Module 7 Flashcards by Unknown Unknown

Aphasia

Loss of express/understand written or verbal language

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Apraxia

Inability to carry out purposeful movement

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Agnosia

Inability to recognize objects/people despite intact sensory skills

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Ataxia

Disorders affecting coordination of voluntary muscle movements
affects balance, muscle coordination and speaking

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Aphagia

Loss of ability to swallow

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Types of Dementia

Alzheimers
Vascular
Lewy Body
Frontotemporal
Creutzfeld-Jakob (rare)

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3 D’s

Dementia
Depression
Delirium

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Delirium

temporary, impaired cognitive state
rapid onset
reversible
affects attention more than memory

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Dementia

group of disorders that result in an overall decline in cognitive function: memory, abstract thinking, judgment, mood, disorientation, math ability, planning, ability to do ADL’s. may also result in personality, mood and behavioral changes

does not involve altered consciousness (LOC intact).

dementia is caused by neurodegeneration, vascular problems and repeat injury

gradual progressive disease. not curable.

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Vascular Dementia

caused by impaired perfusion to areas of the brain

causes: thromboembolism, stroke, occluded arteries

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Diagnosis of Dementia

no diagnostic test exists for dementia
diagnosis depends on ruling out other disorders (delirium) and thorough health assessment
information from secondary sources (friends, family, caregivers)

diagnosis can only be confirmed with a post-autopsy biopsy

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Vascular Dementia Risk Factors

chronic conditions: hypertension, diabetes, cardiac disease, hyperlipidemia, atherosclerosis 
age
gender (men at higher risk)
stroke
smoking
alcoholism

*anything that would impair tissue perfusion

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Definition of cognition

all mental processes related to human thought

observation, integration, application, memory

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6 Domains of Cognition

Complex Attention
Learning  & Memory 
Perceptual Motor Function
Social Cognition
Executive Function
Language

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Types of Memory

Working Memory
Declarative Episodic (events that happened)
Declarative Semantic (words, knowledge, facts)
Immediate (very brief)
Working (small info that can be used in a short timeframe)
Procedural (long-term retention and retrieval)

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Definition of perception

an individual’s perception of their environment

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Declarative memory

the ability to consciously learn or recall information

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Visuospatial cognition

capacity to comprehend, retain, use visual representations and their spatial relationships

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Executive Function

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higher level thinking

involved in consciousness, voluntary action, future-oriented

Scope of Cognition

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Intact –> Impaired

Basic Cognitive Impairment

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Perception
Pattern Recognition
Attention

Higher Order Impairment

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Learning
Comprehension
Insight
Problem-Solving
Reasoning
Decision-Making
Creativity 
Metacognition (thinking about your thinking)

Brain Homeostasis

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brain consumes about 20% of total blood oxygen –> requires adequate perfusion and oxygenation
fluid + electrolyte balances

Physiological Changes of Older Adults

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reduced brain mass
some loss of neurons
atrophy of neurons
loss in number and length of dendrites
loss in number of axons
increase in segmental demyelination 
reduced production of neurotransmitters
loss of synapses

synaptic loss = key indicator of aging
effect: slower processing, may be slight changes in memory, changes in learning

Areas of the brain impacted with aging

Hippocampus Corpus callosum Prefrontal Lobe

Types of Cognitive Impairment

``` Dementia Delirium Depression Cognitive Impairment not Dementia Focal Cognitive Impairment (only specific cognitive domains affected) Intellectual Disability Learning Disability ```

Definition of Intellectual Disability

<70 IQ Score | diagnosed in adolescence (<18 years)

Consequences of Cognitive Impairment

``` reduced ability to do ADLs increased fall risk complicated disease management decreased independence higher incidence of hospitalization ```

Dementia Modifiable Risk Factors

``` Smoking Alcoholism Chronic conditions: hypertension, hyperlipidemia, diabetes, cardiac disease Hearing loss (use of hearing aids) Cognitive Engagement Activity levels Obesity Diet/nutrition History of head trauma Environmental Exposures (pollution, toxins) ```

Dementia Non-modifiable Risk Factors

Age (>65) Gender (women higher risk) Genetics (PS1, PS2, APP identified) Congenital disorders - Down syndrome

Primary Prevention

``` Nutrition Exercise Social activity Regular medical care Prenatal care Reduce high-risk behavior Genetic Counseling (genetic testing, mature pregnancies) Use of hearing aids/glasses ```

Assessment tests

MOCA | MMSE (mini mental stimulation exam)

Mechanism of Vascular dementia

1) atherosclerosis of carotid/cerebral arteries --> impaired tissue perfusion to brain causing stroke 2) rarefaction/remodeling due to hypertension --> impaired tissue perfusion to brain

Delirium Risk Factors

``` urinary catheters side effects of medication use of restraints sensory deprivation (acute hospital setting) fluid & electrolyte imbalance - dehydration, respiratory acidosis pain sepsis fever ```

Signs of delirium

``` distractibility disorientation (time, place, person) hallucinations altered consciousness (LOC) disturbed sleep-wake cycle incoherent speech impaired short-term memory physical signs: dilated pupils, tachycardia, diaphoresis ```

Signs of Dementia

``` impaired memory (esp short term memory) disorientation (time, place, person) apathy, depression, anxiety reduced ability to do ADL's wandering reduced complex attention reduced abstract thought (planning, judgment) personality, mood, behavioral changes reduced math ability problems with language --> aphasia later stage: aphagia, ataxia, apraxia ```

Dementia Treatment

``` manage chronic conditions group therapy music therapy somatosensory therapy (massage) reorient to time, space, person --> mount a clock manage fall risk --> ensure patient safety involve client in ADL's as much as possible positive reinforcement/encouragement advance care planning, directives caregiver education exercise reminiscence simple communication, face-to-face ```

Acalculia

loss of ability to to math

Agraphia

loss of ability to write

MMSE Normal Score

26-30

MMSE Mild CI score

20--25

MMSE Moderate CI score

10-19

Severe CI Score

0-9

What is the MMSE

Mini Mental Status Exam Screening tool used to assess cognitive impairment in individuals Commonly used to assess severity of dementia in diagnosed patients designed to be used in clinical/hospital settings

Normal MOCA Score

Above or equal to 26

Module 7 Flashcards

(45 cards)