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Geriatrics Del & Dem
Delerium and Dementia in the elderly
| Question | Answer |
|---|---|
| Impoverished thinking is associated with | Dementia. Delirium manifests more disorganized thinking |
| difficulty finding words (impoverished thinking) is associated with | Dimentia. Delirium is associated with incoherent, hesitant, slow or rapid speech |
| Dementia definition | chronic deterioration of mental function sufficiently severe to interfere wtih daily living. Key features: 1)gradually progressing coursre (usually months to years) 2) No disorder of alertness |
| Risk Factors for dementia | age, fam hx, genetic mutations (alzheimer's), head trauma, hormone replacement therapy, CVD risk factors (vascular dementia), Low education levels |
| Protective factors against dementia | lesiure activities, aerobic and strength training, educational attainment, reducing CVD risk factors, head trauma protection |
| Potentially reversible or arrestable conditions associated with dementia (very unlikely to be reversible!) | Hypothyroidism, Vitamin B12 Deficiency,Neurosyphyllis,Subdural Hematoma,Vascular diseases (Multi-infarct ,Binswanger’s),Space-occupying lesions,Normal pressure hydrocephalusDepression (“pseudodementia” or depressive pseudodementia) |
| Progressive degenerative diseases causing dementia | Alzheimer’s DiseaseDementia of the Lewy Body TypeParkinson’s Disease DementiaFrontotemporal Dementia (Pick’s Disease)Huntington’s DiseaseCreutzfeldt-Jakob DiseaseAIDS Dementia |
| No. 1 degenerative disease causing dementia | Alzheimers |
| 25% of parkinson's patients will develop | dementia |
| Reversible Causes of Dementia Pneumonic | Drugs, Emotional disorders, Metabolic or endocrine disorders, Eye and ear dysfunctions, environmental, Nutritional deficiencies, Tumor and trauma, Infections, Atherosclerotic complications and alcohol |
| Drugs to be on the look out for with elderly and may be a reversible cause of dementia | Anticholinergics |
| Nutritional deficiencies that may be reversible causes of dementia | Vit B12, Folate |
| Symptoms tend to progress rapidly in: dementia or pseudodementia? | Pseudodementia and patient is very aware and bothered by the cognitive loss. |
| Near miss answers are uncommon in | depressed people (won't likely try). |
| Primary degenerative dementia (PDD) | another name for alzheimer's dz |
| CT and MRI in alzheimer's | not diagnostic |
| Brain biopsy in Alzheimer's shows | neurofibrillary tangles and neurtic plaques |
| Diagnosing Alzheimer's | this is a clinical diagnosis, and a diagnosis of exclusion. Multiple cognitive deficits manifested by memory impairment and at least 1 of the following: aphasia, apraxia, agnosia, disturbances in executive fxn. Impairment in social or occupational fxn |
| Alzheimer facts | generally presents in the 7th-8th decade, mean survival is 8-10 years |
| Mild Alzheimers | sx subtle and often undetected, decline of short-term memory |
| Moderate Alzheimers | Language abilities and ability to think abstractly and exercise judgement impairedDecline of visual and spatial skills |
| Severe Alzheimers | loss of long term memory, problem sleeping, weak unable to walk or talk, incontinent, completely dependent on the caregiver |
| Vascular dementia facts | M>F, >60, Stepwise time course of deficits, hx of htn, tia, stroke, focal neuro sx are common |
| Primary Degenerative Dementia Facts | F>M, >75, gradually progressive time course of deficits, hx of htn, stroke, tia, focal neuro sx are less common |
| Gait disturbance, incontinence and dementia is a triad seen in | normal pressure hydrocephalus |
| Main cause of Amnestic Syndromes | Thiamine deficiency, trauma or anoxia |
| Benign senescent forgetfulness | not really a dementia. person remembers what they forgot later. |
| Hx for the dementia patient | list drugs, cv and neuro hx, characterize sx (nature of the deficit, onset and RATE or progression, associated psych sx: depression, anxiety, agitation, paranoia, psychotic features), assess social situation, wandering, incontinence, endangering behavior |
| Assessing the social situation of the dementia patient | living arrangements, social supports, basic and instrumental ADLs |
| PE of the dementia patient | BP, CV exam, Neurologic, mental status exam: formal assessment is important, evaluate: memory, orienatation, intellectual fxn, judgment, affect, Folstein MMSE, clock drawing, fact test |
| Diagnostic studies in dementia pt | Blood studies: cbc, chem7, cal + phos, LFTs, Thyroid fxn, Vit B12 & folate, RPR (for latent syphilis) , ?ESR, ?HIV. Radiologic: CT or MRI, Other studies: neurophysiological testing |
| FACT test | Fruits, animals, colors and towns. Pt should be able to name at least 10 of each. |
| ___ is a test for latent syphillis | Rapid plasma reagin (RPR) |
| Drug therapy for dementia | cholinesterase inhibitors (for mild to moderate: slows down decline by months, not a dramatic difference that can be seen immediately), NMDA antagonist (moderate to severe) |
| Delirium and prevention | Delirium is often preventable. Dementia is only rarely preventable. |
Created by:
ltm12