Dementia/Delirium

What is normal aging

mild changes in memory and rate of information processing

defecits are generally not very progressive and usually do not affect daily functioning

learning or acquisition performance declined uniformly with increasing age

delayed recall or forgetting remained relatively stable with aging

What is the definition of dementia

disorder characterized by impairment of memory and at least one other cognitive domain (language, visual spatial connection, executive function)

decline and interference with daily function and independence (different from previous level)

What are challenges associated with dementia

retaining information, handling complex tasks, reasoning, spatial ability and orientation, language, behavior

how do you evaluate for dementia

cognitive test, mental status exam, depression, physical examination, lab tests (b12, hypothyroidism, neurosyphilis, HIV)

What are causes of dementia

alzheimers disease, dementia with lewy bodies, frontotemporal dementia, parkinson disease dementia, less common neurogenerative disorders(huntington disease), non-neurodegenerative dementia(vascular dementia)

what is the physiology of alzheimer’s disease

accumulation of beta amyloid plaques in the brain, neurofibrillary tangles distributed throughout the brain which degenerates neurons and synpases leading to atrophy of the cerebral cortex - over time loss of mass of brain (some areas destroyed

symptoms of alzheimers disease

memory impairment, declarative episodic memory

what is dementia with lewy bodies

produces a gradual, progressive decline in cognitive abilities with motor parkinsonism

symptoms associated with dementia with lewy bodies

rapid eye movement sleep behavior disorder, visual hallucinations, fluctuations in level of alertness, prominent visuospatial dysfunction, manifests parkinsonism and cognitive decline contemporaneously

what is frontotemporal dementia

damage to frontal and temporal lobes of the brain

symptoms of frontotemporal dementia

unusual behaviors, emotional problems, communication difficulties, difficulty walking (occurs at younger age)

Most common manifestations of parkinsons and when does the dementia begin

visual hallucinations and delusions

dementia emerges 5-8 years after the onset of the movement disorder

What characterizes huntington disease

choreiform movements (one side of the body jerking/twitching), psychiatric problems, dementia

what is huntington disease caused by

trinucleotide repeat in the huntington gene and inherited in an autosomal dominant pattern

What is vascular dementia caused by

CV issue or impaired cerebral blood flow

risk factors for dementia and cognitive decline

midlife hypertension, midlife obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, social isolation, low educational attainment

What is stage 1 of global deterioration scale for assessment of primary degenerative dementia

no cognitive decline, normal function, no memory loss

What stage lasts two years and there is moderate cognitive decline, cannot travel alone, withdrawing from friends/family and can detect cognitive problems

stage 4

What is the difference between stage 2 and 3 of global deterioration scale for assessment of primary degenerative dementia

• Stage 2 - very mild, forgets names, misplaces familiar objects, symptoms not evident to loved ones or doctors 

• Stage 3 - mild cognitive decline, increased forgetfulness, slight difficulty concentrating, decreased work performance, gets lost more frequently, difficulty finding the right words, loved ones begin to notice (2-7 yrs)

what stage are you only able to carry out ADLs with help and difficulty counting down from 10

stage 6

What are characteristics of stage 7

cannot speak or communicate, requires help with most activities, loss of motor skills, cannot walk

What are dietary supplements that can help with dementia

gingko biloba - helps with circulation

vitamin B/coconut oil/fish oil

what diet is recommended for dementia

Mediterranean - helps provide protective nutrients to the brain

What are the primary medications used to treat dementia

cholinesterase inhibitors, atypical antipsychotics and mood stabilizers, antidepressants and anxiolytics

what is the definition of delirium

a clinical syndrome caused by a medical condition, substance intoxication or withdrawal or medication side effect characterized by a disturbance of consciousness with reduced ability to focus, sustain, or shift attention

What is the presentation for someone with delirium

loss of mental clarity, distractibility, appear drowsy/lethargic/comatose, memory loss, disorientation, hallucinations, language difficulties

what are examples of medical causes of delirium

fluid/electrolyte disturbances, infections, drug/alcohol toxicity, metabolic disorder, low perfusion, postoperative, withdrawal

What are common substances/medications that could cause delirium in withdrawal

alcohol

barbiturates, benzodiazepines, SSRIs, sedative hypnotics

what are examples of infectious causes of hypnotics

sepsis, encephalitis, meningitis, syphilis, CNS abscess

What are examples of metabolic causes of delirium

acidosis, electrolyte disturbances, hepatic/renal failure, hypoglycemia, hypercalcemia

What deficiencies can cause delirium

vitamin B12, hypovitaminosis, niacin, thiamine

What are toxins/drugs that can cause delirium

street drugs, alcohols, pesticides, industrial poisons, carbon monoxide, cyanide, solvents

what is alcohol withdrawal delirium

rapid-onset of fluctuating disturbance in attention and cognition, sometimes with hallucinations in the presence of alcohol withdrawal

When does withdrawal delirium begin

between 72 and 96 hours after the patients last drink

What are severe symptoms of alcohol withdrawal delirium

agitation, autonomic hyperactivity, fever, tachycardia, hypertension, drenching sweats - seizures and delirium tremens can be life- threatening

delirium vs dementia

delirium - onset is rapid, ability to focus is impaired symptoms can come and go

dementia - onset of minor symptoms that progress over years, remains alert in early stages, memory/thinking stay at constant level

What factors increase baseline vulnerability for dementia

underlying brain disorders, advanced age, sensory impairment

What are factors that precipitate disturbances

polypharmacy, infection, dehydration, immobility, malnutrition, use of bladder catheters

What are drugs that precipitate delirium

anticholinergics, benzodiazepines, narcotics in high doses

What are nursing interventions for delirium

use of visual and hearing aids, monitor meds(especially benzodiazepines), avoid and treat medical complications, manage pain