Delirium
A disturbance of consciousness and a change in cognition that develop over a short period of time 3:10
Dementia
Multiple cognitive deficits that include impairment in memory
What is the new way of referring to Late-Life Disorders in DSM-5?
Mild Cognitive Disorders or Major Cognitive Disorders
How is a cognitive disorder determined to be 'Mild'?
SD's below cognitively normal range
How is a cognitive disorder determined to be 'Major'?
3 or more SD's below cognitively 'normal' range
Once it is determined whether the cognitive disorder is 'Mild' or 'Major', what is the next stage of diagnosis?
then specify whether associated with Alzheimer's disease Frontotemporal lobar degeneration Lewy body disease Vascular disease Traumatic brain injury Substance/medication use HIV infection Prion disease Parkinson's disease Huntington's disease Another medical condition Multiple etiologies Unspecified
Compare Dementia & Delirium?
Dementia gradual deterioration of abilities Delirium rapid onset
What should be considered when looking at disorders of old age?
Physical Health Mental Health Social Implications
What is a gerontologists concept of old age?
Young old 65-74 Old old 75-84 Oldest old 85+ 6:00
How has the number of people 85+ increased over the last 2 decades?
170.6% increase
7:30
What are some positive & negatives of aging?
Negatives
- lonely
- death of loved ones
- declining health
- cognitive decline
- social stresses (change in appearance)
- medication issues (side effects)
- sleep issues
- loss of loved ones
- cumulative stress effects
Positives
- social selectivity (fewer but closer friends)
- less reactivity to negative stimuli - protected by some stresses & anxieties
-
many wouldn't want to be young again
- financially secure
- less family pressures
What is MCI?
-
Mild Cognitive Impairment
11:15
What are the three levels of cognitive functioning that older people tend to experience?
-
1 in 100 aging people show no cognitive decline
-
(referred to as aging successfully)
-
cognitive decline can be a normal function of aging
-
more than 'normal' decline classified as Mild Cognitive Impairment (MCI)
- (referred to as aging successfully)
- read article by Peterson (summarises what MCI is)
11:50
What process would lead to a diagnosis of MCI?
-
report of cognitive impairment by patient
-
change in condition
-
not normal
-
not dementia
-
cognitive decline
-
preserved functional abilities
-
memory impairment
-
YES
-
NO
- not normal
- not dementia
- cognitive decline
- preserved functional abilities
- YES
- NO
Peterson (2011)
11:50
What are the two sub-types of MCI?
-
Amnestic MCI
-
memory impairment
-
Nonamnestic MCI
-
no memory impairment
- memory impairment
- no memory impairment
What is the Peterson's Criteria?
-
level of cognition required to meet criteria for MCI (relative to mean)
-
1.5 standard deviations below the norm
- 1.5 standard deviations below the norm
What is Amnestic MCI?
-
one of the two subtypes of MCI
-
memory impairment
-
either alone or alongside other cognitive decline
- either alone or alongside other cognitive decline
14:00
What is Nonamnestic MCI?
-
one or more areas of cognitive decline
-
no memory impairment
14:30
What is a critical distinction between an individual diagnosed with dementia and an individual diagnosed with MCI?
-
no functional decline
-
i.e., performing in every day life
- i.e., performing in every day life
What is the Prevalence of MCI?
-
10-20% of individuals over 65yrs
-
Amnestic more common than Nonamnestic MCI
-
11% to 4%
- 11% to 4%
dont need to know percentages for exam - just know that Amnestic is more prevalent
15:40
What are the possible outcomes for an individual diagnosed with MCI?
-
increased risk of developing Dementia (i.e., MCI is a warning sign)
-
10% compared to 1% of normal go on to develop Dementia
-
some revert back to 'normal' at 6mnth follow up
- 10% compared to 1% of normal go on to develop Dementia
Risk Factors
Genetic - plaques & tangles
Lifestyle
What is the current treatment/management for a person with MCI?
-
observation
-
at 6mnth point
-
it is a separate 'transitory' phase - not fitting into other treatment
- at 6mnth point
17:40
What is Dementia?
-
A deterioration of cognitive abilities such that social and/or cognitive functions are impaired.
-
Mild cognitive impairment – risk factor for dementia
-
third leading cause of death in
- Mild cognitive impairment – risk factor for dementia
18:40
What are the social implications of dementia?
-
huge burden not only personally but socially
-
over 300,000 living with dementia in Australia
-
with no current cure, 1 million projected by 2050
-
3rd leading cause of death in Australia
-
single greatest cause of disability
no need to memorise these figures just understand the weight of the burden
19:00
What is the prevalence & prognosis of dementia?
-
Prevalence
-
Worldwide: 25 million (0.4% population)
-
Australia: 245,000 (quadruple by 2050)
-
Increases with age
-
Prognosis
-
Highly individual
- Worldwide: 25 million (0.4% population)
- Australia: 245,000 (quadruple by 2050)
- Increases with age
- Highly individual
What are the stages of progression in Dementia?
-
Stage 1 (MILD)
-
Difficulty remembering things; forget simple things; forget words for items;
-
awareness of memory lapses;
-
mood swings
-
Stage 2 (MODERATE)
-
More severe memory impairment; asking repetitive questions;
-
Difficulty in every day life; become messy; social withdrawal;
-
recite the past often;
-
personality changes;
-
inability to recognize familiar people;
-
socially withdrawn;
-
sleep disturbances;
-
loss of inhibition
-
Stage 3 (SEVERE)
-
Oblivious to surrounding environment;
-
Unable to care for self;
-
may lose ability to communicate;
-
Sleep often;
-
Often vulnerable to other illnesses.
- Difficulty remembering things; forget simple things; forget words for items;
- awareness of memory lapses;
- mood swings
- More severe memory impairment; asking repetitive questions;
- Difficulty in every day life; become messy; social withdrawal;
- recite the past often;
- personality changes;
- inability to recognize familiar people;
- socially withdrawn;
- sleep disturbances;
- loss of inhibition
- Oblivious to surrounding environment;
- Unable to care for self;
- may lose ability to communicate;
- Sleep often;
- Often vulnerable to other illnesses.
20:00
What are the three main types of dementia?
-
Alzheimers
-
Frontotemporal
-
Vascular
When & how was Alzheimer's Disease first observed?
-
Observed by Alzheimer in 1906
-
Brain tissue irreversibly dies
-
marked deterioration on memory & cognition
- Brain tissue irreversibly dies
- marked deterioration on memory & cognition
22:30
What are some characteristics of alzheimer's Disease
-
Absentmindedness,
-
irritability
-
attention
-
short-term/working memory
As progresses
- Language problems, word finding, disorientated
- socially withdrawn
- Depression
- changes in sleep & appetite
- not recognising others
