Dementia- ch. 7 health in aging

teach the laypersons 10 things to be aware of

1. Memory loss that disrupts daily life 2. Challenges in planning or solving problems 3. Difficulty completing familiar tasks at home, at work or at leisure 4. Confusion with time or place 5. Trouble understanding visual images and spatial relationships 6. New problems with words in speaking or writing 7. Misplacing things and losing the ability to retrace steps 8. Decreased or poor judgment 9. Withdrawal from work or social activities 10. Changes in mood and personality

chance of dementia at 65? 85?

1/ 10 and 1/ 5

what percent of dementia is familia

10%

annual cost of dementia

172 billion

researchers looks at how many different stages of dementia

3

# of Americans living with dementia

5.3 mil, 1/10 americans have a family member with dementia

chances of getting dementia if your parents have it

50/50, early on-set

% of dementia patients that live at home

70%

alzheimers association looks at how many different stages of dementia

7; stage 1- no impairment stage 7- very severe

OTCS

A number of herbal and/or vitamin claims Vit E - based on the antioxidant protection against free radicals; limited evidence of benefit Ginko biloba - limited evidence of slight benefit Huperzine A - cholinesterase inhibitor but dose unknown Coenzyme Q10 - no evidence, not recommended Phosphatidylserine - protective lipid but needs research Coral calcium - no benefit

dementia

A syndrome of global decline in overall brain function exhibited by impaired cognition, memory, psychological and personality changes and physiological impairment. result of apraxia, aphasia, agnosia or altered executive functioning slow/ stair step onset chronic illness many symptoms over time chronic decline

late onset dementia is linked to the presence of

APOE ε3- it presents the risk, not actual diagnosis

alzheimers

Actual cause is unknown Cortex of the brain shrinks -Neurofibrillary tangles (inside neurons) -Amyloid plaque formation (outside neurons) Other theories on causation have not been proven

other exams for AD

Alzheimer's Disease Assessment Scale Blessed Information-Memory-Concentration Test Clinical Dementia Rating Scale

types of brain imaging used for AD

CT or MRI will reveal cerebral atrophy, some stroke damage or tumors atrophy of the brain- positive diagnosis

care- giver issues for family members with dementiated loved ones

Caregivers are 'on duty' 24/7 Emotionally and physically exhausted Depression Loss of life partner Family members may have conflict Guilt if can not handle the care Lack of available resources Lack of understanding about the illness

what causes dementia

D- drug use, toxins, alcoholism (meth/ formaldehyde, embalming fluid) E- emotional disorders (schizophrenia- late term schizophrenics have levels of dementia; depressives have psuedo- dementia syndrome) M- metabolic or endocrine disorders (hypothyroidism, B12 deficiency Some diabetics eventually lose cognitive function, some lupus Sensory deprivation gradually develops into a dementia syndrome because the individual loses touch with the external environment E- eyes/ ears (sensory loss) N- nutritional loss T- tumors, brain disease (alzheimers) I- infections (syphillis/ AIDS) A- ateriosclerotic- vascular bleeds

anti-convulsants

Depakote,Lamictal, Tegretol, etc. Often used as adjuvant meds in the management of anger outbursts Sedation is an issue Efficacy is an issue Medication interactions

cholinesterase inhibitors- types, purpose, side effects

Donepezil (aricept)- most common in clients for early dementia rivastigmine (exelon); 2nd generation (reminyl/ razadyne) tacrine (cognex)- designed to increase levels of acetylcholine side effects: nausea/ vommitting, diarrhea, decreased appetite

some side effects of anti-psychotic drugs

Orthostatic hypotension Neuroleptic malignant syndrome Agranulocytosis Seizures Hyperglycemia Obesity Arrhythmias Urinary retention Constipation Blurred vision Dry mouth Akathesia Pseudoparkinsonism Tardive dyskinesia sedation

diseases that lead to dementia

Parkinson's, Creutzfeldt-Jakob disease, mad-cow, normal pressure hydrocephalus, Huntington's, Pick's, Lewy body dementia Binswanger's disease Frontotemporal dementia Corticobasal degeneration Certain conditions that can cause childhood dementia HIV-associated dementia Other infections within the brain, such as Creutzfeldt-Jakob disease Huntington's disease and other rare hereditary dementias Head trauma, such as dementia pugilistica (also known as boxer's syndrome).

short administered bedside exam for AD

SET test- used in Europe

typical responses to antipsychotic drugs in older people

Slower clearance and longer effect Anti-psychotics often cause confusion and agitation themselves Over-sedation is a huge problem CNS symptoms in elderly can be related to physiological illness i.e. UTI, CHF, med toxicity Major medication interaction potential and SE

agnosia

altered, impaired visual perception

2 greatest causes of dementias

alzheimer's vascular dementia

relocation syndrome symptoms for an impaired individual

behaviors like aggression, anger, wandering

memantine (namenda)

best known for dementia alzheimers used in combination with cholinesterase inhibitors Regulates the activity of glutamate; protects cells against excess glutamate which destroys information processing cells side effects- HA, constipation, confusion, dizzine

substance in spinal fluid that can be used in alzheimers diagnosis- and who found it

beta- amyloid protein= abeta16 Gothenburg researchers

vascular dementia

caused by minor strokes or Transient ischemic attack; the disease progresses in a stairstep fashion- the individual will plateau and improve between strokes similar symptoms to alzheimers and treated the same

stage 3- severe dementia

constant movement hums, sings, hits, bites, in repetitive motion talks in single syllables - can't be understood no longer can write multiple sensory losses is incontinent all the time does not know who he/she is - has 'lost' sense of self does not listen or talk to others

difference between dementia and forgetfulness

dementia is a change in memory, forget an entire experience, little delayed recall and gradual decline in overall function and cognition forgetfulness is lifelong, forgets parts of experiences, delayed recall and otherwise intact pathology

relocation syndrome symptoms for an un impaired individual

depression, withdrawal, psychosomatic complaints

stage 1- mild dementia

desperately clings to present reality wants to know where he/she is ambulatory unless other chronic disease uses language that is easily understood makes up excuses for memory loss denies loss of memory, eyesight, hearing, mobility wants everything in it's proper place resists change denies feelings of loneliness, anger, rejection, fear, etc. muscles are stiff precise in body movements, rigid, tense eyes clear, focused becomes furious when places with disoriented residents

apraxia

difficulty voluntarily moving muscle groups; oral aprexia- difficulty making speech sounds or mouth movements without muscle weakness

aphasia

difficulty with speech d/t left brain damage; word loss, language structure, flow

pretzels jakobs dementia

doesnt go through all stages of dementia

presenting symptoms of AD

early stages- people will cover their symptoms, professionals are not trained to assess, can be indicative or other disorders

additional losses of dementia

eating dressing ambulation self care communication decision- making phyical deterioration

laypersons

family of dementia patient; or older person considered

altered executive functioning

inability to follow commands or to function with intent and control

dislocation (relocation) syndrome

involuntary change in location or circumstances; impaired and un impaired older people can experience symptoms; prolonged symptoms with increased cognitive decline symptoms decrease with planning and support (nurses can help)

most common in what ethnicity

latino and african american populations with later onset

symptoms of alzheimers

less talkative less social withdrawn reluctance to engage cognition- impaired organization speech- word loss, substitution, swearing memory- short term loss emotion- unable to complete word tasks, driving orientation, forget to attend functions

stage 2- moderate dementia

loses track of time past time becomes present time confuses people in present with people from past thinks parents are still alive good memory for past events wants to go to his/her old home sees vivid images of past, hears, smells, etc from past has at least one sensory defect uses cloth, objects of clothing to substitute for people loses sense of humor withdraws and creates own unique language loose, indirect, wavering body muscles and movements in space speech low, unclear, eyes moving freely, unfocused most of the time hysterical responses to trauma

2 major areas of treatment

medications psychosocial/ behavioral

mental status exam used to diagnose AD- average score at diagnosis

mini mental state exam (MMSE); 17

medications for alzheimers

no cure, just slow the process, all have side effects cholinesterase inhibitor, memantine, psychotropics, anti- convulsants, OTC

do amyloid plaques automatically imply alzheimers

no; it is the volume that is implicated. some individuals have both neurofibrillary triangles and amyloid plaques

diagnosis for Alzheimers is based on

presenting symptoms mental status exams physical exam and labs brain imaging

lewey bodies

protein deposits in the brain nerve cells

delirium

rapid onset related to an acute event confusion, agitation, hallucinations and is reversible when addressed

antipsychotic

used to treat delusions, hallucinations, agitation,aggression, repetitive behaviors, catastrophic responses some names: Risperdal, Abilify, Geodon, Zyprexa; haldol micro doses needed for older adults efficacy is questioned side effects- confusion, metabolic imbalances

when conducting a physical exam and lab- what should you assess for

weakness visual/ hearing impairments labs should be comprehensive

dementia more common in men or women?

women- 16% men- 11%