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27 Cards in this Set

  • Front
  • Back
Delirium
1. Often temporary confusion and disorientation
2. Reduced level of consciousness
3. Cognitive change that a dementia cannot better explain
4. Symptoms develop rapidly
5. History, physical examination suggest a medical condition caused the condition
Subtypes of Delirium
1. Due to a general medical condition
2, Substance-induced delirium
3. Multiple etiology delirium
4. Delirium not otherwise specified
Potential Causes of Delirium
1. Substances
2. Poisons
3. Fevers
4. Infections
5. Infections
6. Head injury/trauma
7. Sleep deprivation
8. Immobility
9. Excessive stress
Delirium Statistics
10-30% in acute care
Highest prevalence in older adults, AIDs patients, medical patients
Full recovery = several weeks
Treatment and Prevention of Delirium
*Treat underlying medical conditions
*Psychosocial interventions: education, reassurance, coping strategies

*Proper medical care
*Proper medication use
Dementia
*Gradual deterioration of brain functioning (Degenerative)
*Affects multiple domains: judgement, memory, language, advanced cognitive processes
*Multiple etiologies
*May or may not be reversible
Progressive Dementia: Initial Stages
*Memory impairment
*Visuospatial skill deficits
*Agnosia
*Delusions
*Depression
*Agitation
*Aggression
*Apathy
Agnosia
Inability to recognize and name objects
Facial Agnosia
Inability to recognize familiar faces
Progressive Dementia: Later Stages
*Continued cognitive decline
*Assistance with activities of daily living
~Independent: driving, cooking, cleaning, managing finances
~Basic: grooming, bathing, eating, toileting, dressing
*Results in death
Dementia Statistics
Onset = any age
Most common in the elderly
5% over age 65
20-40% over age 85
Women > Men (Longer lifespan, estrogen)
Types of Dementia
1. Alzheimer's
2. Vascular
3. General Medical Condition
4. Substance-Induced
5. Multiple Etiologies
6. Not Otherwise Specialized
Clinical Description: Dementia of the Alzheimer's Type
1. Multiple Cognitive Deficits
2. Develop gradually and steadily
3. Confusion
4. Agitation/Combativeness
5. Depression
6. Anxiety
7. Sundowner Syndrome: symptoms become worse at the end of the day
Aphasia
Difficulty with language
Apraxia
Impaired motor function
Agnosia
Failure to recognize objects
Executive Functioning
Difficulties with planning, organizing, sequencing, or abstracting information
Alzheimer's Statistics
Deterioration: early & later stages = slow
Deterioration: middle stages: rapid
Post diagnosis survival = 8 years
onset = 60s-70s
Early onset = before 65
Prevalence: 5 million Americans several million worldwide
Higher in poorly educated and women
Cognitive Reserve Theory
Higher educational reserve may create a mental reserve that helps one cope longer with cognitive deterioration that marks the beginning of dementia

More synapses are built up and therefore the full signs of dementia are delayed even longer
Clinical Description: Vascular Dementia
1. Progressive brain disorder
2. Blockage or damage to blood vessels
3. Onset is often sudden (stroke)
4. Variable impairments
5. Cognitive disturbances
6. Obvious neurological signs
~greater motor problems
~weakness in limbs
7. Significant impairments
Vascular Dementia Statistics
Prevalence
*1.5% in age 70-75
*15% in age 80 or older
Men > Women
*higher rates of cardiovascular disease
Most require formal nursing care
Death from infection
*pneumonia
*weak immune system
Dementia Due to Other Medical Conditions
1. HIV: 29-87% of those with AIDS
2. Head Trauma: accidents, concussion, memory loss is prime symptom
3. Parkinson's:
*dopamine pathway damage
*motor problems:tremors, posture, walking, speech
*Not all with Parkinson's develops dementia
4. Huntington's
*genetic autosomal dominant disorder
*sub-cortical dementia pattern
~20-80%
~100% if old enough
5. Creutzfeldt-Jakob
*1 in a million
*linked to mad cow disease
Causes of Alzheimer's
1. Neurobiological influences
*neurofibrillary tangles (like a fraying piece of string)
*more rapid atrophy (loss of connections between nerve cells in brain)
*amyloid plaques (deposits between neurons that slow down or inhibit transmission)
2. Genetic influence
*polygenetic
*chromosome 14 = early onset
*chromosome 19 = late onset
Dementia: Psychosocial and Social Factors
1. No current direct causes
2. Lifestyle Factors
*Drug use (+)
*Stress (+)
*Diet (+-)
*Exercise (-)
3. Cultural Factors
4. Psychosocial
* educational attainment
*coping skills
* social support
Medical Treatment of Dementia
Three areas of focus
1. Prevention
2. Delaying Onset
3. Symptom Management
Psychosocial Treatment of Dementia
1. Focus on teaching skills to make up for lost abilities
2. cognitive stimulation
3. smart homes
4. main emphasis on the caregivers
Prevention of Dementia
1. Control blood pressure
2. Staying socially active
3. Staying physically active
4. Prevent head trauma
5. Reduce neurotoxin exposure
6. Limit drug and alcohol use