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27 Cards in this Set
- Front
- Back
Delirium
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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 |
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Subtypes of Delirium
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1. Due to a general medical condition
2, Substance-induced delirium 3. Multiple etiology delirium 4. Delirium not otherwise specified |
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Potential Causes of Delirium
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1. Substances
2. Poisons 3. Fevers 4. Infections 5. Infections 6. Head injury/trauma 7. Sleep deprivation 8. Immobility 9. Excessive stress |
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Delirium Statistics
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10-30% in acute care
Highest prevalence in older adults, AIDs patients, medical patients Full recovery = several weeks |
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Treatment and Prevention of Delirium
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*Treat underlying medical conditions
*Psychosocial interventions: education, reassurance, coping strategies *Proper medical care *Proper medication use |
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Dementia
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*Gradual deterioration of brain functioning (Degenerative)
*Affects multiple domains: judgement, memory, language, advanced cognitive processes *Multiple etiologies *May or may not be reversible |
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Progressive Dementia: Initial Stages
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*Memory impairment
*Visuospatial skill deficits *Agnosia *Delusions *Depression *Agitation *Aggression *Apathy |
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Agnosia
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Inability to recognize and name objects
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Facial Agnosia
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Inability to recognize familiar faces
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Progressive Dementia: Later Stages
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*Continued cognitive decline
*Assistance with activities of daily living ~Independent: driving, cooking, cleaning, managing finances ~Basic: grooming, bathing, eating, toileting, dressing *Results in death |
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Dementia Statistics
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Onset = any age
Most common in the elderly 5% over age 65 20-40% over age 85 Women > Men (Longer lifespan, estrogen) |
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Types of Dementia
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1. Alzheimer's
2. Vascular 3. General Medical Condition 4. Substance-Induced 5. Multiple Etiologies 6. Not Otherwise Specialized |
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Clinical Description: Dementia of the Alzheimer's Type
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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 |
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Aphasia
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Difficulty with language
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Apraxia
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Impaired motor function
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Agnosia
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Failure to recognize objects
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Executive Functioning
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Difficulties with planning, organizing, sequencing, or abstracting information
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Alzheimer's Statistics
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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 |
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Cognitive Reserve Theory
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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 |
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Clinical Description: Vascular Dementia
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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 |
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Vascular Dementia Statistics
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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 |
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Dementia Due to Other Medical Conditions
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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 |
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Causes of Alzheimer's
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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 |
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Dementia: Psychosocial and Social Factors
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1. No current direct causes
2. Lifestyle Factors *Drug use (+) *Stress (+) *Diet (+-) *Exercise (-) 3. Cultural Factors 4. Psychosocial * educational attainment *coping skills * social support |
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Medical Treatment of Dementia
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Three areas of focus
1. Prevention 2. Delaying Onset 3. Symptom Management |
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Psychosocial Treatment of Dementia
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1. Focus on teaching skills to make up for lost abilities
2. cognitive stimulation 3. smart homes 4. main emphasis on the caregivers |
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Prevention of Dementia
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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 |