NURS Clinical Science Exam 2 Prep - Dementia

What is dementia?

an ‘umbrella’ term used to describe a collection of symptoms related to cognitive decline

What does dementia include?

cognitive, behavioral and psychological symptoms

What is dementia a result of?

biological changes in the brain

What is the most common cause of dementia?

alzheimer’s

What is very prevalent?

mixed dementia

What makes up 60-80% of dementia?

alzheimer’s

What makes up 10-40% of dementia?

vascular

What makes up 10-25% of dementia?

lewy bodies

What makes up approximately. 10% of dementia?

frontotemporal

What is alzheimer’s?

most common type of dementia

What is not a normal part of aging?

alzheimer’s

What is the result of alzheimer’s?

neurofibriallary tangles and neuritic plaques

What is etiology and genetic risk of alzheimer’s disease?

age, gender, genetics, incidence, prevalence

What is a common age for alzheimer’s disease?

65 and older

What gender is mostly likely to get alzheimr’s?

women

What is history of alzheimer’s disease?

onset, duration, progression, course of symptoms, functional status

What are stages of physical assessment for alzheimer’s disease?

attention, concentration, judgement, perception, learning and memory, communication and language, information processing, behavior, personality, self-maangement changes

What are laboratory and imaging assessments for alzheimer’s disease?

PET imaging, MRI, CT, genetic testing

What is structural damage in the brain for alzheimer’s disease?

amyloid plaques and neurofibrillary tangles

What is the second most common degenerative disease of CNS?

alzheimer’s disease

What are characteristics of alzheimer’s disease?

memory loss, confusion, dementia, inability yto think or communicate effectively, affects memory, cognitive function, and behavior, inflammation

How many people are affected by dementia?

50% of the population over 85

What do structural changes in the brain result in?

cause loss in number and function of neurons

What do symptoms of alzheimer’s disease result from?

progressive damage to neurons in hippocampus

What is the hippocampus?

learning and memory

What part of the brain is most affected during alzheimer’s?

hippocampus

What does the hippocampus require?

acetylcholine as neurotransmitter

What occurs in the majority of patient with Alzheimer’s?

agitation

What accompanies agitation during alzheimer’s?

delusions, parnoia, hallucinations, or other psychotic symptoms

What atypical antipsychotic drugs control agitation with alzheimer’s?

risperidone and olanzapine

What convential antipsyhcotics are ocassionaly prescribed for agitation with alzheimer’s?

haloperidol

What is not as common as agitation, but may occur during alzheimer’s?

anxiety and depression

What is used to control unease and excessive apprehension?

anxiolytics

What are kinds of anxiolytics?

busprione and benzodiazepines

What is prescribed when major depression inerferes with daily activies for alzheimer’s?

mood stabilizers

What are kinds of mood stabilizers?

sertraline, citalopram, fluoxetine

What is citalopram?

may help with agitation in alzheimer’s; may also adversely affects patien’ts cognitive status

What is mild alzheimer’s dementia (early stage)?

may function independently; he or she may still drive, work and be part of social activities

What is commonly seen during mild alzheimer’s?

person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects

What are symptoms of mild alzheimer’s?

trouble remebering names, challenges performing tasks in social or work settings, forgetting material that one just read, losing or misplacing a valuable object, increasing trouble with planning or organizing

What is moderate alzheimer’s?

tupically the longest stage and can last for many years

What are symptoms of moderate alzheimer’s?

difficulty with ADLs, anxiety, agitation, suspiciouness, sleep distrubances, wandering, pacing, difficulty rexognizing family/friends

What are ADL’s during moderate alzheimer’s?

confusion about where they are or what day it is; the nedd for help choosing priper clothing; trouble controlling bladder; changes in sleep pattern

What is the result of damage to nerve cells in the brain?

difficult to express thoughts and perform routine tasks; forgetfulness of events or about one’s own personal hisotry

What is severe alzheimer’s?

in the final stage of this disease, individuals lose the ability to respond to their environment

What is the result of severe alzheiemer’s?

loss of speech, total dependence on caregiver, loss of appetite, loss of bowel and bladder control (palliative care or hospice invovled)

When do alzheimer’s symptoms typically being?

after the age of 65 years but may appear as early as the age of 40 years

What is life expentancy from symptom onset of alzheimer’s?

20 years or more, typically 4 to 8 years

What is common behavior with alzheimer’s?

depression and aggression

What is an early symptom of alzheimer’s?

memory difficulties

What is a causative actor in alzheimer’s?

chornic inflammation of the brain

What is given to help improve memory in alzheimer’s disease?

pharmacologic therapies

What are the goals of pharmacotherapy for alzheimer’s disease?

slow memory loss (progression), slow dementia symptoms, improve ADLs, improve behavior, improve cognition

What is symptomatic cognitive treatment for alzheimer’s?

acetylcholinesterase inhibitors and NMDA receptor antagonist

What is disease-modifying treatment for alzheimer’s?

anti-amyloid monoclonal antibodies

What is associated symptom management of alzheimer’s?

medications for agitation or depression

What is the efficacy of drug therapy?

no cure

What is intensified during drug therapy for alzheiemer’s?

effect of acetylcholine at cholinergic receptor

What are cholinesterase inhibitors?

prevent breakdown of acetylcholine; enhance transmission in cholinergic neurons

What drug is used to slow progression of alzheimer’s?

cholinesterase inhibitors

What are kinds of cholinesterase inhibitors?

donepezil (aricept), galantamine (razadyne, reminyl), rivastigmine (exelon)

What are acetylcholinesterase inhibitors?

inhibit acetylcholinsterase, increasing acetylcholine in the brain

What are the effects of acetylcholinesterase inhibitors?

improve or stabilize memory, cognition, and daily functioning

What are common side effects of acetylcholinesterase inhibitors?

nausea, diarrhea, decreased appetite, and weight loss

What must be monitored when taking acetylcholinesterase inhibitors?

bradycardia dizziness, syncope, and falls

What is the drug class of donepezil (aricept)?

acetylcholinesterase inhibitor

What is the drug class of rivastigmine (exelon)?

acetylcholinesterase inhibitor

What is the drug class of galantamine (razadyne)?

acetylcholinesterase inhibitor

What is the drug class of memantine (namenda)?

NMDA receptor antagonist

What is the drug class of donepezil/memantine (namzaric)?

combination therapy

What is the drug class of lecanemab (leqembi)?

anti-amyloid monoclonal antibody

What is dextromethorphan/bupropion (auvelity)?

treatment for agitation associated with dementia due to alzheiemr’s disease

What is sertraline (Zoloft)?

may be used to treat comorbid depression; not an alzheimer’s treatment itself

What patch is used to treat alzheimers?

rivastgimmine (exelon)

What is donepezil?

improves memory in cases of mild to moderate alzheimer dementia by enhancing the effects of acetylcholine in neurons in the cerebral cortex that have not been damaged

When should patients recieve donepezil?

at least 6 months prior to assessing maximum benefits of drug therapy

What are the therapeutic effects of fonepezil?

often short-lives, and the degree of improvement is modest, at best

What is an advantage of donepezil?

long half-life permits it to be given once daily

What is the availability of donepezil?

transdermal patch; delivers consistent doses of the drug through the skin

When is admin. alert of donepezil?

prior ot bedtime; most effective when given on a regular schedule

What is the onset of oral donepezil?

less than 20 min

What is the peak of oral donepezil?

3-4 hours

What is the duration of oral donepezil?

variable

What is the onset of transdermal patch donezpezil?

2-4 hours

What is the peak of transdermal patch donepezil?

72-72 hours

What is the duartion of transdermal patch donepezil?

variable

What are common side effects of donepezil?

vomiting and diarrhea

What are less common effects of donepezil?

abnormal dreams, fainting, and darkened urine

What are CNS side effects of donepezil?

insomnia, syncope, depression, headache, and irritability

What are contraindications of donepezil?

GI bleeding and jaundice

What may speed the elimination of donepezil?

phenobarbital, phyenotin, dexamethasone, and rifampin (seizure meds.)

What may be used to treat donepzil overdose?

anticholingerics such as atropine

What doses does aricept come in?

5, 10, and 23 mg

What are NMDA receptor antagonist?

memantine blocks excessive glutamate acitivty at NMDA receptors, helping reduce excitotoxic neuronal damage

What are NMDA receptor anagonist mainly used for?

moderate to severe alzheiemr’s disease and may help preserve function temporarily

What are adverse effects of NMDA receptor antagonist?

dizziness, confusion, headache, and constipation

When is memantine (namenda) typically prescribed?

after aricept stops working

What is memantine (Namenda)?

approved for treatment of moderate to severe alzheiemr’s

What does memantine reduce?

abnormally high levels of glutamate

What is the action of memantine?

protective funciton in reducing neuronal clacium overload