Cognitive and Behavioral Disorders in the Geriatrics
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| Is Dementia part of the normal aging process? | * no
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| Diagnostic criteria of Dementia ? | *Impairment of Memory and one of the following severe enough to interfere with daily functioning:
-Aphasia
-Apraxia
-Agnosia
-Impaired executive function
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| Alzheimer’s Disease patho ? | * Extracellular deposition of amyloid-beta protein producing neuritic plaques
----*Development of neurofibrillary tangles----* narrow gyri and widened sulci
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| At least two physiological impairments may contribute to AD ? | * reduced cerebral production of acetylcholine transferase....* Excessive NMDA receptor stimulation
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| Alzheimer’s Treatment ? | *Cholinesterase Inhibitors - to keep ACh ....* NMDA Receptor Antagonists...* Vit. E
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| Alzheimer’s Disease-Diagnosis ? | * no confirmatory test besides brain biopsy after death.... * DSM-IV Diagnostic Criteria:
-Impairment of recent memory
-Gradual onset and continued decline of cognitive ability
..At least one of the following:
-Aphasia
-Apraxia
-Agnosia
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| Best test for Alz ? | * Slums test...not mmse
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| Dementia with Lewy Bodies (DLB)Dx Criteria ? | * you see Lewy Bodies.... * Dx = Dementia criteria, Plus At least two of the following three clinical features:
-Cognitive fluctuations
-Visual hallucinations
-Parkinsonism (Dementia preceding motor symptoms)
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| Good Dx tool ? | * mini mental cog status test...tests cognitive issues, not memory
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| DLB Tmt ? | *Nonpharmacological therapy is first choice...* cholinesterase inhibitors , atypical psychotics, and levodopa
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| Vascular Dementia how to Dx ? | * imaging (CT/MRI)...* vascular issues
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| Vascular Dementia Tmt ? | * control vascular risk factors
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| Parkinson’s Disease with Dementia (PDD)criteria ? | * criteria states that with PDD, the motor symptoms occur at least 1 year prior to the cognitive symptoms
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| Tmt of PDD ? | * cholinesterase inhibitors
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| Frontotemporal Dementia basics ? | * Characterized by focal atrophy of the frontal and temporal lobes.......* Progresses more rapidly than AD, onset to death is 8.7 years versus 11.8 years in AD
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| Reversible Dementia (Delirium) basics ? | * meds induced, alcohol, metabolic disorders, depression, etc.
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| Top Diagnosis tool? | * history
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| Mini Mental Status Exam scores ? | * 26-30 is normal
....20-25 mild deficit
....10-19 moderate deficit
....<10 severe deficit
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| Depression masquerading as Dementia ? | * History of becoming lost and disoriented, w/ a history of depressed mood.......So ask if they are ever depressed or feel sad.....* antidepressive drugs have been shown to bring them out of depression, which brings them out of their dementia state
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