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Delirium & Dementia
Delirium & Dementia
48
Psychology
Graduate
11/29/2012

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Cards

Term
What does Cognition refer to?
Definition
Refers to mental process such as comprehension, judgment, memory, language and reasoning
Term
When is Cognitive Impairment Disorder (CID) diagnosed?
Definition
When there is a clinically significant deficit in cognition and a change in a person's previous level of function.
Term
Is cognitive impairment reversible?
Definition
Can be irreversible or fully reversible.  Depending on the cause.
Term
What are the 3 types of cognitive impairment disorders?
Definition
Dementia, Delirium, Amnestic Disorders
Term
What is the first step of assessing for CID?
Definition
History & Physical to provide baseline data.  
Term
What diagnostic Testing tool is used for assessing CID?
Definition
Mini-mental status exam (MMSE)
Term
What is important to rule out for CID?  What tool is used for that?
Definition
Important to rule out depression as patients are in the early stages of dementia sometimes present with symptoms similar to depression.  Tool used is Geriatric Depression Scale.
Term
What else is important when assessing for CID?
Definition
Interview pt, caregiviver, family.  Spend time w.  caregiver or family.
Term
What are the 6 subcategories of DSM-IV Classification of Dementia?
Definition
Dementia of Alzheimer's Type, Vascular Dementia, Dementia due to Other General Medical Conditions, Substance-induced persisting Dementia, Dementia due to Multiple Etiologies, Dementia Not otherwise specified.  
Term
What is Dementia of Alzheimer's Type?
Definition
Usually occurs in persons over 65.  Manifests progressive intellectual disorientations of dementia, delusions, or depression
Term
What is Vascular Dementia?  Also known as?
Definition
Caused by vessel thrombosis or hemorrhage. Also known as multi-infarct dementia. 
Term
What id dementia due to other general medical conditions?
Definition
HIV infections, traumatic brain injury, Parkinson's, Huntington's, Pick's, Greutzfeldt-Jakob, normal-pressure hydrocephalus, hypothyroidism, brain tumor, vitamin B-12 deficiency.
Term
What are 2 subtypes of Alzheimer's Dementia?
Definition
Early Onset prior to 65.  Late Onset after 65
Term
What is the Etiology of Alzheimer's Dementia?
Definition
Exact cause unknown.  Factors include beta-amyloid plaques, neurofibrillary tangles, cell death, reduction in neurotrasmitters, genetic factors.
Term
What are Beta-amyloid Plaques?
Definition
Accumulation of beta-amyloid forms plaques
Term
What are Neurofibrillary Tangles?
Definition
Disrupt normal intracellular transport and result in cell death
Term
What is the Neurotransmitter Theory?
Definition
Decrease in neurotransmission of acetylcholine; dopamine, norepinephrine, serotonin
Term
What are Genetic Factors for Alzheimer's?
Definition
Chromosomes 1, 14, 21
Term
Oxidative Stress, Free Radicals and Mitochondrial Dysfunction
Definition
Mitochondrial damage-->Increase in free radicals-->Oxidative Stress
Term
Inflammation for Alzheimer's?
Definition
Inflammation in brain is early hallmark
Term
What is the main difference between Vascular Dementia and Alzheimer's dementia?
Definition
More abrupt onset.  
Term
What is the primary age of patients with Vascular Dementia?
Definition
60-75
Term
What are the causes of Vascular Dementia?
Definition
Series of small strokes, or transient ischemic attacks.  Other factors include advanced age, diabetes, heart disease, high cholesterol, hypertension, TIA's , cerebral emboli, thrombosis
Term
What are the Symptoms of Dementia?
Definition
Memory loss, disorientation of time and place, Apraxia, Agnosia, Confabulation, Sundown Syndrome, Catastrophic Reaction, Perseveration Phenomenon, Hyperorality, Psychosis
Term
What is Aphasia?  Expressive? Receptive? Global?
Definition
Alterations or loss of language ability.  Expressive (speaking or writing), Receptive (understanding), global (usually more severe)
Term
Define Apraxia.  How do we test this?
Definition
Impaired ability to carry out motor activities.  MMSE we write a command on a piece of paper, have the pt read it and then do what it says
Term
Define Agnosia.  How do we test this?
Definition
When the pt is unable to name common objects.  MMSE hold up a watch and a pen or pencil and ask the pt to name them
Term
Define Confabulation
Definition
When a pt (unconciously) fills memory gaps with detailed fantasy that he or she believes is true but actually has no basis in fact.
Term
What is Sundown Syndrome?
Definition
Describe nighttime disorientation.  Characterized by drowsiness, confusion, ataxia, and accidental falls
Term
What is Catastrophic Reaction?
Definition
Agitation that occurs secondary to the awareness of one's intellectual deficits under stressful circumstances.  Can show verbal or physical aggression
Term
What is Perseveration Phenomenon?
Definition
Repetitive behaviors such as lip licking, finger tapping, pacing or echolalia
Term
What is Hyperorality?
Definition
Pt has ned to taste and chew objects that are small enough to be put into his or her mouth
Term
Describe psychosis for Alzheimer's dementia
Definition
Early stages they are hyper alert to compensate for cognitive loss.  They are more suspicious.  Later stages of AD, psychosis in form of hallucinations or delusions.  
Term
What are the 4 main medications given for Dementia?
Definition
Cholinesterase Inhibitors, NMDA Blocker, Antipschotics, Antidepressants, Benzodiazepines
Term
How do Cholinesterase Inhibitors work?  Popular drugs used?  
Definition
Increase levels of acetylcholine, the neurotransmitter involved in memory, judgment and other thought process.  Aricept, Exelon, Razadyne, Cognex
Term
What do NMD Aspartic BLockers do?  which is a popular drug?
Definition
Restore neuron function.  Namenda (memantine).
Term
What other drugs are used to treat Dementia?
Definition
Antipsychotics. Antidepressants.  And SSRIs may helpwith insomnia or reduced appetite?  Benzodiazepines could be used to treat anxiety.  Benzos may also caus paradoxical effect and increase anxiety.  
Term
What are Nursing Interventions for Dementia?
Definition
Protect pt from injury, danger, monitor food and fluid intake, regular exercise, regular medical visits, speak in calm manner, minimize confusion, outdoor activities, increase social interaction, support and educate caregivers
Term
What is Delirium?
Definition
An acute disorder characterized by short term confusion, disorientation and changes in cognition
Term
What are the 3 criterias for Delirium in DSM-IV language?
Definition
A) disturbance of consciousness with reduced ability to focus, sustain or shift attention B) a change in cognition (memory deficit, disorientation, language disturbance) or development of perceptual disturbance.  C) Develops over a short period of time.
Term
What are the classifications of Delirium?
Definition
Delirium Due to general medical conditions, substance-induced Delirium, Substance Withdrawal Delirium, Delirium due to multiple Etiologies, Delirium not otherwise specified
Term
What are the causes of Delirium?
Definition
Acute or Chronic Illness, Hormonal or Nutritional Factors, Sensory Impairments, Medication.
Term
What is the hallmark of delirium?
Definition
Impaired conciousness.  Impairment of cognitive functioning that develop rapidly over a short period of time.  
Term
What are some psychomotor impairments associated with delirium?
Definition
tremor or problems with coordination
Term
What are the attention and wakefulness disturbances associated with delirium?
Definition
Difficulty with alertness and direction of focus.  Have reduced daytime wakefulness and nightime restlessness/sleeplessness.
Term
What is associated with Management of Delirium?
Definition
ID, treat underlying cause, supportive physiologic care, promote safety, acute hospital-based care
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