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247 Cards in this Set
- Front
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Cognitive d/o cause a clinically significant deficit in cognition that represents a
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major change from the indicidual's previous baseline level of functioning
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The two common cognitive d/o are
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Delirium
Dementia |
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General Etiology of cognitive do
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Cognitive d/o are a general medical condition
a result of ~substance use or abuce ~rxn to medications or toher ingested agents ~combo of all of these |
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Deliruim is a ______ not a disease
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syndrome
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Hallmark sx of delirium
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Disturbance of consciousness accompanied by changes in cognition
(Delirium is NOT accounted for by other current medical conditions) |
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Delirium is NOT accounted for by
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other current medical conditions
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Delirium is common in
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common , ESPECIALLY in elderly
0.4% in gen us pop 18+ 1.1% in 50+ 30% inpatients 50+ 60% elderly in nursing homes 25% in cancer pts 40% inpatients w/ aids 80% terminal pt near death |
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In pt w/ psych d/o this is often mistaken for worsening of psychotic sx instead of a separate distinct condition
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Delirium
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Risk factors for Delirium
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age 50 & +
multisys med illness (the sicker they are the higher the risk) substance abuse past episode of delirium |
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past episode of delirium
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increases risk of delirium
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Substance abuse
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cause and risk factor for delirium
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the more physically ill the pt the higher the risk for
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delirium
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rate of onset of delirium
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disturbance of consciousness develops over a short time, usually hours to days
(this disturbance tends to fluctuate during the course of the day) |
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Disturbance of consciousness fluctuates during the cours of the day
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Delirium
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Reversal of sleep-wake cycle is common in
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Delirium
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Pts are awake at night and sleep during the day often in
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delirium
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The pt exhibits purposeless, random actions
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Delirium
Psychomotor agitation should be assessed for in hx |
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The more quickly the underlying physiological disturbance is recognized and tx
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the more rapidly the delirium will resolve
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Sx of this d/o my persist for months in a pt when unrecognized
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Delirium
most sx reslove w/in 3-6 months |
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On physical exam find evidence that sig clinical sx are a consequence of direct physiological process, substance abuse or general medical condition
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delirium
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On physical exam usually nonspecific neurological abnormalities are found
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Delirium
Tremors incoordination urinary incontinence Myoclonus nystagmus asterixis increased muscle tone & reflex |
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Asterixis
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A flapping motion of the wrists
a nonspecific neurological abnormality often found on physical exam in delirium |
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tremors
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a nonspecific neurological abnormality often found on physical exam in delirium
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nystagmus
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(eye shutter)
a nonspecific neurological abnormality often found on physical exam in delirium |
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myoclonus
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(brief involuntary twitching of muscle or group of muscles)
a nonspecific neurological abnormality often found on physical exam in delirium |
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urinary incontinence
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a nonspecific neurological abnormality often found on physical exam in delirium
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incoordination
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a nonspecific neurological abnormality often found on physical exam in delirium
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increased muscle tone & reflex
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a nonspecific neurological abnormality often found on physical exam in delirium
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appearance of delirious pt
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unconcerned w appearance
disheveled Highly Inattentive |
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unconcerned w appearance
disheveled Highly Inattentive |
appearance of delirious pt
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Speech of pt w/
delirium |
impaired
disorganized rambleing incoherent slurred Dysarthria (impaired ability to articulate words) Dysnomia (impaired ability to name objets) Dysgraphia (impaired ability to write) |
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impaired
disorganized rambleing incoherent slurred Dysarthria Dysnomia Dysgraphia |
Speech of pt w/
delirium |
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Dysarthria
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Impaired ability to articulate words
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Dysnomia
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Impaired ability to name objects
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Dysgraphia
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impaired ability to write
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Impaired ability to articulate words
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Dysarthria
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Impaired ability to write
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Dysgraphia
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Impaired ability to name objects
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Dysnomia
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Rapid unpredictable shifts in affective state w/o known ppt
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Affect of delirium
~lethargic ~agitated |
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Affect of delirium
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Rapid unpredictable shifts in affective state w/o known ppt
~lethargic ~agitated |
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jillusions are the most common perceptual disturbances in this d/o
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delirium
Hallucinations less common than illusions but may be presnet Charted under thought process |
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Thought process of delirium
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Disorganized
distractable Perceptual disturbances *illusions most common *hallucinations less common than illusions but may be present Delusions |
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Thought content is hared to determin in dellirium because
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hard to engage pt in meaningful conversation
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What is usually the 1st sx to appear in delirum ?
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Orientation
Usually disoriented to time and place |
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1st sc in delirum
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Usually disoriented to time and place
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Lab & diagnostic findings in delirium
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findings consistent w/ underlying physiological etiology
EEG abnormalities *generalized slowing *generalized increased activity if delirum is r/t EtOH withdrawal |
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EEG abnormalities
*generalized slowing *generalized increased activity if delirum is r/t EtOH withdrawal |
found in delirium
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EEG in delirium
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EEG abnormalities
*generalized slowing *generalized increased activity if delirum is r/t EtOH withdrawal |
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diff dx for delirium
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*dementia
*substance intoxication or withdrawal *schizophrenia *schizophreniform d/o *mood d/o with psychotic features |
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Clinical mgmt of delirium
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undertake tx of underlying condition or d/o
avoid the use of new medications whenever possible as using them may cloud the diagnostic picture |
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undertake tx of underlying condition or d/o
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Main tx of Delirium
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Main tx of Delirium
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undertake tx of underlying condition or d/o
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pharm mgmt in delirium
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Symptomatic tx
Agitation and psychotic sx *antipsychotic agents *anxiolytic agents *Haldol, risperdal, and ativan commonly used |
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Haldol, risperdal, and ativan commonly used
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for agitation & psychotic sx in delirium
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non pharm mgmt of delirium
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Safety
determine reality orientation frequently Pay attn to basic needs: *Hydration *nutrition Pts should be neither sensory deprived nor overstimulated Helpful to have in pt's room familiar pics/decor, clock or calender, & reg orientation to person place and time |
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Helpful to have in delirium pt's room
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familiar pics/decor/[[l, clock or calender, & reg orientation to person place and time
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______Pts should be neither sensory deprived nor overstimulated
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delerium
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Delirium is associated with high morbidity usually from
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INJURY
High morbidity also results from associated problems r/t inactivity *pneumonia *hydration & nutritional deficits |
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children and delirium
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They are especially susceptible
r/t immature brain development Often mistaken for uncooperative behavior most common in febrile states meds known to affect cognition *anticholinergic meds |
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delirium is most common in febrile states in
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kids
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If a kid is not soother by common methods think
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delirium
common methods (e.g. parental presence) |
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Meds Known to affect cognition in kids can cause
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can cause; delirium especially common with anticholinergic meds
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R/t immature brain development
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delirium in kids (they are especially susceptible)
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Often mistaken for uncooperative behavior
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delirium in kids
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Dementia is a group of d/o characterized by development of
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multiple cognitive deficits:
*impaired executive fxning *impaired global intellect w/ preservation of level of consciousness *impaired problem solving *impaired organizational skills *altered memory |
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impaired global intellect with preservation of level of consciousness
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One of the multiple cognitive deficits that characterize Dementia
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impaired executive fxning
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One of the multiple cognitive deficits that characterize Dementia
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impaired problem solving
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One of the multiple cognitive deficits that characterize Dementia
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Imparied organizational skills
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One of the multiple cognitive deficits that characterize Dementia
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Altered memory
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One of the multiple cognitive deficits that characterize Dementia
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Various forms of dementia share common sx but have different
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underlying pathology
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DAT
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Dementia of Alzheimer's type
*most common type *gradual onset and progressive decline WITHOUT focal neurological deficits *Hallmark amyloid deposits and neurofibrillary tangles |
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Hallmark of DAT
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amyloid deposits and neurofibrillary tangles
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amyloid deposits and neurofibrillary tangles
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Hallmark of DAT
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gradual onset and progressive decline WITHOUT focal neurological deficits
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DAT onset
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DAT ONSET
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gradual onset and progressive decline WITHOUT focal neurological deficits
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DAT has a gradual progressive decline without ....
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focal neurological deficits
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no focal neurological deficits
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DAT
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Most common type of dementia
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DAT
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Most commonly occurring Dementia
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Dementia of the Alzheimer's type
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2nd most common type of dementia
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Vascular dementia (VD)
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Vascular dementia prevalence
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2nd most common type of dementia
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DAT prevalence
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most common type of dementia
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used to be called multi-infarct dementia
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Vascular dementia (VD)
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vascular dementia aka
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multi-infarct dementia
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multi-infarct dementia aka
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vascular dementia
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primary caused by cardiovascular disease
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vascular dementia
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characterized by step-type declines
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Vascular dementia
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vascular dementia characterized by
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step type declines
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Vascular dementia caused by
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primary caused by cardiovascular disease
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Most common in men with preexisting high BP & cardiovascular risk factors
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Vascular dementia
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Vascular dementia most common in
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men with preexisting HTN and cardiovascular risk factors
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Hallmarks of Vascular dementia
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Carotid bruits
fundoscopic abnormalities enlarged cardiac chambers |
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Carotid bruits
fundoscopic abnormalities enlarged cardiac chambers |
Hallmarks of Vascular dementia
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carotid bruits
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Hallmarks of Vascular dementia
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fundoscopic abnormalitites
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Hallmarks of Vascular dementia
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enlarged cardiac chambers
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Hallmarks of Vascular dementia
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Dementia dut to HIV disease Classified as a
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subcortical dementia
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Parenchymal abnormalities visualized on MRI scan
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Dementia due to HIV disease
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HIV associated neurocognitive d/o
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less severe form of Dementia due to HIV disease
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HIV encephalopathy
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Dementia due to HIV disease
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HIV encephalopathy and HIV-associated neurocognitive d/o
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Less severe forms of Dementia due to HIV disease
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HIV can cause many _____ sx
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HIV can cause many PSYCHIATRIC sx
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Manifests by progressive cognitive decline, motor abnormalities and behavioral abnormalities
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Dementia due to HIV disease
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Dementia due to HIV disease manifests by
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progressive cognitive decline, motor abnormalities and behavioral abnormalities
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Progressive cognitive decline with motor abnormality think...
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also manifests behavioral abnormalities Dementia due to HIV disease
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Development of dementia in pt with HIV is an indicator of
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Poor prognosis; death usually occurs w/in 6 months
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Death usually occurs w/in 6 months of
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Dementia due to HIV disease
& Crutzfeld-Jacob disease |
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Psychotic sx usually occur in late stage of infection with
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Dementia due to HIV disease
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Clinical signs of late-stage HIV related dementia inculde _____, -----, ______, & ________ impairment
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Clinical signs of late stage HIVE related dementia include COGNITIVE, MOTOR, BEHAVIORAL, & AFFECTIVE impairment
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Global cognitive impairment
mutism seizures Hallucinations delusions apathy mania |
Clinical signs of late-stage HIV related dementia
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Clinical signs of late-stage HIV related dementia
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Global cognitive impairment
mutism seizures Hallucinations delusions apathy mania |
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Protease inhibitors and psych drugs
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Protease inhibitors (AIDS drug) can INCREASE levels of
*wellbutrin *benzodiazepines *SSRIs Use caution when prescribing these drugs to individuals taking protease inhibitors |
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Use caution when prescribing what drugs to individuals taking protease inhibitors
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*wellbutrin
*benzodiazepines *SSRIs Protease inhibitors (AIDS drug) can INCREASE levels |
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Protease inhibitors (AIDS drug) can INCREASE levels of
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*wellbutrin
*benzodiazepines *SSRIs |
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Protease inhibitors may induce the metabolism of
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Depakote
Ativan thus causing subtherapeutic levels |
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Depakote
Ativan & protease inhibitors |
Protease inhibitors may induce the metabolism of Ativan and depakote thus causing subtherapeutic levels
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Protease inhibitors may increase....
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*wellbutrin
*SSRIs *Benzodiazepines (not ativan) |
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Protease inhibitors may decrease
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Ativan and depakote thus causing subtherapeutic levels by inducing the metabolism of these drugs
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Pick's disease aka
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frontotemporal dementia
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frontotemporal dementia aka
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Pick's disease
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Picks's disease is
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Pick's disease is a rare and permanent form of dementia that is similar to Alzheimer's disease, except that it tends to affect only certain areas of the brain.
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Neuronal loss
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Pick's disease
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gliosis
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Seen with Pick's disease
Gliosis is a proliferation of astrocytes in damaged areas of the central nervous system (CNS). This proliferation usually leads to the formation of a glial scar. Astrocytes are relatively large glial cells and have various functions, including accumulating in areas where neurons have been damaged. It is the most important histopathological sign of CNS injury. Gliosis and neuronal loss in certain brain regions are findings seen in various neurodegenerative disorders such as Alzheimer's disease, Korsakoff's syndrome, multiple system atrophy, prion disease, multiple sclerosis (after an acute attack) and AIDS dementia complex. It can also be found in Parkinson's disease, ALS and Huntington's disease. |
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Pick's bodies present
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Pick's disease
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Personality and behavioral changes in EARLY stage
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Pick's disease
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Cognitive changes in later stages
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Pick's disease
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Kluver-Bucy syndrome
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hypersexuality
hyperorality placidity is a behavioral disorder that occurs when both the right and left medial temporal lobes of the brain malfunction. The amygdala has been a particularly implicated brain region in the pathogenesis of this syndrome. |
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hyperorality
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Kluver-Bucy syndrome (seen in Pick's disease)
n oral tendency, or compulsion to examine objects by mouth" |
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placidity
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not easily upset or excited; calm
Kluver-Bucy syndrome (seen in Pick's disease) |
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hypersexuality
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Characterized by a heightened sex drive or a tendency to seek sexual stimulation from unusual or inappropriate objects.
Kluver-Bucy syndrome (seen in Pick's disease) |
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Neuronal loss, gliosis, and personality changes in early stage
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Pick's disease
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Creutzfeld-Jacob disease
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is a form of brain damage that leads to a rapid decrease of mental function and movement
is a rare, degenerative, invariably fatal brain disorder. belongs to a family of human and animal diseases known as the transmissible spongiform encephalopathies (TSEs). Spongiform refers to the characteristic appearance of infected brains, which become filled with holes until they resemble sponges under a microscope. CJD is the most common of the known human TSEs. |
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Fatal and rapidly progressive d/o
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Creutzfeld-jacob disease
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Occurs mainly in adults middle age or older
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Creutzfeld-jacob disease
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initially manifests with fatigue, flue-like sx and cognitive impairment
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Creutzfeld-jacob disease
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later manifests w/ aphasia
apraxia emotional lability depression mania psychosis marked personality changes dementia |
Creutzfeld-jacob disease
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Death usually occurs within 6 months
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Creutzfeld-jacob disease
& HIV related dementia |
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Creutzfeld-jacob disease initially manifests
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with fatigue, flue-liek sx and cognitive impairment
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Creutzfeld-jacob disease late manifestations
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apraxia
emotional lability depression mania psychosis marked personality changes dementia |
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Huntington's disease is what type of dementia
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subcortical type of dementia
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Huntington's disease characterized mostly by
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motor abnormalities
(e.g. choreoathetoid movements) |
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Psychomotor slowing and difficulty with complex tasks
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Huntington's disease
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Memory, language and insight usually intact until late stages
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Huntington's disease
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high incidence of depression and psychosis
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Huntington's disease
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Choreoathetoid movements, psychomotor slowing and difficulty with complex tasks
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Huntington's disease
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Lewy body disease
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*Caused by lewy inclusion bodies in the cortex
*Presents with hallucinations, Parkinsonian features Extrapyramidal side effects (EPS) Reacts adversely to antipsychotics |
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Reacts adversely to antipsychotics
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Lewy body disease
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caused by lewy inclusion bodies in the cortex
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Lewy body disease
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presents with
*hallucinations *Parkinsonian features *extrapyramidal side effects |
Lewy body disease
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Etiology of Dementia
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Primary cause mostly unknown
*General med condition, *result of substance use or abuse *reaction to meds or ingested agents *combo of these Genetic loading Autosomal dominant trait Inherited alleles for apolipoprotein E-4 (APOE4) on chromosome 19 suspected to be r/t late onset dementia |
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Etiology of DAT
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Diffuse cerebral atrophy and enlarged ventricle
Decreased ACh and NE Genes of chromosomes 1 14 21 have been identified in families w/ hx of DAT |
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Inherited alleles for apolipoprotein E-4 (APOE4) on chromosome 19 suspected to be r/t
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late onset dementia
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genetics of late onset dementia
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Inherited alleles for apolipoprotein E-4 (APOE4) on chromosome 19 suspected to be r/t late onset dementia
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APOE4
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Inherited alleles for apolipoprotein E-4 (APOE4) on chromosome 19 suspected to be r/t late onset dementia
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Apolipoprotein E-4
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Inherited alleles for apolipoprotein E-4 (APOE4) on chromosome 19 suspected to be r/t late onset dementia
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Genes on what chromosomes have been identified in families with hx of DAT
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1
14 21 |
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Autosomal dominant trait
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etiology of dementia
Genetic loading *chromosomes 1, 14, 21 in DAT *chromo 19 inherited alleles for APOE4 in late onset dementia |
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DAT incidence
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the most common form of dementia
affects an estimated 4 million Americans duration of illness averages 8-10 yrs |
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Duration of illness DAT
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8-10 yrs
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Incidence of dementia in young
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often misdiagnoses or unrecognized especially in early stages and in young pts
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Incidence of dementia in US elderly
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1.6% of ppl 65 or older
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most common ppl to have dementia
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individuals age 85 or older
16-25% of 85 & + affected |
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Risk factors for dementia
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Age
Multisystem medical illness Genetic loading (fam hx dementia in 1st order relative) Hx of substance use or abuse |
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Dementia does or does not have prodromal sx period
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Does
sig & protracted prodromal sx period usually noted before full onset of illness |
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In dementia assess for medical hx of
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HTN
strokes head trauma and psychiatric illness (depression, anxiety, schizophrenia) meds, EtOH, tabacco, substance use (and hx) |
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In dementia assess a detailed hx of present illness including
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time frame
progression associated sx |
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Most prominent feature of dementia
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memory impairment
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usually earliest sx of dementia
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memory impairment
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Memory impairment produces multiple deficits in daily functioning such as
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~unable to learn new info
~forgets past info ~loses valuables ~forgets ADLs (eat, dress) ~becomes easily lost ~has other cognitive deficits such as impaired executive functioning |
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Instruments for assessing level of impairment in dementia
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~mini-mental State examination (MMSE)
~Short portable Mental status Questionnaire (SPMSQ) ~Blessed Dementia Rating scale (BDRS) ~St Louis university mental status examination (SLUMS) ~Montreal Cognitive assessment (MoCA) |
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BDRS
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Blessed Dementia Rating scale
Instruments for assessing level of impairment in dementia |
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SPMSQ
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Short portable Mental status Questionnaire
Instruments for assessing level of impairment in dementia |
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MMSE
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mini-mental State examination (MMSE)
aka Folstein is a brief 30-point questionnaire test that is used to screen for cognitive impairment. Instruments for assessing level of impairment in dementia |
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SLUMS
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St Louis university mental status examination (SLUMS)
Instruments for assessing level of impairment in dementia |
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St Louis University Mental status examination
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SLUMS
For detecting mild cognitive impairment and dementia Instruments for assessing level of impairment in dementia |
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Mini-mental status examination
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Instruments for assessing level of impairment in dementia
MMSE |
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MOCA
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Montreal Cognitive Assesment
is a one-page 30-point test administered in approximately 10 minutes. Instruments for assessing level of impairment in dementia |
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appearance of someone with dementia
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apraxia
decreased self-care ADLs |
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Speech of dementia pt
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~deterioration of lang skills
~aphasia ~circumlocutory phrases ~Indefinite object recognition (e.g. calling items "things" and unable to find discrete name. In advanced stages are mutism echlalia |
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Mutism
echolalia |
In advance stages of dementia
speech characteristics |
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indefinite object recognition
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e.g. calling items "things" and unable to find the discrete name
in speech pattern of dementia |
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memory in dementia is impaired in many dimensions of memory
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*word registration
*recall *retention *recognition |
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*word registration
*recall *retention *recognition |
memory in dementia is impaired in many dimensions of memory
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Psych diff dx for dementia
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mood d/o
delirium anxiety d/o |
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Non psych diff dx for dementia
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~Parkinson's disease
~hearing loss ~B12 & folate deficiencies ~trauma esp w/ hx of falls ~hypothyroidism ~infection (UTI) ~cerebrovascular accident ~polypharmacy ~EtOH intoxication |
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General clinical mgmt of dementia
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R/o or tx any conditions that may contribute to cognitive impairments
Discontinue unnecessary meds, especially sedative and hypnotics |
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Pharm mgmt for cognitive sx
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N-methy D- aspartate Glutamate receptor antagonist
Prevent over excitation of glutamate receptors and stabilize the nerurodegenerative process |
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Prevent over excitation of glutamate receptors and stabilize the nerurodegenerative process
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N-methy D- aspartate Glutamate receptor antagonist
Pharm mgmt for cognitive sx |
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N-methy D- aspartate Glutamate receptor antagonist
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Pharm mgmt for cognitive sx
Prevent over excitation of glutamate receptors and stabilize the nerurodegenerative process |
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Memantine
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is for cognitive sx in dementia
*May slow the degenerative process *Promotes synaptic plasticity *may be used in combo w/ cholinesterase inhibitors |
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May slow the degenerative process
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memantine (namenda 10-20mg bid)
given for cognitve sx in dementia |
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Stabilize the neurodegenerative process
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N-methy D-aspartate glutamate receptor antagonists
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Cholinersterase inhibitors is used with
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Mild to moderate alzheimer's disease
Not effective in end-stage disease |
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may be initiated for mild to moderate alzheimer's disease
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Cholinersterase inhibitors
Not effective in end-stage disease |
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Not effective in end-stage disease of dementia
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Cholinersterase inhibitors
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Does not prevent pathological progression of dementia
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Cholinersterase inhibitors
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Treats only sx Does not prevent pathological progression of dementia
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Cholinersterase inhibitors
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Treats only sx, slows loss of functions, and may improve agitated behaviors
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Cholinersterase inhibitors
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Slows loss of fxn and may improve agitated behaviors
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Cholinersterase inhibitors
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Commonly used Cholinersterase inhibitor agents
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Donepezil (aricept)
Rivastigmine tartrate (exelon) *increase gradually to avoid nausea Tacrine (Cognex) |
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Should stop theses agents if side effects develop (usually nausea and vomiting)
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Cholinersterase inhibitors
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Modest clinical improvement in some pts with studies showing 2-3 pt improvement in MSE testing
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Cholinesterase inhibitors
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Cholinersterase inhibitors shows ____ improvement
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Modest clinical improvement in some pts with studies showing 2-3 pt improvement in MSE testing
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Donepezil
|
Aricept
a Cholinesterase inhibitors 5-10mg/d now 1st line best w/ mild sx may elevate LFTs so monitor |
|
|
Aricept
|
Donepezil
5-10mg/d a Cholinersterase inhibitors 5-10mg/d now 1st line best w/ mild sx (cognitive) may elevate LFTs so monitor |
|
|
1st line for cognitive sx
a Cholinesterase inhibitors |
Donepezil / Aricept
a Cholinersterase inhibitors 5-10mg/d now 1st line best w/ mild sx may elevate LFTs so monitor |
|
|
Best Cholinersterase inhibitor with mild sx (cognitive)
|
Donepezil / Aricept
a Cholinersterase inhibitors 5-10mg/d now 1st line best w/ mild sx (cognitive) may elevate LFTs so monitor |
|
|
Rivastigmine tartrate
|
Exelon
1.5-6mg bid a cholinesterase inhibitor best with moderate sx (cognitive) increase gradually to avoid nausea |
|
|
Exelon
|
Rivastigmine tartrate
1.5-6mg bid a cholinesterase inhibitor best with moderate sx (cognitive) increase gradually to avoid nausea |
|
|
Best with moderate sx (cognitive)
|
Rivastigmine tartrate/ exelon
1.5-6mg bid a cholinesterase inhibitors increase gradually to avoid nausea |
|
|
Tacrine
|
Cognex
40-160 mg/d a cholinesterase inhibitors (given to tx cognitive sx of dementia) May elevate LFTs & cause liver toxicity so, monitor Many drug interactions |
|
|
Cognex
|
Tacrine
40-160 mg/d a cholinesterase inhibitors (given to tx cognitive sx of dementia) May elevate LFTs & cause liver toxicity so, monitor Many drug interactions |
|
|
Cholinesterase inhibitor with many drug interactions
|
Cognex/tacrine
40-160 mg/d a cholinesterase inhibitors (given to tx cognitive sx of dementia) May elevate LFTs & cause liver toxicity so, monitor Many drug interactions |
|
|
Psychosis and agitation pharm mgmt
|
try non pharm therapies 1st
use antipsychotic agents regularly for agitation or psychotic symptoms Use lowest effective dose & attempt to wean periodically Antipsychotics may cause many SE of sig in elderly *EPS *Sedation *Postural hypotension *anticholinergic SE |
|
|
Antipsychotics may cause many SE of sig in elderly
|
*EPS
*Sedation *Postural hypotension *anticholinergic SE |
|
|
Antipsychotics and elderly
|
try non pharm therapies 1st
use antipsychotic agents regularly for agitation or psychotic symptoms Use lowest effective dose & attempt to wean periodically |
|
|
Benzos may or may not be used for tx anxiety or infrequent agitation in dementia
|
they can be
but they are not as effective as antipsychotics for severs sx |
|
|
are not as effective as antipsychotics for severs sx
|
Benzos may or may not be used for tx anxiety or infrequent agitation in dementia
|
|
|
Depression in dementia
|
tx pt w/ depressive sx
*depressed mood *insomnia *fatigue *irritability *appetite loss Use lowest effective dose tx for 6-12 mo then attempt to wean; depression may recur & require lifelong tx SSRIs have fewer SE than TCAs |
|
|
Pts with dementia may have less depression as
|
the dementia progresses & they become less aware of their circumstances
|
|
|
Pharm tx of depression in dementia
|
SSRIs have fewer SE than TCAs
Use lowest effective dose tx for 6-12 mo t hen attempt to wean; depression may recur & require lifelong tx |
|
|
Nonpharm mgmt of dementia
|
*Educate pt & family
*assist long term planning * *behavior therapy *recreational therapy *reminiscence therapy *Maintain simple daily routine *Integrate cultural beliefs into mgmt |
|
|
Reminiscence therapy in dementia
|
used to process through any unresolved issues and recollect the past
|
|
|
Used in dementia to process through any unresolved issues and recollect the past
|
Reminiscence therapy in dementia
|
|
|
Used in dementia to identify caused of problem behaviors and change the environment to reduce the problem behaviors
|
Behavior therapy in dementia
|
|
|
Behavior therapy in dementia
|
Used in dementia to identify caused of problem behaviors and change the environment to reduce the problem behaviors
|
|
|
Used in dementia to reduce agitation and promote normalized behavior
|
Recreational therapy
are & pet therapy in dementia |
|
|
Recreational therapy
are & pet therapy in dementia |
Used in dementia to reduce agitation and promote normalized behavior
|
|
|
maintaing a simple daily routine in dementia for
|
bathing
dressing eating toileting bedtime |
|
|
Even subtle neurocognitive impairment may affect
|
Psychological coping
|
|
|
Psychological coping
|
may be affected even by a subtle neurocognitive impairment
|
|
|
Major psychodynamic themes for individuals with HID-related dementia are issues of
|
Guilt
self-esteem fear of dying |
|
|
Guilt
self-esteem fear of dying |
Major psychodynamic themes for individuals with HID-related dementia are issues of
|
|
|
Because the client may not be able to give a complete and accurate hx
|
family or friends should be questioned about any unusual behavior or mental status changes
|
|
|
Changes in the level of activity, in interest in other people or in personality are clues in HIV related dementia to an
|
to an acute central nervous system disturbance
(under psychotherapeutic approaches for HIV- related dementia) |
|
|
In HIV related-dementia Some changes are directly d/t brain dysfunction while others are d/t
|
psychological distress over a systemic problem
e.g. anxiety that the person is dying (under psychotherapeutic approaches for HIV- related dementia) |
|
|
The spectrum of neuropsych and neurological manifestations in HIV related dementia depends on
|
the severity of immunosuppression
|
|
|
In HIV related dementia neuropsychiatric d/o are much more prevalent in
|
late stage illness
|
|
|
Psychiatric d/o in HIV related dementia
|
may preexist or result from HIV
|
|
|
Dementia is primarily a disease of older adults but
|
can occur in children
|
|
|
Dx of dementia based on impaired cognition so dx no applicable until
|
ages 4-6 yrs when cognition can be fully assessed
|
|
|
How old do you have to be to get a dx of dementia
|
4-6yrs when cognition can be fully assessed as dx is based on impaired cognition
|
|
|
Dementia in children usually presents as
|
deterioration in functions such as school performance or delay in normal development
|
|
|
Techniques if pt is poor historian
|
~use collateral persons for info
~seek previous record if available ~ask pt to bring in current medicine bottles ~Ask pt to describe usual methods of taking meds ~ask pt to describe the effect of the meds and what they think they are for |
|
|
Dementia goes on axis ___
but the type goes on axis ___ |
Dementia goes on axis III
but the type goes on axis I |
|
|
DAT diagnostic criteria
|
memory impairment AND
2 or more *aphasia *apraxia *agnosia *executive fxning probs ~sig impairment: decline from previous fxning ~gradual onset & continuing cognitive decline ~Not b/x other CNS condition. Systemic condition or substance induced condition ~S/s do NOT occur exclusively during cours of delirium ~Not accounted for by another Axis I d/o |
