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42 Cards in this Set
- Front
- Back
DSM Criteria for Delirium
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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 |
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DSM Criteria for Dementia
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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 |
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Aphasia
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language disturbance
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Apraxia
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impaired ability to carry out motor activities despite intact motor function
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Agnosia
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failure to recognize or identify objects despite intact sensory function
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Executive functioning
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planning, organizing, sequencing, abstracting
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Four cardinal features of Delirium
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1. Acute onset and fluctuating course
2. Inattention 3. Disorganized thinking 4. Disturbance of consciousness |
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Sundown Syndrome
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symptoms and problem behaviors become more pronounced in the evening, may occur in both delirium and dementia
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Dementia
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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
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may misjudge date (days-months)
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Moderate dementia
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May misjudge city, state, time
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Severe dementia
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Disoriented x3
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Characteristics of Dementia (the 5 A's)
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*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 |
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Confabulation
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filling in gaps with false, but plausable info
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Perseveration
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repeating the same detail over and over again
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How long does the usual course of DAT last?
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9-10
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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 |
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Leading cause of death in DAT
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pneumonia
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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)
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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 |
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Stages of Alzheimer's Disease
Stage 1 |
-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 |
-Moderate
-Confusion -Individual requires cuing and prompting as symptoms cont to intensify and interefere with ADLs -Lasts 2-5 yr |
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Stages of Alzheimer's Disease
Stage 3 |
-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 |
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Stages of Alzheimer's Disease
Stage 4 |
-Late
-End Stage -Unable to communicate, no recognition of self/others, totally dependent on caregivers |
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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 |
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First line tx for Alzheimer's
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Acetlycholinesterase inhibitors
Tacrine (Cognex) Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) |
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Action of Cholinesterase Inhibitors
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Prevent the breakdown of acetylcholamine and thereby increase its availability at cholinergic synapses
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Indications for Cholinesterase Inhibitors
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Modestly improves cognition, behavior, function. Slows disease progression.
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Side effects of Cholinesterase Inhibitors
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N/V, diarrhea, insomnia, fatigue, muscle cramps, incontinence, bradycardia, and syncope
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Why is tacrine (Cognex) no longer used extensively?
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hepatotoxic
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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
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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
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Drug of choice for AD
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Donepezil (Aricept) because its once per day dosing and fewer side effects
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Rivastigmine (Exelon) should always be taken with ___ to reduce ______ side effects.
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Food, gastrointestinal
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Atypical antipsychotics used in AD
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Risperdal, Zyprexa, Seroquel, Anxiolytics, Benzodiazepines
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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
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