

1. no ability to create new memories
2. little recognition of close family members
3. processing skills are seriously impaired
4. purposeful goal-directed occupation is lost

46

Late Stage of AD Motor Skills (12)

1. bed bound with eventual loss of postural control
2. hyperflexia
3. apraxic gait
4. frontal release signs
5. paratonia (involuntary resistance)
6. Seizures may occur
7. Contractures -
8. Pressure Ulcers - all due to immobility
9. UTI -
10. pneumonia -
11. incontinence
12. appetite decrease and eventual dysphagia

47

Late Stage of AD Psychiatric Symptoms (2)

1. Sleep cycle is disturbed, spend 60% of day sleeping
2. Hallucinations persist

48

General treatment approach for AD

1. Supportive care for the patient
2. Supportive care for the caregiver/family
3. disease treatment
4. symptom treatment, including cognitive, mental, and behavioral symptoms

49

Early Stage of AD Impact on Client factors (14)

1. ADLs remain intact
2. IADLs are impacted due to memory loss, disorientation, and inability to make money transactions
3. Have driving retested periodically
4. Memory loss impacts education
5. Memory loss impacts leisure
6. Social participation is not longer easy or enjoyable
7. Performance Skills are unaffected
8. Process skills of temporal organization are impacted
9. Forget to continue, sequence, and properly terminate tasks
10. communication is impaired - can't articulate thoughts and needs
11. attempts to compensate for memory loss
12. Neglect habits and routines
13. Roles change
14. Cultural and spiritual context remain, participation declines

50

Early Stage of AD Mental Fns. impacted (

1. memory
2. orientation
3. perception
4. higher-level cognition
5. mental fn of language
6. calculation

51

Middle Stage of AD impacted client factors (17)

1. impairment in all areas of occupations - can not live alone
2. IADLs are neglected or performed w/o proper sequence or completion
3. safety is an issue
4. No ability to perform in work or education
5. Leisure participation is limited to activities that do not require problem solving or decision making
6. Friends and family needed for any social participation b/c of difficulty initiating or organizing social interaction outside of his or her immediate environment.
7 Decline in visuospatial skills - positioning, reaching, poor judgment of distance
8. All process skills impacted
9. Communication limited due to aphasia and memory loss
10. performance patterns severely limited
11. Roles are lost
12. Cultural context begins to diminish
13. personal and temporal context are confused
14. Orientation to person place and time is affected
15. Disinhibition
16. progressive impairment in all cognitive fn
17 emotions are not well regulated.

52

Late Stage of AD impacted client factors (

1. All areas of occupations diminish and are lost
2. Fully dependent
3. All performance skills and patterns are impaired
4. Eventually loses all Fn capacity
5. Speech is reduced to a few words and then lost entirely
6. No awareness or understanding of culture, social or spiritual contexts
7. Mental fn completely impaired
8. neuromusculoskeletal and movement-related fn are seriously impacted
9. Muscle strength and tone, and voluntary movement are limited due to nerve cell damage
10. Ability to swallow lost

53

Once the ability to swallow is lost in the late stage of AD, the family must decide if they want to 2)

1. provide artificial life support OR
2. all the natural course of the illness to proceed to death