Dementia

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Author:
aphongsy
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196078
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Dementia
Updated:
2013-01-28 23:36:38
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  1. What are two type of cogntive concerns with geriatrics
    • First determine if condition is an ACUTE or CHRONIC condition
    •   -Delirium
    •        Acute on-set
    •        reverisble
    •        present in 30% of elderly in hospital
    •        Prognosis depends on uderlying cause
    •        mortality 25%
    •        true medical emergency
    • Dementia
    •        Chronic
    •        gradual progression
    •        10% 65> affected
    •        50% 85> affected
    •        mild, moderate, severe stage 
    •        cognitive and motor dysfunction 
    •        dysphagia/pneumonia
    •        Alzheimer is most common form 
    •         potential for
    •           aspriation pneumonia
    •           sepsis
    •           pressure ulcer
    •           UTI
  2. Mild form
    mild memory changes and language
  3. Moderate dementia
    Classic symtoms identifible
  4. severe dementia
    Impaired intellectual cognition and dysfunctional motor abilities

    Incresased risk of complication resulting in death
  5. Eitology of delirium
    • metabolic
    • toxin
    • infectious
    • structural changes
    • drug s/e is most common cause
    • hypoxia
    • hypo/hyperglycemia
    • renal/hepatic failure
    • thyroid disease
    • anemia
    • electrolyte  imblance
    • acid/base distrubance
    • hypotension
    • hypo/hyperthemia
    • seizure
    • CNS leisons
    • sensory deprivation
  6. Drugs that percipitate delirium
    • sedative-hypontic
    • minor tranquilzer
    • major tranquilers
    • tricylic antidepressant
    • BB, Calcium blockers
    • anticholimergic
    • antihistamine
    • antiparkinson
    • cimetidine
    • digoxin
    • lithum
    • muslce relaxant
    • opioids
    • NSAIDS
    • corticosteroids
    • theophylline
  7. Causes of dementia
    •  Degenertive dementia (major cause)
    •        Alzheimer
    •        senile dementia of alzheimer type
    • Vascular dementia
    • Combination of the two
    • Drugs
    • Posttrumatic
    • Infections
    • Vitamin deficiency (B12 Thiamine)
    • Lension (tumors)
    • Hydrocephalus
  8. Name chromosome linked to dementia
    • Chromosome 21
    •   production of precusor of beta-amyloid protien seen in alzheimer.
    • Chromsome 19
    •   linked to apolipoprotien E alleles 1-4 seen in alzheimer

    • Nongentic factor
    •  viral 
    •  enviromental toxin
    •  trace metals
    •  deficiency of neurotrphic horomes
    •  deficit of acetylcholine in CNS
    •  physiological changes
    •      neuronal death
    •      neurofillary tangle
    •      neurtic plague
  9. Detail hx obtained from
    • family
    • friends
    • nursing staff
  10. Which of the two brain failure needs to be assessed quickly
    • Delirium
    • Its important to identify and treat the rapid changes associated with delirium that could increase chances of mortality

    drug induce must be considered
  11. What are cardial features of Delirium
    • Decrease awreness (self/enviroment)
    • impaired attention span
    • preceptual distrubance(hallucination)
    • incoherent speech
    • disruptrd sleep-wake cycle
    • Increased/decrease psychomotor activities (tachycardia, pyrexia, hyperhydrosis, diaphroesis)
    • disorientation
    • memory impairment
    • rapid onset with flucuation of lucidness
  12. With dementia

    Physical exam start with mental status for cognitive impairment eval.
    • Through Hx to screen for
    •   HTN
    •   TIA
    •   CVA
    • An abrupt onset=vascular dementia
    • Screen for depression and drug abuse
    • Hallucinaton/Parkinson feature=Lewybody dementia
    • Incotinence/ataxia=Normal pressure Hydrocephalus dementia
  13. How to differentiate between Depression and dementia
    Important to distinguish because depression is treatable

    • depression
    •  seeking medical attention
    •  rapid onset/known with percision
    •  aware of cognitive loss
    •  depression will present with vegatitive que of speech "dont know" to questions
    •   behavior not congruent with cognitive loss
    • Give emprical trail of antidepressant if in doubt






     
  14. What labs are ordered for delirium and dementia evaluations
    • CBC
    • Glucose
    • electrolytes
    • renal, liver, thyroid function
    • vit B12
    • Thiamine
    • folate
    • Calcium, phosphate
  15. What studies can be ordered for delirium and dementia
    • CXR
    • EKG
    • neuroimaging (CT, MRI, PERT, SPECT)
    • HIV, syphills serology
    • lumbar puncture
    • EEG
    • neurophyso eval
    • speech pathology
  16. treatment for delirium
    • -gentle approach to optimize sensory function
    •   reduce enviro stimus and surround with   familarity (family, friends)
    • -avoid restraints if possible
    • -use chemical agents cautiously b/c delirium may be drug induced or worsen with additional drugs.
    •  -Use sedative drugs if patient is danger to self or others.  Wean off drug when possible
  17. treatment of dementia
    • Comprehesive approach
    •   Optimize function
    •   mananage complications
    •   Ed patient and family
    •   social services
    • Treatment targets the underlying etiology.
    • Dengen Dementia (alzheimer)
    •   Combine phram therapy was superior for slows mental decline as compared to single therapy
    •   Cholinesterase inhibtors
    •      donepezil
    •      rivastigmine
    •      galantamine
    • combine with N-methy-D-aspartate receptor antagonist
    •      memantine
    • Vascular dementia
    •     treatment for preventive and managment of cardiovascular risk and prophlaytic therapy for preventing stokes.

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