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57 Cards in this Set
- Front
- Back
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What is cognition?
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Mental processes such as comprehension, judgement, memory, language and reasoning.
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When is cognitive impairment disorder diagnosed?
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When there is a clinically significant deficit in cognition and a change in a person's previous level of function
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Cognitive impairment is what kind of symptom of CIDs?
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cardinal!! Classical
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When do cognitive disorders often occur?
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Later in life, but can occur at any time
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T/F cognitive disorders can be reversible?
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True. While others are not
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What is the standard tool to assess cognitive function?
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Mini-mental status exam
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What can a HCP provider do to successfully track subtle cognitive deficits, fluctuating symptoms and progressing disease?
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A full and detailed patient history and physical exam
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What mental disorder is encouraged to be ruled out before a true diagnosis of CID can be made?
What test is used? |
Depression
-Can use the Geriatric Depression Scale |
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What are the 6 types of dementia classified under the DSM>?
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1. Alzehimers Type
2. Vascular Dementia 3. Dementia due to other general medical conditions 4. Substance-induced persisting dementia 5. Dementia due to multiple etiologies 6. Dementia NOS |
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What types of general medical conditions can cause dementia?
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HIV, traumatic brain injury, Parkinson's, Huntington's, Pick's, Creutzfedt-Jakob, normal pressure hydrocephalus,
hypothyroidism, brain tumor, B12 deficiency |
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What are the 2 types of Alzheimer's and how are they distinguished?
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1. Early onset: before age 65
2. Late onset: after age 65 |
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How many stages are present in the progression of alzheimers? who was the creator of these stages?
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Seven
-Barry Reisberg MD |
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What are the biological theories related to the cause of Alzheimer's?
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1. Beta amyloid plaques in cells
2. Neurofibrillary tangles 3. Decrease in NTs of Ach, dopamine, norepi and serotonin |
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Which chromosomes are thought to be connected to Alzheimer's?
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1, 14, 21
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What is the link between mitochondrial damage and alzheimers?
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Mitochondrial damage > increase free radicals > oxidative stress
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What is an early hallmark sign of alzheimer's?
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Short term memory loss and brain Inflammation
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What % of dementia is caused by vascular event?
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20%
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What is the time of onset of vascular dementia?
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More abrupt than alzheimer's and primarily in patients ages 60-75
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What is the cause of vascular dementia?
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Small focal deficits which are typically caused by a series of small strokes (ministrokes) or TIA's
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What are the Contributing factors to vascular dementia?
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1. Advanced age
2. diabetes 3. heart disease 4. high cholesterol 5. HTN 6. TIAs 7. Cerebral emboli or thrombosis |
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What are the major symptoms of dementia?
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1. Memory Loss
2. Disorientation 3. decreased ability to concentrate or learn new material 4. difficulty making decisions 5. Poor judgement |
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What are the 3 "A" symptoms of dementia?
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1. aphasia
2. Apraxia 3. Agnosia |
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What is aphasia? What are the 3 types?
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loss of language ability
-Form of impoverished speech or difficulty finding words -Expressive, receptive and global |
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Define Apraxia.
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an impaired ability to carry out motor activities despite intact sensory function.
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How do we test for apraxia?
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During the MMSE, write a command on a piece of paper, have the pt read it ant then do what it says
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What is agnosia?
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when the pit is unable to name common objects.
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How do you test for agnosia?
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In the MMSE, hold up a watch or pen and ask the patient to name them
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What is confabulation?
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Is when a pt (unconsciously) fills in memory gaps with detailed fantasy that he or she believes is true but actually has no basis in fact.
-An unconscious way of compensating for memory loss |
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What is sundown syndrome?
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Is the term used to describe nighttime disorientation. It's characterized by drowsiness, confusion, ataxia and accidental falls
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What is a catastrophic reaction in dementia?
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Agitation that occurs secondary to the awareness of one's intellectual deficits under stressful circumstances.
-this is basically when the pt overreacts to relatively minor stress and this is common in pts with dementia. |
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Describe the dementia symptom of Perserveration Phenomenon.
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characterized by repetitive behaviors such as lip licking, finger tapping, pacing or echolalia
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What is hyperorality in dementia patients?
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when the pt has a need to taste and chew objects that are small enough to be put in his or her mouth.
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T/F psychosis is present in many pts with dementia?
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True.
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WHat type of delusions or hallucinations are seen in late stages of alzheimers?
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Mostly paranoid or persecutory
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What are the psychotic symptoms of dementia patients often associated with?
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Physical aggression and violence.
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What classes of medications are used to treat dementia?
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1. Cholinesterase Inhibitors
2. NMDA blocker 3. Antipsychotics 4. Antidepressants 5. Benzos |
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What are the drugs classified as Cholinesterase Inhibitors?
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Aricept (donepizil)
Exelon (rivastigmine) Razadyne (galantamine) Cognex (tacrine) |
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What is the name of the drug classified as a NMDA blocker?
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Namenda (memantine)
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What have the used of NMDA blockers been shown to do for dementia patients?
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improve cognition by restoring neuron function
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What is the most important nursing intervention for dementia patients?
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Safety.
-remove hazardous items -protect form potential obstacles -Dont let them wander from the unit |
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How often should dementia patients see their HCP?
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every 3-6 months
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How should the HCP speak to a patient with dementia?
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Calm manner using a soft, low pitched voice; stating the explainations simply and completely.
Add orientating details to each conversation |
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What should dementia patients be encouraged to do daily?
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Exercise, outdoor activities, increase social interaction
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What is delirium?
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Acute disorder characterized by short term confusion, disorientation and changes in cognition
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What is the DSM language for delirium?
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A. Disturbance of consciousness iwth reduced ability to focus, sustain or shift attention
B. a change in cognition (memory deficit, disorientation, language disturbance) or development of perceptual disturbance C. This develops over a short period of time |
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List the subcategories of delirium.
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1. Delirium due to...(medical condition)
2. Substance-induced delirium 3. Substance withdrawal delirium 4. Delirium due to multiple etiologies 5. Delirium NOS |
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Since delirium is classified as a group of signs and symptoms that cluster together, the proper term for delirium is a _____ rather than a disease.
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syndrome
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What are the causes of delirium?
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1. Acute or chronic illness
2. Hormonal or Nutritional factors 3. Sensory Impairments 4. Medication |
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What are examples of acute or chronic illnesses that can cause delirium?
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CHF, pneumonia, renal and liver disease
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List some examples of hormonal or nutritional factors that can cause delirium.
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-Diabetes
-Adrenal or thyroid imbalance -malnutrition -dehydration |
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What type of sensory impairments commonly cause delirium?
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-Vision or hearing loss
-sleep deprivation -Black patch delirium: elderly people who wear a patch for cataracts |
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What is the hallmark symptom of delirium?
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Impaired consciousness, usually seen in combination with global impairments of cognitive functioning.
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What type of psychomotor behaviors are common with delirium?
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Tremor or problems with coordination
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What happens to the sleep/wake cycle of patients with delirium?
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They have reduced with daytime wakefulness and nighttime restlessness/sleepiness.
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What is the activity level like for patients with delirium?
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They can be hypo or hyperactive or they can alternate between the 2
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What is the focus of management of delirium?
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identifying and treating the underlying cause.
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What can occur if the underlying cause of delirium is not treated quickly?
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Irreversible neurological damage can occur
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