Term
| when does geriatrics start? |
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Definition
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Term
| when is treatment considered to be most effective for pts at risk for dementia? |
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Definition
| when they show mild cognitive impairment |
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Term
| what is mild cognitive impairment? |
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Definition
| the transitional state between the cognitive changes of normal aging and the fully developed features of dementia. characterized by: memory complaint, memory impairment for age/education, preserved general cognitive functioning, intact activities of daily living, and not demented. |
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Term
| what are the 4 main causes of dementia? |
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Definition
| alzheimers, parkinsons, lewy body disease and vascular dementia |
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Term
| a 78 year old generally healthy male presents with his daughter, who is concerned about her father’s recent memory lapses. she became alarmed when he forgot her name last week and notes that he has become sloppy in his appearance and seems “like a different person.” which assessment would you want to obtain? |
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Definition
| mini-mental state exam or the geriatric depression scale |
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Term
| what characterizes dementia due to alzheimers? |
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Definition
| this neurodegenerative process results in cognitive deficits which cause significant decline in social or occupational functioning (dress, toileting, ambulating, feeding) AND represent a substantial decline in previous level of functioning. other causes are not responsible for the deficits - which do not occur exclusively during delirium. |
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Term
| who usually notices dementia before even family members? |
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Definition
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Term
| what characterizes the mini mental status assessment? |
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Definition
| usually the folstein is used. it's a good idea to do the test at regular intervals to establish a baseline. clock drawing is also a good test. |
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Term
| why is early identification important? |
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Definition
| medications to slow the progression are available, there is a therapeutic window of efficacy for tx, and identification allows for anticipatory guidance. |
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Term
| what is important in getting a hx w/a dementia pt? |
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Definition
| the info should be corroborated w/a close contact |
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Term
| what characterizes the diagnostic w/u for dementia? |
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Definition
| CBC, comprehensive metabolic profile, B12, folate, TFTs, VDRL (neurosyphilis), ESR, lyme titer, CT of head, EEG/MRI, and neuropsych testing. additionally: toxins/drugs/heavy metals, ESR, and lumbar puncture if CA/CNS infection suspected. |
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Term
| what imaging study is most sensitive for dementia? |
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Definition
| MRI. will likely show widening of sulci. |
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Term
| what areas of the brain are affected earliest by alzheimer's? |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| what other than cognitive impairment characterizes alzheimer's? |
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Definition
| 1 of: aphasia, apraxia, agnosia, and disturbance in executive functioning. |
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Term
| what are the risk factors for alzheimer's? |
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Definition
| age, fam hx, head trauma, down syndrome, lower educational achievement, and apolipoprotein E gene on chr 9 (alleles: 2,3,4) |
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Term
| what characterizes vascular dementia? |
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Definition
| 2nd leading cause of dementia. predisposing factors: HTN, DM, prior TIAs,and CVA. tx: control underlying disease and antiplatelet therapy. |
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Term
| what are the important components of the physical exam for dementia pts? |
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Definition
| comprehensive neurological exam (lateralizing, frontal release signs [pt should stop blinking when you poke above their eye a few times]), nutritional status, signs of abuse, neglect, CV diseases/risk factors, and hearing/visual loss |
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Term
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Definition
| pts are usually younger and present w/rapidly progressing dementia and myoclonus |
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Term
| what are some reversible/treatable dementias? |
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Definition
| toxin/drug-induced states, endocrinopathies, vitamin deficiencies, systemic/metabolic disorders, CV disorders, hydrocephalus, affective disorders, trauma, neoplastic disorders, and sensory deprivation |
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Term
| what characterizes fronto-temporal dementia? |
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Definition
| behavioral changes are prevalent, language disturbances appear early, visuospatial orientation remains intact until late in the disease process, and single photon emission CT shows hypoperfusion in the frontal/temporal lobes before atrophy. |
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Term
| what characterizes lewy body dementia? |
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Definition
| fluctuating cognitive performance (psychomotor), well-formed visual hallucinations (small animals), prominent/persistent memory impairment occurring later in the disease and *neuroleptic sensitivity. |
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Term
| what characterizes dementia due to a chronic subdural hematoma? |
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Definition
| dementia may be related to a trauma hx in 1/3 of pts. contrast may be necessary for imaging as the density of the lesion may be the same as the normal brain parenchyma. |
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Term
| what characterizes dementia due to chronic traumatic encephalopathy? |
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Definition
| progressive dementing illness in persons subjected to recurrent concussions. |
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Term
| what is the triad for normal pressure hydrocephalus? |
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Definition
| gait apraxia, urinary incontinence, and mental status changes (***wet, wobbly, wild***). |
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Term
| what are the only 2 drugs approved for alzheimers? |
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Definition
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