VCU DPT - Lifespan 2 (Dementia, Delirium, Depression)

some age expected related cognitive changes:

a) _____ effort to encode info from short term memory

b) _____ processing time

c) ________ memory retrieval

d)) ______ cognitive flexibility

e) __________ selective/divided attention

a) more

b) longer

c) slower

d) less

e) less

what is selective attention?

divided attention?

being able to focus on something other than stimuli present

doing different things at once

we expect:

ability to learn is ______________

retained

barring pathology, you should be able to _____ as you get older

learn

as you get older, how does short term memory change

it is worse

so you need to practice more and more

the capacity to learn remains _________ as age

intact

modifications may be needed to facilitate learning, such as _______ time and _____ distractions

more

less

- avoid doing too much at one time, limit external distractions

_______ is a mental health disorder that impacts how one thinks, feels, acts

depression

- cluster of sx for most days, couple week, impacting self and state

______ is a resersible medical emergency by acute disturbance of consciousness, cognition, or perception

- due to metabolic factors, infections, toxic factors

delirium

___________ is a general term for progressive cognitive impairment resulting in impaired ADLs

dementia

state which of the following fits: delirium, depression, dementia

a) reversible medical emergency that has an acute disturbance of consciousness, cognition, or perception due to metabolic/infectious/toxic factors

b) general term for progressive cognitive impairments, resulting in impaired ADLs

c) mental health disorder impacting how one thinks, feels, acts, percieves world

a) delirium

b) dementia

c) depression

do delirium, dementia, depression have overlapping symptoms?

if so, name some

yes

sleep changes, appetite changes, energy changes, mood disturbances

is it possible to have more than one of dementia, delirium, depression at once

yes

sleep changes, appetite changes, energy changes, mood disturbances are symptoms of:

dementia

delirium

depression

All three!! overlapping sx

difference in dementia vs alzheimer's disease

dementia is umbrella term

alz is specific type of dementia

dementia/major neurocognitive disorder defined as:

- cognitive decline in at least two of WHAT 5 domains

- decline from PLOF

- interferences wth ADL

focus and attention

memory

communication and language

reasoning/judgement

visual perception

cognitive decline in 2 of the following domains

- focus/attention

- memory

- communication and language

- reasoning/judgement

- visual perception

significant decline from PLOF

interfernece with ability to perform everyday activities

DEFINE WHAT

dementia/major neurocognitive disorder

dementia is a ______ term

umbrella

what type of dementia is most prevlant?

alz

define vascular dementia

issue with blood vessels in brain

alz is characterized by ____________, with symtpoms including ________

beta tangles and amyloid plaques

memory, language, visuospatial skills

vascular dementia is characterized by what sx

impaired motor skills and judgement

frontotemporal dementia

- characterized by what

- sx?

frontal and temporal lobe deterioration

persoanlity changes, language issues

lewy body dementia:

characterized by?

symptoms include?

lewy body protein deposits

hallucinations, disordered sleep, impaired thinking

t/f: some dementia types are related to parkinson's, huntington's, HIV

true

affects movement

mild cognitive impairment may/may not progress to ___________

dementia

cognitive decline that exceeds expectedage related change is ________

mild cognitive impairment

is mild cognitive impairment common?

yes fairly, and about half do not report

is hearing loss and depression risk factors for dementia

yes

mini-cog dementia screen is scored 0-5

what do high scores mean, and low

0-2 indicate a high likelihood of cognitive impairment

3-5 is low likelihood of cognitive impairment

mini mental status exam: how to interpret scores

high is normal cognitive function (24-30)

lower is severe impairment (less than 17)

mild cognitive function (18-23)

of the mini-mental state examination, montreal cognitive assessment, and mini-cog

which is strongest

MoCA

most involved

is exercise indicated to help with...

- preventing cognitvie decline?

- adults with MCI?

- adults with mild dementia?

- adults with moderate dementia?

- adults with severe dementia?

YES

is exercise indicated to help with...

- older adults improve gait?

- decreasing fall risk?

- increasing strength?

YES

pharmacology

communication

educaiton/learning

behavior expression

risk management

functional mobility assessment

training and exercise

care partner

these are all considerations for _______ with dementia

PT plan

______ is the most common mental health condition among older adults

depression

depression leads to higher risk of what (3)

dementia diagnosis

falls

decreased functional capacity

loss and grief

caretaking responsibilities

cognitive impairment

poor social support/isolation

alcohol abuse

older than 75

these are _________ for depression

risl factors

social support

volunteering

physical activity

religion, spirituality, meaning making

these are all _________ of depression

protective factors

is the detection rate of depression in PCP high

NO!! less than 50%

- may consider somatic complaints to not be associated, just psychological manifestations

what are some multisystem barrier to depression diagnosis and treatment (5)

somatic symptoms instead of emotional

underreporting/dismissing sx to 'normal aging'

limited knowledge of diagnostic or resources

time and productivity pressures

limited healthcare coverage

what is the geriatric depression scale for

a screening tool used for moderate to severe depression

- would refer in a psych referral; but use judgement too

can medications, impaired motivation, low energy levels, and negative outlook impact PT plan with depression?

YES

depression PT plan of care:

a) may have a ____ course of therapy

b) prefer __(matter of fact/cheerful demeanor)___

c) have a ___ emphasis on building self efficacy

d) may need ___ assistance to establish goals

a) longer

b) matter of fact

c) increased

d) increased

depression PT plan of care:

e) want to ________ emphasis on short term goal

f) persistant ____________

g) be aware of the PT's ___________

e) increase

f) encouragement

g) mental health

_______ is a reversible medical emergency

delirium

what are 2 things that is really important to know about the treatment of delirium

it is prevetable and reversible

t/f: delirium is often the first sign of an acute illness/underlying problem

true

t/f: delirium is more common in pts with dementia

t

symtpoms of delirium (3)

acute change

rapid onset

fluctuations

what are 3 subtypes of delirium

hyperactive, hypoactive, mixed types

what is Confusion Assessent Method (CAM) used for

to evaluate suspected prescen of delirium

the ______ assesses if:

- acute onset of changes

- inattention (required)

- disorganzied thinking or altered LoC

CAM

what does richmond agitation sedation scale used for

to assess state patient is in, with delirium

which is easier with delirium: prevention or treatment

prevention

30-40% of delirum is _______________

preventable

which is more effective for delirum, prevention or treatment

prevention

what is the PINCHME mnemonic

identify causes of delirum

Pain

Infection

Nutrition

Constipation

Hydration

Medication

Environemetn

what are some things to do, orientation and cognitive wise, to help prevent delirium

get adequate sleep

mobilize pt

give vision and hearing aids

can

- stimulating orientation/cogntiion

- avoiding restraints/foley catheters

- avoid high risk meds

help prevent delirim

yes

describe general delirum treatment

mimics prevention!!

cognitive stimulation, avoid restraints, mobilize, adequate sleep, avoid high risk meds, etc

brief low dose of antipsychotic can be helpful for ______active delirum

hyper

_________:

- acute onset

- fluctuating course

- hours to weeks of duration

- alterted/impared consciousnesss and attention

- incr/decr psychomotor changes

- usually reversible

- CAM, RASS are assessment tools

delirium

_________:

- insidious onset

- progressive

- lasts years

- clear consciousness

- attention/psychomotor impact dpeends on type

- irreversible

- MMSE, Mini-cog, MoCa used as assessment tools

dementia

_________:

- acute to insidious onset

- can be chronic

- may last months or years

- clear consciousness

- attention and psychomotor changes may be decreased

- usually is reverisble

- GDS is assessment tool

depression

where should you refer for

- depression, delirium, dementia

PCP

neurologist

psychiatrist

neuropsych