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Alzheimer's Disease, Dementia, and Delirium
Terms in this set (61)
Is delirium preventable?
What is the definition of delirium? How long does it usually last?
an acute but temporary confusion characterized by disorganized thinking, difficulty concentrating, and sensory misperceptions; 1-7 days
What is the pathophysiology of delirium?
alteration of how the brain metabolizes carbohydrates combined with a chemical imbalance of the neurotransmitter chemicals acetylcholine, dopamine, and serotonin, resulting in mental confusion
Why are older adults more susceptive to delirium?
liver decreases in size (where drugs are metabolized), decreased size of nephrons as the kidney decreases in size leading to a decreased half-life of drugs -- with both of these, the older person is more sensitive to drugs
What types of drugs are the older person more sensitive to? (6)
sleeping pills, anti-anxiety medications, opioids, Benadryl, anticholinergic (anti bladder spasms), anesthesia drugs
______% of older adults experience delirium post op? ______% of all ICU patients experience this?
15-53% (about half); 80%
What is the most frequent hospitalization complication of the older adult?
What are the 3 consequences of delirium?
length of stay in the hospital (increased dependency and become more susceptible to infections, and lose ability to do ADLs), mortality rate increased, increased rates of permanent Long Term Care admissions
What is the defining characteristic of delirium?
sudden change from baseline
What are the 3 types of delirium?
hyperactive, hypoactive (quiet), mixed
What are 2 symptoms of hypoactive delirium? Hyperactive?
hypoactive - stupor, lethargy
hyperactive - agitation and hallucination
What are 7 risk factors for delirium?
advanced age, dementia, functional dependency, poly pharmacy, surgery, require ICU care, unrelieved pain
What is poly pharmacy considered to be?
around 4-5 daily doses of drugs
Why is surgery a risk factor for delirium?
there is a plethora of anesthesia drugs given to the patient
What are the 6 early signs of delirium? 3 late signs?
early - inability to concentrate, irritable, insomnia, loss of appetite, restless, confused
late - agitation, misperceptions, hallucinations
From a medication stance, how can you prevent delirium? (3)
avoid giving them sleeping pills, anticholinergic drugs like Benadryl and bladder spasm drugs, and avoid poly pharmacy
In terms of environmental factors, how can you prevent delirium? (4)
putting them in the presence of their family, reorient patient to time/place/situation, making sure they have access to hearing aids or glasses, making sure there isn't constant light/interruptions/alarms
Why isn't it good to give older patients anticholinergic drugs?
they block neurotransmitters in the brain --> greater risk for delirium
Other than medication and environmental factors, what are 3 causative factors of delirium that you can eliminate?
inadequate nutrition and fluids to maintain electrolyte balance (sodium and potassium), immobility, loss of normal sleep patterns (cluster the care so patients get proper REM sleep)
There is ______% muscle loss for everyday you stay in bed.
What is Confusion Assessment Method (CAM)? What is the criteria?
an evidence based way to assess for delirium; if they have all findings in box 1 or any one finding in box 2
How does the PET scan of someone with Alzheimer's compare to that of a normal brain?
significantly less brain activity -- less firing of the nerve cells
What is semantic paraphrasia?
nonsensical verbiage in which it is hard to follow what they're saying
1/3 of patients who have dementia also have which 4 conditions?
depression, semantic paraphrasia, aggression, remember things from a long time ago but not more recently
What is the definition of dementia?
umbrella term for a group of brain disorders characterized by gradual decline of cognitive abilities resulting in loss of memory, judgment, language, and orientation to the point where it interferes with daily activities
What 4 cognitive abilities are lost with dementia?
memory, judgment, language, orientation
About how much brain mass is lost per decade after the age of 40?
What is MCI?
mild cognitive impairment -- a syndrome involving impaired cognitive function that is not classified as dementia, because these phenomenons don't result in the person not being able to do their ADLs
______% of older adults develop MCI. ______% of this subgroup develops Alzheimer's.
Currently, ______% of older adults have dementia. What is supposed to happen to this statistic by 2050?
15%; double to 30%
What are the 3 most common type of dementia in order?
Alzheimer's disease - 60-80%
vascular dementia - 20%
dementia with Lexy bodies - 10%
What is the cause of frontotemporal dementia? Who is most at risk for it? At what age does onset usually begin? Is it a gradual or sudden onset?
mutations in tau protein and TDP43, causing them to clump abnormally in the frontal and temporal areas of the brain; people with family history most at risk; gradual onset between age 40-70
What characterizes the course of frontotemporal dementia (2)? What are the 3 typical manifestations of it?
progressive decline in motor and speech skills
1. marked symmetrical lobar atrophy of frontal and temporal lobes
2. erratic behavior
3. memory deficits occurring much later in the disease
What is the cause of Lewy body dementia? Is it a gradual or sudden onset?
abnormal protein called a synuclein in the brain stem and cortex causing an increase in Lewy body cells; gradual
What characterizes the course of Lewy body dementia (3)? What are the 3 typical manifestations of it?
progressive decline in cognition, behavior, and motor symptoms
1. Parkinson like muscle rigidity and postural instability
3. sleep disturbances
What is the cause of vascular dementia? Is it a gradual or sudden onset? What condition puts a patient at a large risk for this?
multiple small infarcts or major single ischemic/embolic or hemorrhagic lesions that causes a decreased supply to the brain; sudden; stroke
What characterizes the course of vascular dementia (2)? Describe the typical manifestations of it.
irregular course and improvement is possible; depends on the area of the brain it affects
What is the cause of Alzheimer's dementia (3)? Describe the onset.
cause - amyloid plaques (clusters of proteins) in between nerve cells, neurofibrillary tangles (twisted stands of protein) to keep the synapse from sending signals to each other, loss of connections between neurons
onset - pathological process that begins 3-20 years before symptoms begin to appear
What characterizes the course of Alzheimer's dementia? What are the 3 typical manifestations of this?
course - progression from mild to severe is highly variable between 3 and 20 years
manifestations - first short-term memory loss and then long-term, behavior and personality changes, loss of language skills
How can you diagnose Alzheimer's dementia?
you can't until doing an autopsy after death
What is the 6th leading cause of death in the US?
In the late stages of Alzheimer's dementia, what happens (5)?
unresponsive, incontinent, patient requires total care, dysphasia (forget they are eating and that they have to swallow), unable to obtain upright position
What is dysphasia?
What is the function of the tau protein in the brain? What happens when it collapses?
keeps strands in the brain straight and healthy --> becomes twisted strands and tangles when it collapses
What percentage of Alzheimer's patients inherited it?
For those who inherit the Alzheimer's gene, how does this work (3 parts)?
they have a 50/50 chance of inheriting 1 in 3 gene mutations for it:
1. amyloid precursor protein
What are the 8 risk factors for Alzheimer's disease in those who do not have the Alzheimer's mutation?
1. inherited gene variant apolipoprotein E
2. environmental risk factors
8. head trauma (concussions)
What is a variant?
individual DNA sequence in each of our genomes that cause our unique appearance --> increases risk for developing Alzheimer's
What are 4 health promotions to encourage to potentially prevent Alzheimer's disease?
1. increase physical activity
2. eat a diet low in saturated fats
3. increase the level of education to build up 'cognitive reserve'
4. engage in social and cognitive activities
Who was Auguste Deter?
the first person known to have Alzheimer's in which Dr. Alzheimer obtained her brain to do studies
What are the 10 warning signs of Alzheimer's?
memory loss, difficulty performing familiar tasks, language problems, disorientation to time and place, poor judgment, problems with abstract thinking, misplacing things, changes in mood/behavior, changes in personality, loss of initiative
What are 2 ways to test dementia neuropsychologically?
mini-Cog test and mini-mental status examination
What are the components of the mini-mental status examination? (5)
orientation, registration (3 unrelated objects), attention and calculation, recall, language
What are the 4 non-behavioral clinical presentations of dementia?
pain that can't be vocalized, eating problems (best to give puree'd foods or finger foods), prone to infections, prone to elimination problems
In the case of dementia, if the nursing diagnosis is chronic confusion, what are 3 important nursing interventions?
1. monitor nonverbal signs and subtle changes in status
2. monitor undernutrition, assist with feeding and remind to swallow
3. respond to difficult behavior by redirecting, distraction, and reassurance
In the case of dementia, if the nursing diagnosis is risk for injury, what are 3 important nursing interventions?
1. institute fall risk prevention
2. monitor for wandering
3. when amount of care exceeds resources, place in long term care
In the case of dementia, if the nursing diagnosis is risk for compromised human dignity, what are 4 important nursing interventions?
1. maintain the patient's dignity and self-worth
2. provide the patient with basic care needs
3. social stimulation to combat depression (like listening to music)
4. frequent reorienting to place and time
What are the 2 best medications for Alzheimer's disease? What effect does this have (general)?
cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists; treats symptoms but does not cure but the efficacy of the drug eventually decreases
What is the method of action of cholinesterase inhibitors? What is an example?
increases amount of acetylcholine in the brain to improve memory; aricept
What is the method of action for NMDA?
blocks excess amounts of glutamate, which damages nerve endings in the brain
What is reminiscence therapy?
encouraging residents to remember and talk about the past, focusing on pleasant events
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