Cognitive Impairment Disorders In The Older Adult

Front 1

DSM Criteria for Delirium

Back 1

A. Disturbance of consciousness
B.A change in cognition or dev. of a perceptual disturbance that is not better accounted for by a preexisting, est., or evolving dementia
C. Dev. over a short period of time and fluctuates during day
Due to: GMC, subs-induced, mult. etiologies, or not known

Front 2

DSM Criteria for Dementia

Back 2

A. The dev. of mult. cog. deficits manifested by both:
1. Memory impairment
2. One (or more) of the following cog. disturbances: Aphasia, Apraxia, Agnosia, dist. in executive functioning
B. The cog. def. in A1 and A2 each cause sig impairment in social/occup function and rep a sig decline from a prev level of function

Front 3

Aphasia

Back 3

language disturbance

Front 4

Apraxia

Back 4

impaired ability to carry out motor activities despite intact motor function

Front 5

Agnosia

Back 5

failure to recognize or identify objects despite intact sensory function

Front 6

Executive functioning

Back 6

planning, organizing, sequencing, abstracting

Front 7

Four cardinal features of Delirium

Back 7

1. Acute onset and fluctuating course
2. Inattention
3. Disorganized thinking
4. Disturbance of consciousness

Front 8

Sundown Syndrome

Back 8

symptoms and problem behaviors become more pronounced in the evening, may occur in both delirium and dementia

Front 9

Dementia

Back 9

syndrome of brain dysfunction characterized by gradual, progressive, chronic deterioration of cognitive functioning and global impairment of intellect with NO CHANGE in consciousness

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Minimal dementia

Back 10

may misjudge date (days-months)

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Moderate dementia

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May misjudge city, state, time

Front 12

Severe dementia

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Disoriented x3

Front 13

Characteristics of Dementia (the 5 A's)

Back 13

*Amnesia (must have mem loss)
*Apraxia (trouble doing things despite intact motor system)
*Agnosia (trouble recognizing things objects, body, reflec. of self)
*Aphasia (expressive/receptive)
*Abstraction problems

Front 14

Confabulation

Back 14

filling in gaps with false, but plausable info

Front 15

Perseveration

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repeating the same detail over and over again

Front 16

How long does the usual course of DAT last?

Back 16

9-10

Front 17

First 3 years of DAT

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memory loss and personality changes

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Second 3 years of DAT

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Cortical signs
-Aphasia
-Apraxia
-Agnosia
-Impaired executive function

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Final 3-4 years of DAT

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Physical decline
-Bowel/bladder incontinence
-Gait disturbances
-Muteness
-Dysphagia

Front 20

Leading cause of death in DAT

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pneumonia

Front 21

Primary dementia

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irreversible, progressive, and not secondary to any disorder (ex: Alzheimer's and vascular dementias)

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Secondary dementia

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occurs as a result of some other pathological process. (ex: AIDS-related dementia, Korsakoff's syndrome)

Front 23

Diagnostic Tests for dementia/AD

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-Brain Imaging (CT, PET) to reveal brain atrophy and rule out other conditions
-MMSE and other tests to ID deterioration in mental status and brain damage
-Physical/neuro exam
-Complete medical/psych hx
-Review of meds
-Nutritional Eval

Front 24

Stages of Alzheimer's Disease
Stage 1

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-Mild
-Forgetfulness
-Individual attempts to compensate for memory deficits and difficulty with word recall
-May last as long as 2 yr

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Stages of Alzheimer's Disease
Stage 2

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-Moderate
-Confusion
-Individual requires cuing and prompting as symptoms cont to intensify and interefere with ADLs
-Lasts 2-5 yr

Front 26

Stages of Alzheimer's Disease
Stage 3

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-Moderate to Severe
-Ambulatory Dementia
-Unable to identify familiar obj/people
-Expressive/receptive language is quite limited and gross motor skills are impaired
-Length varies from 2-5 yr

Front 27

Stages of Alzheimer's Disease
Stage 4

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-Late
-End Stage
-Unable to communicate, no recognition of self/others, totally dependent on caregivers

Front 28

Diagnosis of DAT

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-by clinical examination
-At least 2 deficits on MMSE (one must be memory impairment)
-Medical Causes Ruled Out
-H&P and Neuro Exam within norm limits

Front 29

First line tx for Alzheimer's

Back 29

Acetlycholinesterase inhibitors
Tacrine (Cognex)
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

Front 30

Action of Cholinesterase Inhibitors

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Prevent the breakdown of acetylcholamine and thereby increase its availability at cholinergic synapses

Front 31

Indications for Cholinesterase Inhibitors

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Modestly improves cognition, behavior, function. Slows disease progression.

Front 32

Side effects of Cholinesterase Inhibitors

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N/V, diarrhea, insomnia, fatigue, muscle cramps, incontinence, bradycardia, and syncope

Front 33

Why is tacrine (Cognex) no longer used extensively?

Back 33

hepatotoxic

Front 34

NMDA Antagonist used for Alzheimer's

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Memantine (Namenda)

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Action of Memantine

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Normalizes levels of glutamate, which in excessive quantities contributes to neurodegeneration

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Indications for Memantine

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Tx of mod to severe Alzheimer's disease. No evidence that it modifies underlying disease

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Side effects of Memantine

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Dizziness, agitation, HA, constipation, and confusion

Front 38

Warnings for memantine

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Clearance is reduced with renal impairment. Use cautiously with moderate renal impairment. Do not use with severe renal impairment

Front 39

Drug of choice for AD

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Donepezil (Aricept) because its once per day dosing and fewer side effects

Front 40

Rivastigmine (Exelon) should always be taken with ___ to reduce ______ side effects.

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Food, gastrointestinal

Front 41

Atypical antipsychotics used in AD

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Risperdal, Zyprexa, Seroquel, Anxiolytics, Benzodiazepines

Front 42

Indications for atypical antipsychotics in AD

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Used with extreme caution for paranoid thinking, hallucinations, and agitation. Questionable efficacy in clinical trials