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Flashcards in Delerium and Dementia Deck (21)
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1

Dementia
-onset
-clinical features

Onset: slow onset over years

Sx:
-sx do not rapidly fluctuate
-memory impairment
-at least one of the following:
--aphasia = unable to understand or express speech
--apraxia = inability to perform required movements
--agnosia = cannot recognize and object

2

Delirium:
-what is this?
-onset
-clinical features
-prognosis

What: disturbance in consciousness and reduced ability to focus, to sustain focus, or shift attention.

Onset: may be rapid

Clinical features:
-change in cognition
-disturbance in consciousness that develops over a short period of time and fluctuates
-may also have:
--disturbance in sleep-wake cycle
--disturbance in psychomotor behavior
-emotional disturbance
-rapid unpredictable shifts from one emotional state to another.

Prognosis:
-lasts days to weeks, but rarely months. usually completely reversible.

3

Delirium:
-initial dx work up
-risk factors

Work up:
-all medical hx (esp psych, CA, infection, SHx, medications)
-look for drug or alcohol abuse/poisons
-VS
-Blood and urine tests
-Radiology

Risk factors:
-dietary difficulties
-in hospital
-dementia
-FHx of mental illness
-acute stress (loss of spouse or change in environment)

4

What are some Initial interventions for changes in mental status: Delirium?

recognize and treat underlying cause

Reduce stimuli

use simple, clear language

reassurance for person and family

be aware of increased risk for mortality

5

Initial interventions for changes in mental status : DEMENTIA

Testing to ensure dx: neuropsych testing, mental status assessment, neurological exam

Discuss long term care plans

discuss advance directives

refere to alzheimers association

Slow down and be present

6

Dementia:
-what is this?

What: neurocognitive disorder, significant cognitive decline that interferes with daily living

7

Alzheimers Dz:
-pathophys
-prognosis
-stages

patho: progressive accumulation of protein fragment beta amyloid plaques outside neurons and twisted strand of the protein tau inside neurons which damage and kill brain cells.

prognosis: cannot be slowed down or cured, fatal

Stages:
-Preclinical: measurable changes in the brain may be present 20yrs before sx
-Minimal cognitive impariment d/t AD: mild but measurabl changes in thinking abilities that are noticeable but do not affect daily acitivies
-Dementia d/t AD: quite noticeable memory, thinking, and behavioral sx that impair ability to function in daily life with a steady gradual progression over 10-15Yrs.

8

What are the sx of:
-mild (early stage)
of Active AD?

Mild: problems coming up with the right word or name, trouble remembering names when introduced to new ppl, greater difficulty performing tasks in social or work settings, forgetting material that one just read, losing or misplacing a valuable object, increasing trouble with planning or organizing.
**can be in this stage 1-5years

9

What are the sx of:
-moderate (middle stage)
of Active AD?

Moderate:
-forgetfulness of events or about ones own person hx
-feeling moody or withdrawn
-being unable to recall address or phone numbers
-confusion about where they are or what day it is
-needing help choosing proper clothing for the day or season
-trouble with bowel and bladder control
-changes in sleep patterns
-personality and behavioral changes
*can last 1-5 years in this stage

10

What are the sx of:
-severe (late stage)
of Active AD?

Severe:
-require full time around the clock assistance including personal care
-lose awareness of recent experiences as well as their surroundings
-require high level of assistance with ADL
-experience changes in physical abilities: walk, sit, swallow
-have increasing difficulty communicating
-become vulnerable to infections, especially pna.
*usually lasts 1-2yrs

11

What do alzheimers pts usually die from?

aspiration pna.

12

Risk factors of AD?

age, FHx, HTN, DM, high cholesterol, African american. female, level of education, socio-economic status

alcohol use, downs syndrome, head trauma, depression, exercise, obesity, smoking

13

Vascular Dementia:
-what is the initial sx
-who is high risk for this?
-progression

Initial sx:
-impaired judgement or impaired ability to make a decision

-high risk individuals:
--HTN, DM, high cholesterol

Progression:
slow progression over years

14

Dementia w/ Lewy Body:
-sx
-what are lewy bodies?
-associated conditions
-progression

Sx: similar to AD
early on: sleep disturbances, VISUAL HALLUCINATIONS**, gait imbalance, and parkinsonian movement features.

Lewy bodies: abnormal aggregations of the protein alpha synuclein that accumulates in neurosn

may coexist with parkinsons or alzheimers

Progression: steady, gradual

15

Frontotemporal lobar degeneration:
-includes what syndromes?
-sx
-progression

INcludes: behavioral varient-FTLD, primary progressive aphasia, picks dz, corticobasal degeneration, and progressive supranuclear palsy

Sx: marked changes in personality and behavior and difficulty with producing or comprehending language, memory is spared***

-progression: usually starts at 60Yo and is steady and rapid

16

What is mixed dementia?

Parkinsons Dz Dementia:
-sx

Alzheimers with another type.

Parkinsons sx:
-problems with movement, slowness, rigidity, tremor, and changes in gait and speech, depression common

17

Creutzfeld-Jakob Dz:
-cause
-sx

Cause; prior that causes other proteins through the brain to misfold and malfunction

Sx: impairs memory and coordination and causes behavior changes

18

Normal Pressure Hydrocephalus Dementia:
-sx
-who's at increased risk?

Sx: difficulty walking, memory loss, inability to control urination

Risk:
-hx of brain damage and meningitis are at increased risk.

19

What are the 10 warning signs of Alzheimers Dementia?

Memory changes that disrupt daily life

challenges in planning or solving problems

difficulty completing familiar tasks

confusion with time or place

trouble understanding visual images and spatial relationships

new problems with works in speaking or writing

misplacing things and losing ability to retrace steps

decreased or poor judgement

withdrawal from work or social acitivites

changes in mood or personality

20

Follow up for AD

follow neurocognitive decline with MMSE

Follow other chronic dz

Ensure caregivers are doing OK.

21

What are the principal stressors and illnesses for caregivers?

financial, emotional, and physical

stress: lack of sleep, no time off

juggling job and caregiving

income status

continues worsening of own dz (many die before the person with AD)