Dementia, by Dr Kamal Kejriwal MD AAFP, CMD Geriatric Fellowship Program Director, Kaiser Fontana
Dementia, by Dr Sherif Iskander Geriatric Fellows Dr Marian Assal, Geriatrician, Kaiser Fontana, as presented within the 2018 January GWEP conference
An 83-year-old woman presented with fever, shortness of breath, and poor oral intake. She has a history of multiple medical conditions and is on several medications. On examination, she has a fever and signs of respiratory distress. The physician is concerned about pneumonia and increased depression, but her cognitive status was not assessed. Delirium is an acute fluctuating syndrome of altered attention, awareness and cognition, especially common in elderly hospitalized patients. It is often misdiagnosed as depression or dementia. Non-pharmacological prevention and treatment of underlying causes are most important, while antipsychotics may be used short-term for severe symptoms if needed.
Schizophrenia is a major psychotic disorder characterized by delusions, hallucinations, disorganized speech and behavior. It has been defined and categorized in different ways over time. Current diagnostic criteria require symptoms for at least one month. The causes are thought to involve genetic and environmental factors. The disorder follows a variable course with acute episodes potentially followed by chronic or residual phases with negative symptoms. Diagnosis involves assessing for specified symptoms and impairment. Treatment aims to control symptoms and improve functioning.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
Dementias are acquired cognitive impairments that affect memory, language, visuospatial ability, and other mental functions, impairing daily living. The most common type is Alzheimer's disease, which results from neuronal disruption and loss. A thorough evaluation involves assessing onset and progression of symptoms, neuropsychiatric features, physical exam including brief cognitive tests, and ruling out other treatable causes. The leading cause is Alzheimer's disease, whose risk increases dramatically with age and involves memory loss and other cognitive deficits that gradually worsen over years.
Dementia is a chronic syndrome that causes deterioration in cognitive abilities beyond normal aging. It is caused by brain diseases or injuries that damage or destroy nerve cells. The document discusses the anatomy and lobes of the brain, defines dementia, explores the pathophysiology and clinical manifestations such as confusion and behavioral changes. Diagnostic tests include cognitive assessments and brain imaging. Management involves both pharmacological treatments like Aricept as well as non-pharmacological approaches like a consistent routine and environment. Nurses help by addressing issues like disrupted sleep, communication problems, and infection risk. Health education focuses on diet, hygiene, medication adherence, and lifestyle factors.
- Neurocognitive disorders include delirium, disorders due to Lewy bodies, Alzheimer's disease, frontotemporal disorders, vascular disorders, and traumatic brain injuries.
- Delirium involves an acute change in consciousness and cognition that fluctuates in severity. It is often caused by medical issues, medications, or substance withdrawal. Treatment focuses on resolving the underlying cause.
- Disorders like those due to Lewy bodies, Alzheimer's disease, and frontotemporal disorders cause progressive cognitive decline due to brain changes. Symptoms and severity vary by type. Management includes medications, environmental modifications, and supportive care.
- Vascular and traumatic brain injury disorders arise from disruptions to the brain's
The document discusses dementia, including its various types, symptoms, diagnostic criteria, assessment methods, and treatment options. It defines dementia as the loss of cognitive and intellectual function without impairment of perception or consciousness. The five major types of dementia are Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal dementia, and Parkinson's disease with dementia. Assessment involves interviews, examinations, and tests to evaluate cognition, function, and rule out other conditions. Treatment focuses on enhancing quality of life and includes both non-pharmacological and pharmacological approaches.
An 83-year-old woman presented with fever, shortness of breath, and poor oral intake. She has a history of multiple medical conditions and is on several medications. On examination, she has a fever and signs of respiratory distress. The physician is concerned about pneumonia and increased depression, but her cognitive status was not assessed. Delirium is an acute fluctuating syndrome of altered attention, awareness and cognition, especially common in elderly hospitalized patients. It is often misdiagnosed as depression or dementia. Non-pharmacological prevention and treatment of underlying causes are most important, while antipsychotics may be used short-term for severe symptoms if needed.
Schizophrenia is a major psychotic disorder characterized by delusions, hallucinations, disorganized speech and behavior. It has been defined and categorized in different ways over time. Current diagnostic criteria require symptoms for at least one month. The causes are thought to involve genetic and environmental factors. The disorder follows a variable course with acute episodes potentially followed by chronic or residual phases with negative symptoms. Diagnosis involves assessing for specified symptoms and impairment. Treatment aims to control symptoms and improve functioning.
The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
Dementias are acquired cognitive impairments that affect memory, language, visuospatial ability, and other mental functions, impairing daily living. The most common type is Alzheimer's disease, which results from neuronal disruption and loss. A thorough evaluation involves assessing onset and progression of symptoms, neuropsychiatric features, physical exam including brief cognitive tests, and ruling out other treatable causes. The leading cause is Alzheimer's disease, whose risk increases dramatically with age and involves memory loss and other cognitive deficits that gradually worsen over years.
Dementia is a chronic syndrome that causes deterioration in cognitive abilities beyond normal aging. It is caused by brain diseases or injuries that damage or destroy nerve cells. The document discusses the anatomy and lobes of the brain, defines dementia, explores the pathophysiology and clinical manifestations such as confusion and behavioral changes. Diagnostic tests include cognitive assessments and brain imaging. Management involves both pharmacological treatments like Aricept as well as non-pharmacological approaches like a consistent routine and environment. Nurses help by addressing issues like disrupted sleep, communication problems, and infection risk. Health education focuses on diet, hygiene, medication adherence, and lifestyle factors.
- Neurocognitive disorders include delirium, disorders due to Lewy bodies, Alzheimer's disease, frontotemporal disorders, vascular disorders, and traumatic brain injuries.
- Delirium involves an acute change in consciousness and cognition that fluctuates in severity. It is often caused by medical issues, medications, or substance withdrawal. Treatment focuses on resolving the underlying cause.
- Disorders like those due to Lewy bodies, Alzheimer's disease, and frontotemporal disorders cause progressive cognitive decline due to brain changes. Symptoms and severity vary by type. Management includes medications, environmental modifications, and supportive care.
- Vascular and traumatic brain injury disorders arise from disruptions to the brain's
The document discusses dementia, including its various types, symptoms, diagnostic criteria, assessment methods, and treatment options. It defines dementia as the loss of cognitive and intellectual function without impairment of perception or consciousness. The five major types of dementia are Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal dementia, and Parkinson's disease with dementia. Assessment involves interviews, examinations, and tests to evaluate cognition, function, and rule out other conditions. Treatment focuses on enhancing quality of life and includes both non-pharmacological and pharmacological approaches.
This document provides guidance on assessing patients with dementia. It outlines obtaining a clinical history by interviewing both patients and caregivers to understand onset and progression of mental status difficulties. A mental status examination evaluates various domains including orientation, attention, memory, language, perception and construction. Behavioral rating scales like the Mini Mental State Examination and Mattis Dementia Rating Scale can further assess cognitive impairment. Neuropsychological tests may also help confirm dementia but require more time and specialized administration. The mental status examination is the primary tool for diagnosing and managing dementia.
Overview of Confusion & Delirium for Clinicians (July 2007)Alex J Mitchell
Delirium is a common and serious syndrome among hospitalized patients, with an incidence of 10-15% on admission and 5-40% developing delirium during hospitalization. It is characterized by acute onset and fluctuating features including inattention, disorganized thinking, and altered level of consciousness. Delirium is associated with poor outcomes including prolonged hospitalization, increased mortality rates up to 33% in hospital and 39% after discharge, and persistent symptoms in some patients for months or longer. Non-pharmacological management focuses on treating underlying causes, supportive care, and minimizing risk factors through proper nutrition, hydration, safety measures, and a calm environment with clear communication.
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
This document provides an overview of organic mental disorders, focusing on delirium and dementia. It defines delirium as an acute, transient disturbance in attention, cognition and consciousness that is usually reversible. Dementia is described as a chronic or persistent decline in cognitive abilities severe enough to interfere with daily life. The document outlines the prevalence, causes, signs/symptoms and diagnostic criteria for delirium. It also discusses the types and characteristics of dementia. Nonpharmacological and pharmacological treatment approaches are summarized for delirium, including addressing underlying causes and maintaining behavioral control.
This document defines delirium and discusses its prevalence, risk factors, pathophysiology, clinical presentations, assessment tools, and management strategies. Delirium is an acute confusional state characterized by fluctuating mental status and inattention. It has a prevalence of 20-80% in hospitals and increases mortality risk by 10% per day. Hypoactive delirium is most common. Assessment tools include CAM-ICU and ICDSC. Management prioritizes non-pharmacological strategies like ABCDE bundles and uses anti-psychotics like haloperidol for pharmacological treatment.
Dementia is a chronic progressive mental disorder that affects functions like memory, thinking, and judgement. Alzheimer's disease is the most common form of dementia. It has an insidious onset and progresses slowly over several years, resulting in deterioration of cognition, function, and behavior. Current management focuses on treating cognitive, behavioral, and psychological symptoms, though there is no cure for Alzheimer's disease.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Delirium, dementia and other mental disorder due to brain dysfunction or syst...Sujit Kumar Kar
This document discusses delirium, including its causes, diagnosis, and differences from dementia. It provides ICD-10 diagnostic criteria for delirium which requires symptoms from five dimensions: impaired consciousness/attention, cognitive changes, psychomotor disturbances, sleep-wake cycle disturbances, and emotional/behavioral changes. Delirium has an acute onset and fluctuating course compared to the gradual onset and steady progression of dementia. The document also reviews traumatic brain injury, encephalitis, and other medical conditions that can cause delirium or psychiatric symptoms. It emphasizes the importance of identifying risk factors, making an early diagnosis, and addressing underlying medical issues in managing these patients.
Neuropsychiatric Manifestations of Huntington Disease (2021)Zahiruddin Othman
This document discusses the neuropsychiatric manifestations of Huntington's disease. Huntington's disease is a progressive neurodegenerative disorder caused by a defective gene on chromosome 4. It is characterized by motor, cognitive, and psychiatric symptoms. Psychiatric symptoms include depression, irritability, anxiety, and psychosis. Neuropathology involves gradual atrophy of the striatum due to neuronal loss. Diagnosis is based on family history, motor symptoms, and neuropsychological assessment. Management involves a multidisciplinary approach including pharmacological and non-pharmacological interventions to treat motor, cognitive, and psychiatric symptoms.
Brief psychotic disorder is an acute and transient psychotic condition involving the sudden onset of psychotic symptoms that last for less than 1 month and follow a severe stressor. Symptoms must resolve completely with full return to previous functioning levels. Onset is typically between ages 20-35. Treatment involves hospitalization if safety is a concern along with antipsychotic medication and psychotherapy. Prognosis is generally good with full recovery.
This document discusses delirium, including its causes, symptoms, types, risk factors, tests, diagnosis, treatments, and nursing interventions. Delirium is characterized by impaired consciousness, disorientation, and cognitive impairment. It has various causes like medical conditions, medications, and substance withdrawal. Symptoms fluctuate and include confusion, emotional disturbances, and behavioral changes. Treatment focuses on addressing underlying causes and providing a calm environment. Nursing aims to ensure patient safety, reduce fear and anxiety, meet physical needs, and facilitate orientation.
Neurocognitive disorders are defined as deficits in thought processes or memory due to brain dysfunction that represent a decline from previous functioning. There are several types including dementia, delirium, amnestic disorders, and permanent amnesia caused by conditions like head trauma or poisoning. Symptoms of dementia include memory impairment along with problems using language, objects, understanding sensory input, and executive functioning. Neurocognitive disorders are rare in children/adolescents but increase with age, affecting 1.4-1.6% of those aged 65-69 and 16-25% of those over 85.
This document provides an overview of delirium. It begins by outlining what topics will be covered, including the definition of delirium, differential diagnosis, prevention, diagnosis/assessment, and treatment. Delirium is defined as an acute confusional state involving cognitive and circadian impairments. Risk factors are discussed, as well as how delirium is preventable using a multicomponent strategy targeting risk factors. Diagnosis involves a mental status exam and scales. Treatment focuses on supporting the patient, managing the environment, treating the underlying cause, and occasionally using antipsychotics or benzodiazepines. Outcomes include full recovery in 40% of cases and permanent cognitive impairment or mortality in the remaining cases.
Dementia is a syndrome involving the deterioration of memory, thinking, behavior and the ability to perform everyday activities. It is caused by damage to brain cells that interferes with communication between cells. Alzheimer's disease is the most common form of dementia, potentially contributing to 60-70% of cases. Dementia is diagnosed based on medical history, exams, tests and characteristic changes in thinking and functioning. While there is no cure, medications and therapies can help reduce symptoms or slow progression for some time.
The ppt covers all aspects concerning organic brain disorder - Dementia and Delirium. It includes Alzheimer's, Parkinson's along with clinical features (according to ICD 10); cognitive, physical, neurobiological changes; treatment and assessment scales. Diagrams and charts are included wherever necessary for ease of understanding.
Delirium, also referred to as "acute confusional state" or "acute brain syndrome," is a condition of severe confusion and rapid changes in brain function.
Delirium is a neuropsychiatric syndrome characterized by acute onset of fluctuating cognitive impairment and changes in consciousness. It is common in medically ill patients and often misdiagnosed as psychiatric. Delirium is caused by underlying medical conditions and assessed using DSM criteria of disturbance in attention, cognition, and perception developing over short period. Treatment involves addressing underlying causes, managing symptoms like agitation, and preventing complications through reorientation and family support.
SO GUYS ONCE AGAIN HERE I PRESENT U THE OWN MADE PRESENTATION ON THE TOPIC DEMENTIA I HOPE U LIKE THAT IT IS BEEN USEFUL U WHILE MAKING PSYCHIATRIC PRESENTATION
This document discusses delirium, dementia, and headaches. It provides detailed information on the definition, causes, symptoms, diagnosis and treatment of delirium. It describes some of the main causes of dementia like Alzheimer's disease and Normal Pressure Hydrocephalus. It also discusses different headache syndromes like migraines, tension headaches, and cluster headaches. It highlights some important life-threatening causes of headaches such as brain tumors and subarachnoid hemorrhage.
Delirium is an acute, potentially reversible brain dysfunction manifested by neuropsychiatric symptoms. It is common in hospitalized elderly patients, post-operatively, and in those withdrawing from alcohol. Core features include impaired consciousness, attention, cognition, and perception. Treatment involves identifying and addressing underlying causes, providing supportive care and reorientation, and administering antipsychotic medications like haloperidol to treat the delirium itself. Prognosis depends on severity and underlying causes, with higher mortality risks for those with longer or persistent delirium.
This document discusses neurocognitive disorders including delirium, major neurocognitive disorders such as dementia and amnestic syndrome, mild neurocognitive disorder, epilepsy, and traumatic brain injury. It provides details on the diagnostic criteria, clinical features, epidemiology, treatment, and prognosis of these conditions. Case studies are also presented to illustrate delirium and complex partial seizures.
This document provides guidance on assessing patients with dementia. It outlines obtaining a clinical history by interviewing both patients and caregivers to understand onset and progression of mental status difficulties. A mental status examination evaluates various domains including orientation, attention, memory, language, perception and construction. Behavioral rating scales like the Mini Mental State Examination and Mattis Dementia Rating Scale can further assess cognitive impairment. Neuropsychological tests may also help confirm dementia but require more time and specialized administration. The mental status examination is the primary tool for diagnosing and managing dementia.
Overview of Confusion & Delirium for Clinicians (July 2007)Alex J Mitchell
Delirium is a common and serious syndrome among hospitalized patients, with an incidence of 10-15% on admission and 5-40% developing delirium during hospitalization. It is characterized by acute onset and fluctuating features including inattention, disorganized thinking, and altered level of consciousness. Delirium is associated with poor outcomes including prolonged hospitalization, increased mortality rates up to 33% in hospital and 39% after discharge, and persistent symptoms in some patients for months or longer. Non-pharmacological management focuses on treating underlying causes, supportive care, and minimizing risk factors through proper nutrition, hydration, safety measures, and a calm environment with clear communication.
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
This document provides an overview of organic mental disorders, focusing on delirium and dementia. It defines delirium as an acute, transient disturbance in attention, cognition and consciousness that is usually reversible. Dementia is described as a chronic or persistent decline in cognitive abilities severe enough to interfere with daily life. The document outlines the prevalence, causes, signs/symptoms and diagnostic criteria for delirium. It also discusses the types and characteristics of dementia. Nonpharmacological and pharmacological treatment approaches are summarized for delirium, including addressing underlying causes and maintaining behavioral control.
This document defines delirium and discusses its prevalence, risk factors, pathophysiology, clinical presentations, assessment tools, and management strategies. Delirium is an acute confusional state characterized by fluctuating mental status and inattention. It has a prevalence of 20-80% in hospitals and increases mortality risk by 10% per day. Hypoactive delirium is most common. Assessment tools include CAM-ICU and ICDSC. Management prioritizes non-pharmacological strategies like ABCDE bundles and uses anti-psychotics like haloperidol for pharmacological treatment.
Dementia is a chronic progressive mental disorder that affects functions like memory, thinking, and judgement. Alzheimer's disease is the most common form of dementia. It has an insidious onset and progresses slowly over several years, resulting in deterioration of cognition, function, and behavior. Current management focuses on treating cognitive, behavioral, and psychological symptoms, though there is no cure for Alzheimer's disease.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
Delirium, dementia and other mental disorder due to brain dysfunction or syst...Sujit Kumar Kar
This document discusses delirium, including its causes, diagnosis, and differences from dementia. It provides ICD-10 diagnostic criteria for delirium which requires symptoms from five dimensions: impaired consciousness/attention, cognitive changes, psychomotor disturbances, sleep-wake cycle disturbances, and emotional/behavioral changes. Delirium has an acute onset and fluctuating course compared to the gradual onset and steady progression of dementia. The document also reviews traumatic brain injury, encephalitis, and other medical conditions that can cause delirium or psychiatric symptoms. It emphasizes the importance of identifying risk factors, making an early diagnosis, and addressing underlying medical issues in managing these patients.
Neuropsychiatric Manifestations of Huntington Disease (2021)Zahiruddin Othman
This document discusses the neuropsychiatric manifestations of Huntington's disease. Huntington's disease is a progressive neurodegenerative disorder caused by a defective gene on chromosome 4. It is characterized by motor, cognitive, and psychiatric symptoms. Psychiatric symptoms include depression, irritability, anxiety, and psychosis. Neuropathology involves gradual atrophy of the striatum due to neuronal loss. Diagnosis is based on family history, motor symptoms, and neuropsychological assessment. Management involves a multidisciplinary approach including pharmacological and non-pharmacological interventions to treat motor, cognitive, and psychiatric symptoms.
Brief psychotic disorder is an acute and transient psychotic condition involving the sudden onset of psychotic symptoms that last for less than 1 month and follow a severe stressor. Symptoms must resolve completely with full return to previous functioning levels. Onset is typically between ages 20-35. Treatment involves hospitalization if safety is a concern along with antipsychotic medication and psychotherapy. Prognosis is generally good with full recovery.
This document discusses delirium, including its causes, symptoms, types, risk factors, tests, diagnosis, treatments, and nursing interventions. Delirium is characterized by impaired consciousness, disorientation, and cognitive impairment. It has various causes like medical conditions, medications, and substance withdrawal. Symptoms fluctuate and include confusion, emotional disturbances, and behavioral changes. Treatment focuses on addressing underlying causes and providing a calm environment. Nursing aims to ensure patient safety, reduce fear and anxiety, meet physical needs, and facilitate orientation.
Neurocognitive disorders are defined as deficits in thought processes or memory due to brain dysfunction that represent a decline from previous functioning. There are several types including dementia, delirium, amnestic disorders, and permanent amnesia caused by conditions like head trauma or poisoning. Symptoms of dementia include memory impairment along with problems using language, objects, understanding sensory input, and executive functioning. Neurocognitive disorders are rare in children/adolescents but increase with age, affecting 1.4-1.6% of those aged 65-69 and 16-25% of those over 85.
This document provides an overview of delirium. It begins by outlining what topics will be covered, including the definition of delirium, differential diagnosis, prevention, diagnosis/assessment, and treatment. Delirium is defined as an acute confusional state involving cognitive and circadian impairments. Risk factors are discussed, as well as how delirium is preventable using a multicomponent strategy targeting risk factors. Diagnosis involves a mental status exam and scales. Treatment focuses on supporting the patient, managing the environment, treating the underlying cause, and occasionally using antipsychotics or benzodiazepines. Outcomes include full recovery in 40% of cases and permanent cognitive impairment or mortality in the remaining cases.
Dementia is a syndrome involving the deterioration of memory, thinking, behavior and the ability to perform everyday activities. It is caused by damage to brain cells that interferes with communication between cells. Alzheimer's disease is the most common form of dementia, potentially contributing to 60-70% of cases. Dementia is diagnosed based on medical history, exams, tests and characteristic changes in thinking and functioning. While there is no cure, medications and therapies can help reduce symptoms or slow progression for some time.
The ppt covers all aspects concerning organic brain disorder - Dementia and Delirium. It includes Alzheimer's, Parkinson's along with clinical features (according to ICD 10); cognitive, physical, neurobiological changes; treatment and assessment scales. Diagrams and charts are included wherever necessary for ease of understanding.
Delirium, also referred to as "acute confusional state" or "acute brain syndrome," is a condition of severe confusion and rapid changes in brain function.
Delirium is a neuropsychiatric syndrome characterized by acute onset of fluctuating cognitive impairment and changes in consciousness. It is common in medically ill patients and often misdiagnosed as psychiatric. Delirium is caused by underlying medical conditions and assessed using DSM criteria of disturbance in attention, cognition, and perception developing over short period. Treatment involves addressing underlying causes, managing symptoms like agitation, and preventing complications through reorientation and family support.
SO GUYS ONCE AGAIN HERE I PRESENT U THE OWN MADE PRESENTATION ON THE TOPIC DEMENTIA I HOPE U LIKE THAT IT IS BEEN USEFUL U WHILE MAKING PSYCHIATRIC PRESENTATION
This document discusses delirium, dementia, and headaches. It provides detailed information on the definition, causes, symptoms, diagnosis and treatment of delirium. It describes some of the main causes of dementia like Alzheimer's disease and Normal Pressure Hydrocephalus. It also discusses different headache syndromes like migraines, tension headaches, and cluster headaches. It highlights some important life-threatening causes of headaches such as brain tumors and subarachnoid hemorrhage.
Delirium is an acute, potentially reversible brain dysfunction manifested by neuropsychiatric symptoms. It is common in hospitalized elderly patients, post-operatively, and in those withdrawing from alcohol. Core features include impaired consciousness, attention, cognition, and perception. Treatment involves identifying and addressing underlying causes, providing supportive care and reorientation, and administering antipsychotic medications like haloperidol to treat the delirium itself. Prognosis depends on severity and underlying causes, with higher mortality risks for those with longer or persistent delirium.
This document discusses neurocognitive disorders including delirium, major neurocognitive disorders such as dementia and amnestic syndrome, mild neurocognitive disorder, epilepsy, and traumatic brain injury. It provides details on the diagnostic criteria, clinical features, epidemiology, treatment, and prognosis of these conditions. Case studies are also presented to illustrate delirium and complex partial seizures.
This document discusses reversible causes of dementia and delirium. It begins by defining major neurocognitive disorder and reversible dementias. Common reversible causes of dementia include central nervous system infections, normal pressure hydrocephalus, nutritional deficiencies, drugs, endocrine disorders, depression, and sleep apnea. Delirium is then discussed, including risk factors, pathophysiology, clinical subtypes, DSM-5 criteria, assessment scales, differential diagnosis, course, prevention, and management. Reversible dementias are estimated to account for 8-40% of dementia cases. Early diagnosis and treatment of the underlying cause can improve cognitive functioning.
This document discusses the pathogenesis and management of Alzheimer's disease. It outlines several hypotheses for the molecular pathogenesis of AD including the cholinergic, amyloid, and tau protein hypotheses. It describes biomarkers for AD diagnosis and discusses the role of insulin resistance, metabolic disorders, and diet in AD. Therapeutic strategies target modulation of amyloid beta production and clearance as well as tau phosphorylation.
La enfermedad de Alzheimer (EA), también denominada demencia senil de tipo Alzheimer (DSTA) o simplemente alzhéimer,1 es una enfermedad neurodegenerativa que se manifiesta como deterioro cognitivo y trastornos conductuales. Se caracteriza en su forma típica por una pérdida de la memoria inmediata y de otras capacidades mentales (tales como las capacidades cognitivas superiores), a medida que mueren las células nerviosas (neuronas) y se atrofian diferentes zonas del cerebro. La enfermedad suele tener una duración media aproximada —después del diagnóstico— de 10 años,2 aunque esto puede variar en proporción directa con la severidad de la enfermedad al momento del diagnóstico.
Delirium is an organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behavior, emotion and sleep wake schedule.
Delirium Tremens is a psychotic condition caused by complications from alcohol withdrawal. It involves tremors, hallucination, anxiety and disorientation.
approach to dementia slides Swayang sudha pandaSwayang Panda
1) The document discusses the diagnostic approach and criteria for dementia, including Alzheimer's disease. It covers obtaining a medical history, cognitive and neurological exams, and biomarkers.
2) Risk factors for dementia mentioned include age, family history, genetics like ApoE status, medical conditions, lifestyle factors, and low education.
3) Tests and assessments discussed for diagnosis include cognitive tests, functional scales, and neuropsychiatric inventories. Management focuses on lifestyle modifications like exercise, diet, and cognitive stimulation.
The patient is an 80-year-old male who was brought to the hospital due to complaints of memory loss from his wife. She noticed he had been experiencing gradual onset memory loss over the past 15 days, including an inability to remember daily tasks and financial duties. On examination, he was conscious and oriented but demonstrated memory impairment. A diagnosis of Alzheimer's disease was suspected given his age and symptoms.
Schizophrenia is a chronic psychiatric disorder that affects around 1% of the population. It causes distortions in thinking, perception, emotions, language, sense of self and behavior. Common symptoms include hallucinations, delusions, disorganized speech and behavior. Treatment involves antipsychotic medications to manage symptoms as well as psychosocial therapies to support independent living. Nursing care focuses on ensuring patient safety, promoting treatment adherence, and helping patients maintain functioning.
This document discusses an age-friendly primary care partnership between Fontenelle and UNMC's Geriatrics Workforce Enhancement Program. It receives funding from HRSA and focuses on the 4 M's in primary care: Mentation, which includes delirium, dementia, and depression. Dementia is discussed in more detail, covering etiology, evaluation involving history, physical exam, and labs/imaging, diagnostic criteria for Alzheimer's disease, and treatment options. Delirium is also summarized, including assessment using the Confusion Assessment Method.
Drugs used in the management of Dementia.pdfEugenMweemba
This document discusses drugs used to manage different types of dementia, including Alzheimer's disease, vascular dementia, and dementia with Lewy bodies. It provides information on signs and symptoms, risk factors, clinical course, pathophysiology, and treatment guidelines for each type. For Alzheimer's disease, the recommended first-line treatments are acetylcholinesterase inhibitors or memantine. For vascular dementia, treatment focuses on managing risk factors to prevent additional strokes. Dementia with Lewy bodies may be treated with acetylcholinesterase inhibitors or memantine, though antipsychotics must be used carefully due to risk of worsening symptoms.
Delirium is a state of acute mental confusion that is common and potentially life-threatening in older adults. It is caused by a variety of precipitating factors including age, medical conditions, surgery, medications, sensory impairment and more. Clinically, delirium involves a global disturbance of cognition, consciousness, attention, psychomotor skills and the sleep-wake cycle. It is diagnosed through medical history, exams, and lab tests. Treatment focuses on treating the underlying cause, maintaining fluid/nutrition, and occasionally medications to reduce agitation. Nursing care manages safety risks and symptoms.
This document is a presentation on dementia given by Dr Devavrat Harshe from the Department of Psychiatry at D.Y. Patil Medical College, Hospital & Research Centre. The presentation covers topics such as the difference between normal aging and dementia, common causes and risk factors for dementia, how dementia progresses, diagnostic evaluation, and management strategies which include pharmacological treatments to improve cognition as well as supportive measures for patients and caregivers.
Alzheimer's disease is a progressive neurodegenerative disease that causes loss of neurons and synapses in the brain. The main pathological hallmarks are extracellular amyloid beta plaques and intraneuronal neurofibrillary tangles. Current treatments only temporarily improve cognitive symptoms but do not stop progression of the disease. New treatments are needed to both maintain cognitive abilities and halt the underlying disease process.
Alzheimer's disease is a progressive neurodegenerative disease that causes loss of neurons and synapses in the brain. The main pathological hallmarks are extracellular amyloid beta plaques and intraneuronal neurofibrillary tangles. Current treatments only temporarily improve cognitive symptoms but do not stop progression of the disease. New treatments are needed to both maintain cognitive abilities and halt the underlying disease process.
This document discusses organic mental disorders, specifically delirium and dementia. It defines delirium as an acute organic brain syndrome characterized by clouding of consciousness and disorientation. Dementia is defined as a chronic mental disorder characterized by impairment of intellectual functions and deterioration of personality. Alzheimer's disease is described as the most common cause of dementia. The document outlines the classification, causes, clinical features, diagnosis and management of delirium and dementia, with specific details provided about Alzheimer's disease.
1. Dementia is a growing problem worldwide, affecting over 47 million people in 2015 and projected to increase significantly by 2050 as populations age.
2. Dementia involves the deterioration of cognitive abilities such as memory, judgment, and problem solving that impair daily living. It can be caused by neurodegenerative, vascular, or other medical conditions.
3. Assessing dementia involves evaluating memory impairment, ruling out other causes like depression, and using screening tools such as the MMSE alongside medical exams and tests to determine severity and guide further evaluation.
Dementia is an acquired persistent and progressive impairment in intellectual function, with compromise of memory and at least one other cognitive domain. The key features of dementia include progressive decline in intellectual functions over months to years, loss of short term memory and at least one other cognitive deficit, no disturbance of consciousness, deficits severe enough to cause impairment in daily functioning, and not being in a state of delirium. Dementia can be categorized into reversible or partially reversible dementias and nonreversible dementias. Nonreversible dementias include Alzheimer's disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementias. Treatment involves acetylcholinesterase inhibitors, memantine, managing behavioral problems non-
This document provides information on Alzheimer's disease, including its causes, risk factors, diagnosis, management, and nursing care. Alzheimer's is the most common form of dementia, characterized by progressive impairment in memory, thinking, and behavior. It is caused by brain cell death and genetic and lifestyle factors. Risk factors include age, family history, head trauma, and cardiovascular and lifestyle issues. Diagnosis involves cognitive testing, imaging, and lab tests. Management focuses on improving quality of life through pharmacological treatments, environmental modifications, and activities. Nursing care involves ongoing assessment, addressing needs for self-care and communication, and supporting patients and their families.
We live in an era of medication, but what else can we do to improve mental health? Are we excessively prescribing, can we approach medicine in a more holistic way?
With vision loss comes increased chance of trauma and falls. How can one prevent such injuries from occurring and are their preventative measures one can take?
What is the correlation between CNS active medication and fall risk for the geriatric community and how should one best prevent fall injuries from occurring for those taking such medication?
Approach to oral health for geriatricians apr 2019SDGWEP
This document summarizes Theodore T. Suh's presentation on oral health for older adults. It discusses common oral health issues in seniors like cavities and periodontal disease. It outlines barriers to dental care for seniors like lack of insurance, affordability, and accessibility issues. Medicare does not cover routine dental care while Medicaid coverage varies by state. Poor oral health can impact overall health by increasing risks of conditions like pneumonia and diabetes complications. The presentation provides tips for caregivers on oral hygiene and discusses initiatives to improve oral health education and access for seniors.
Dementia care world's great healthcare economic challenge for 21st cent ap...SDGWEP
Dementia is currently the fastest growing cause of death in America. How do you care for those suffering from Dementia and what are the typical signs of this mental disability
This document provides an overview of heart failure (HF), including definitions, epidemiology, pathophysiology, diagnosis, and treatment. Some key points:
- HF is a clinical syndrome where cardiac output is insufficient to meet the body's demands. It can be acute or chronic, and involve systolic or diastolic dysfunction.
- Risk factors include hypertension, coronary artery disease, and drugs like doxorubicin. Incidence increases with age.
- Diagnosis involves history, physical exam, BNP, echocardiogram, and other tests. BNP is useful to differentiate cardiac from pulmonary causes of dyspnea.
- Treatment depends on stage and includes ACE inhibitors, beta blockers,
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(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
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Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
1. 1
DEMENTIA
Dr Kamal Kejriwal MD AAFP,CMD
Geriatric Fellowship Program
Director, Kaiser Fontana
Dr Sherif Iskander Geriatric Fellows
Dr Marian Assal, Geriatrician,
Kaiser Fontana
2. 2
OBJECTIVES
Know and understand:
• The risks for and causes of dementia
• The evaluation of patients with dementia
• How to plan behavioral and pharmacologic
treatment strategies to minimize the personal,
social, & financial impacts of dementia
• How to refer patients and caregivers to
available community resources
3. 3
TOPICS COVERED
• Epidemiology and Societal Impact
• Risk Factors and Prevention
• Assessment Methods
• Differential Diagnosis
• Treatment and Management
• Resources
7. 4
WHAT IS DEMENTIA?
• An acquired syndrome of decline in memory
and other cognitive functions sufficient to
affect daily life in an alert patient
• Progressive and disabling
• iNnohtearenntaspect of aging
• Different from normal cognitive lapses
8.
9.
10.
11. 5
THE EPIDEMIOLOGY OF
DEMENTIA
• 6%‒8% of people 65 yr have Alzheimer dementia (AD)
Prevalence doubles every 5 yr
Nearly 45% of those aged 85+ have AD
• Vascular dementia co-occurs with an estimated 15%–
20% of AD cases ― “mixed dementia”
• Lewy body dementia (LBD) ― second most common
cause of dementia
12.
13. 7
ETIOLOGY
• Alzheimer disease
Amyloid plaques/oligomers
Tau neurofibrillary tangles
• Lewy body and Parkinson dementia
Cytoplasmic α-synuclein inclusion bodies
• Frontotemporal dementia
Tau or ubiquitin proteins
14. 9
THE GENETICS OF DEMENTIA
Early onset (<60 years old)
• Amyloid precursor protein (APP)
• Presenilin proteins (PS1 and PS2)
Late onset
• Apolipoprotein E gene (APOE 2/3/4) ― chromosome 19
APOE4 ― two alleles confers greatest risk in dose-related fashion
ApProOteEc2tiv―e
• Sleiontgidlee-npuoclymorphisms
Clusterin (CLU-C), complement component receptor 1 (CR1),and
phosphatidylinositol binding clathrin assembly protein (PICALM)
15. 8
RISK FACTORS FOR DEMENTIA
Protective Factors
Definite: unknown
Possible
• NSAIDs
• Antioxidants
• Intellectual activity
• Physical activity
• Statin
Possible
Risk Factors
Definite
• Age
• Family history
• AllePleOE4a
• Down syndrome
• Hraeuamdat
• Fewer years of formal education
• Late-onset major depressive
disorder
• Cardiovascular risk factors
(hypertension, diabetes,
hypercholesterolemia, obesity)
16. 10
ASSESSMEN T: HISTORY
Ask both the patient and a reliable informant
about the patient’s:
history
• Date of onset of current condition and nature
of symptoms
• Medical history
• eCduircraetniotnms& medication
• Paalcttoehrnosluosfeor abuse
• Living arrangements
17. 11
ASSESSMEN T: PHYSICAL
Examine:
• Neurologic status
• Mental status
• Functional status
Include:
• Quantified screens for cognition
For example, Folstein’s MMSE, Mini-Cog,
SLUMS, MoCA
• Neuropsychologic testing
21. 14
ASSESSMEN T: BRAIN IMAGING
Consider imaging when:
• Onset occurs at age <65 years
• Neurologic signs are asymmetric or focal
• Clinical picture suggests normal-pressure hydrocephalus
• Patient has had recent fall or other head trauma
Consider:
• Noncontrast computed topography head scan
• Magnetic resonance imaging
• Positron emission tomography
23. 16
NORMAL AGING
• No consistent, progressive deviations on testing
of memory
• Some decline in processing and recall of new
information: slower, harder
• Reminders work—visual tips, notes
• Absence of significant effects on ADLs or IADLs
due to cognition
24. 17
MILD COGNITIVE IMPAIRMENT
• Subjective complaint of decline in at least one cognitive
domain: noticeable and measurable
• Nmopaiirment in independent living
• 9.4 to 14.3/1000 person-years convert to Alzheimer
disease
• ~50% with amnestic MCI maintain stable level of
impairment or return to normal cognitive status in 35 yr
25. 18
DELIRIUM VS. DEMENTIA
• Delirium and dementia often occur together in older
hospitalized patients
• Tsthinegduiishing signs of delirium are:
Acute onset
Cognitive fluctuations over hours or days
Impaired consciousness and attention
Altered sleep cycles
Search for underlying dementia once delirium cleared
26. 19
DEPRESSI ON VS. DEM ENTI A (1 of 2)
The symptoms of depression and dementia often
overlap:
• Impaired concentration
• Lack of motivation, loss of interest, apathy
• Psychomotor retardation
• Sleep disturbance
27. 20
DEPRESSI ON VS. DEM ENTI A (2 of 2)
• Patients with primary depression are generally
unlike those with dementia in that they:
Demonstrate motivation during cognitive testing
Express cognitive complaints that exceed
measured deficits
Maintain language and motor skills
• ~50% presenting with reversible dementia and
depression progress to dementia within 5 yr
28. 21
ALZHEIMER DISEASE
• aOdnusaelt: gr
• Cognitive symptoms: memory impairment core feature
with difficulty learning new information
• Motor symptoms: rare early, apraxia later
• Progression: gradual, over 8–10 yr on average
• Lab tests: normal
• Imaging: possible global atrophy, small hippocampal
volumes
29. 22
VASCULAR DEMENTIA
• aOynbse:sumdden/stepwise
• Cognitive symptoms: depend on anatomy of ischemia,
but dysexecutive syndrome common
• Motor symptoms: correlates with ischemia
• Progression: stepwise with further ischemia
• Lab tests: normal
• Iomrtaicgainlogr:scubcortical changes on MRI
30. 23
LEWY BODY DEMENTIA
• aOdnusaelt: gr
• Cognitive symptoms: memory, visuospatial,
hallucinations, fluctuations
• Motor symptoms: parkinsonism
• Progression: gradual, but usually faster than AD
• Lab tests: normal
• Imaging: possible global atrophy
31. 24
FRONTOTEMPORAL DEMENTIA
• aOdnusaelt,:ugsruallyage <60
• Cognitive symptoms: executive, language, and
behavioral dysfunction, including disinhibition and
hyperorality
• Motor symptoms: none; may be associated with ALS
in rare cases
• Progression: gradual but faster than AD
• Lab tests: normal
• Imaging: atrophy in frontal and temporal lobes
32. 27
PRIMARY GOAL OF TREATMENT
To enhance quality of life and
maximize functional performance by
improving cognition, mood, and behavior
34. 25
Stage 1: No cognitive impairment
Unimpaired individuals experience no memory problems, and none is evident to a
health care professional during a medical interview.
Stage 2: Very mild cognitive decline
Individuals at this stage feel as if they have memory lapses, especially in forgetting
familiar words or names or the location of keys, eyeglasses, or other everyday
objects. However, these problems are not evident during a medical examination or
apparent to friends, family, or coworkers.
Stage 3: Mild cognitive decline
Early-stage Alzheimer disease can be diagnosed in some, but not all, individuals.
Friends, family, or coworkers begin to notice deficiencies. Problems with memory or
concentration may be measurable in clinical testing or discernible during a detailed
medical interview.
Stage 4: Moderate cognitive decline (mild or early-stage Alzheimer disease)
At this stage, a careful medical interview detects clear-cut deficiencies. The affected
individual may seem subdued and withdrawn, especially in socially or mentally
challenging situations.
THE GENERAL PROGRESSION OF
DEMENTIA (1 of 2)
35. 26
Stage 5: Moderately severe cognitive decline (moderate or mid-stage Alzheimer
disease)
Major gaps in memory and deficits in cognitive function emerge. Some assistance with
day-to-day activities becomes essential.
Stage 6: Severe cognitive decline (moderately severe or mid-stage Alzheimer disease)
Memory difficulties continue to worsen, significant personality changes may emerge,
and affected individuals need extensive help with customary daily activities.
Stage 7: Very severe cognitive decline (severe or late-stage Alzheimer disease)
This is the final stage of the disease when individuals lose the ability to respond to their
environment, to speak, and ultimately to control movement.
THE GENERAL PROGRESSION OF
DEMENTIA (2 of 2)
39. Typical Hospice Eligibility Criteria
(Local Coverage Determinations)
Functional AssessmentStaging
1. No difficulties
2. Subjective forgetfulness
3. Decreased executivefunction
4. Difficulty with complextasks
5. Requires supervision with ADLs
6. Impaired ADLs withincontinence
7. Stage Seven
A. Ability to speak limited to 6
words
B. Ability to speak limited to a
single word
C. Loss of ambulation
D. Inability to sit
E. Inability to smile
F. Inability to hold head up
40. Feeding Tubes inAdvance
Dementia
Studies show no impact of feedingtubes in
advanced dementia on:
Survival(Median survival 56 days)
Pressure ulcer healing
Aspiration pneumonia
Likely increase inburdens
Loss of experience/connection of feeding
Restraints
Complications are common
Dehydration isnot painful
Use associated with decreased satisfaction
with endof life care
Sampson EL, Candy B, Jones L, “Enteral tube feeding or older people with
advanced dementia. Cochrane Database Syst. Rev. 2009;(2):CD007209
41. End of Life DecisionMaking:
Feeding Tubes inDementia
Telephone survey of 450 relatives of SNF
patients
with advanced dementia who had feeding tubes
85%of decisions were made in hospital
47%reported discussion lasted <15minutes
1/3 family members recalled that no risks of tube
feeding presented
50%felt hospital physician was “strongly in
favor of tube insertion”
13%“felt pressured to put in a feeding tube”
Approx. 25%regretted the feeding tube
decision
Kuo, Sylvia, Poster Presentation, American Geriatrics
Society Annual Meeting, May 12, 2010, Orlando,FL
42. Non-pharmacologic Interventions for
Behavioral Problems
Many programs have worked, but difficult to
generalize as to what can be dispensed or
spread
Pain and symptom control
Exercise
Music/Recordings
Optimal level of activity
Environmental changes: light, reassuring
picture
Treating each patient with personalized
care
Resources: A Systematic Evidence Review of Non-pharmacological Interventions for Behavioral Symptoms of Dementia
(VA’s Health Services Research & Development Service’s (HSR&D’s) Evidence-based Synthesis Program (2011)
http://www.hsrd.research.va.gov/publications/esp/Dementia-Nonpharm.pdf
See also extensive materials below from IA Adapt, Interact, Hand in Hand
44. ABCDs Examples
Antecedents
Diagnoses (What is the
cause of dementia? )
What other diagnoses
exist?
Fatigue, hunger,pain
Levels of stimulation
Restraint
Staff or resident
approaches
Gender & Cultural
Lack of exercise
Behaviors
What exactly is the
behavior?
Crying
Yelling
Biting
Hitting
Grabbing
Fecal play
Time of day
Exact setting and details
as possible
Consequences
Attention
Isolation
Abuse
Injury
Medication response
Other positive
reinforcement
B
E=Emotional
Engagement
45. Common ReasonsforDifficult Behaviors
inPatientswith Dementia
Response toTrigger
Other Medical
Pain
Personality
Iatrogenic: othermeds
Sleep Deficit
Social/
Caregiver
Enjoys the behavior
Delirium
Discomfort
Psychosis
Fear/Boredom/Anxiety
Adjustment
Problems
Behaviors
J
46. Approach to Medicationsfor
Behavioral Problems in SNFIV
First try:
Behavioral interventions (at least2 trials)
Medication toxicities minimized
(e.g. anticholinergic medications)
Require (As per Title 22 and CMS)
Behavior causes significant impairment of
quality of life or danger to self or others
Informed consent for seriousrisks(including
death) obtained
Avoid prn antipsychotics in dementia
47. Advancecare planning for
patients with dementia
1. Educate physicians, families and staff about
trajectory of illness ofdementia
2. Elicit patient’s goals of care based on
advance directives and prior values
3. Educate families and physicians about
burdens and benefits of interventions,
including lack of benefit for tube feeding.
4. Complete POLST documents: assess notonly
completion but quality of the conversations
5. Consider hospice ifappropriate
48. 28
NONPHARMACOLOGIC
MANAGEMENT (1 of 2)
• Cognitive rehabilitation
• Supportive individual and group therapy
• Physical and mental activity
• Regular appointments every 3–6 months
• Family and caregiver education and support
• Attention to safety
Need for supervision, wandering, driving etc.
49.
50.
51.
52.
53. 29
NONPHARMACOLOGIC
MANAGEMENT (2 of 2)
• Environmental modification
Orientation and memory measures such as
clocks, calendars, to-do list, visual clues, simple
and compassionate communication style
54.
55. 30
PHARMACOLOGIC MANAGEMENT
• Treatment should be individualized
• Cholinesterase inhibitors: donepezil, rivastigmine,
galantamine
• Memantine
• Other cognitive enhancers
• Antidepressants
• Psychoactive medications
56. 31
CHOLINESTERASE INHIBITORS
(1 of 2)
• Slow breakdown of acetylcholine
• Clinical trials demonstrate modest delay in cognitive
decline compared with placebo in AD
• GI side effects common
Mitigated by slow titration curve
Maximum dosing of donepezil 23 mg/day creates significant
side effects without evidence of improving global function
• No evidence of difference in efficacy among drugs
57. 32
CHOLINESTERASE INHIBITORS
(2 of 2)
• Use in other dementias
Widespread use in vascular dementia not
recommended
Behavioral disturbances in Lewy body dementia can
benefit from treatment
Rivastigmine is FDA-approved for mild to moderate
dementia in Parkinson dementia
Treatment in frontotemporal dementia may worsen
agitation
58. 33
MEMANTINE
• Neuroprotective effect is to reduce glutamate-mediated
excitotoxicity
• Modest benefit on cognition, ADLs, and behavior in AD
• Limited effect on cognition and no evidence to support
widespread use in vascular dementia
• FovDeAd-afoprpmroderate to severe AD
• Common adverse events: constipation, dizziness,
headache
59. 34
OTHER COGNITIVE
ENHANCERS
• Vitamin E (α–tocopherol) may lower rate of decline, but
no evidence of cognitive improvement in AD
No longer recommended due to evidence of increased
mortality with high-dose supplementation
• Selegiline may low rate of decline, but no evidence of
cognitive improvement in AD
• Ginkgo biloba offers no benefit in slowing cognitive
decline in MCI
60. 35
SYMPTOM MANAGEMENT (1 of 2)
• Psychoactive medications
Behavioral disturbances best managed nonpharmacologically,
eg, reducing overstimulation, environmental modification
• Antidepressants
Depressed mood, low appetite, insomnia, fatigue, irritability,
agitation
fPeocstisvieblfyorefdisinhibitionand compulsive behaviors
Caution: falls and anticholinergic effects that may worsen
confusion (ie, paroxetine)
61. 36
SYMPTOM MANAGEMENT (2 of 2)
• 1st/2nd-generation antipsychotics
Limited evidence of efficacy and increased risk of all-cause
mortality in dementia
Should be used with caution in targeting delusions, hallucinations,
and paranoia ― frequently attempt to taper off
• Valproic acid and carbamazepine
Possible options, but with limited evidence and increased risk of
mortality
• Benzodiazepines and anticholinergic medications should
be avoided
62. 37
RESOURCES FOR
MANAGING DEMENTIA (1 of 2)
• Specialist referral to:
Geriatric psychiatrist
Neurologist
Neuropsychologist
• Social worker
• Physical therapist
• Nurse
63. 38
RESOURCES FOR
MANAGING DEMENTIA (2 of 2)
• oArttworilnl,ecyofnservatorship,estate planning
• Community: neighbors & friends, aging & mental health
networks, adult day care, respite care, home-health
agency
• Organizations: Alzheimer’s Association, AreaAgencies
on Aging, Councils onAging
• Services: Meals-on-Wheels, senior citizen centers
64. 39
SUMMARY (1 of 2)
• Dementia is common in older adults but is not
an inherent part of aging
• AsDthei most common type of dementia,
followed by vascular dementia and dementia
with Lewy bodies
• Evaluation includes history with informant,
physical & functional assessment, focused
labs, & possibly brain imaging
65. 40
SUMMARY (2 of 2)
• Primary treatment goals: enhance quality of life
and maximize function by improving cognition,
mood, behavior
• Treatment may involve both medications and
nonpharmacologic interventions
• Community resources should be used to
support patient, family, caregivers
66.
67. 41
CASE 1 (1 of 4)
• An 80-year-old woman is brought to the office because
she has hallucinations of children and small animals
when she is alone in a room. The hallucinations
sometimes disturb and agitate her.
• Hamerilyf also notes that she is having more difficulty
walking and has hand tremors when she sits quietly.
• Sah9e-has month history of short-term memory loss;
problems with orientation that sometimes worsen
dramatically; and difficulty managing her finances,
preparing complex meals, and following TV shows.
68. 42
CASE 1 (2 of 4)
–Mental State Examination is• Hcoerresonthe Mini
23 of 30.
• On physical examination, there are signs of cogwheel
rigidity and resting tremors, which have been noted
for the past year.
69. 43
CASE 1 (3 of 4)
Which of the following is the most likely diagnosis?
A. Dementia with Lewy bodies
B. Alzheimer disease
C. Parkinson disease with dementia
D. Huntington disease
70. 44
CASE 1 (4 of 4)
Which of the following is the most likely diagnosis?
A. Dementia with Lewy bodies
B. Alzheimer disease
C. Parkinson disease with dementia
D. Huntington disease
71. 45
CASE 2 (1 of 4)
• A 67-year-old man comes to the office to establish care.
• History includes mild hypertension.
• The patient is married and maintains an active
professional and social life. He is physically active,
does not smoke, and drinks 1–2 glasses of wine daily.
• Medications include hydrochlorothiazide 12.5 mg/day,
aspirin 81 mg/day, and a daily multivitamin.
72. 46
CASE 2 (2 of 4)
• Fstaomryilyishniotablefor an 84- year-old maternal
aunt who recently died after 6 years in the memory-
disorders unit of a nursing home.
• H’sisdeaautnhthas caused the patient to worry about
his own risk of dementia. He requests a referral for
genetic testing for Alzheimer disease.
• Physical examination is unremarkable.
73. 47
CASE 2 (3 of 4)
Which of the following is true about risk of Alzheimer
disease?
A. Mutations in 4 known deterministic (causative) genes
are associated with autosomal-dominant AD.
B. The lifetime risk of developing AD in the general
population is approximately 20%, assuming a life span
of 75 to 80 years.
C. AD is sporadic in approximately 75% of all cases.
D. Genetic risk for AD varies by race and ethnicity.
74. 48
CASE 2 (4 of 4)
Which of the following is true about risk of Alzheimer
disease?
A. Mutations in 4 known deterministic (causative) genes
are associated with autosomal-dominant AD.
B. The lifetime risk of developing AD in the general
population is approximately 20%, assuming a life span
of 75 to 80 years.
C. AD is sporadic in approximately 75% of all cases.
D. Genetic risk for AD varies by race and ethnicity.
75. 50
CASE 3 (2 of 4)
• Tiehnet’spawtifeexpresses concern about his ability
to drive safely. She sometimes feels nervous riding
with him. She notes that he has stopped driving at
night or when it rains, that he drives shorter distances
and less often since he retired 5 years ago, and that he
received a traffic citation about 4 years ago. He has
had no accidents or additional citations since then.
• Wkehdeinfhaesthinks he is a safe driver, the patient
says, “I’m probably a little bit slower than I used to be,
but overall I’d say yes, I’m still a perfectly safe driver.”
76. 51
CASE 3 (3 of 4)
Which of the following is the strongest evidence of the
patient’s risk for unsafe driving?
A. Patient’s self-restriction and situational avoidance
B. History of a traffic citation in the past 5 years
C. Spouse’s concern
D. Score ≤24 on MMSE
E. Patient’s self-rating of driving ability
77. 52
CASE 3 (4 of 4)
Which of the following is the strongest evidence of the
patient’s risk for unsafe driving?
A. Patient’s self-restriction and situational avoidance
B. History of a traffic citation in the past 5 years
C. Spouse’s concern
D. Score ≤24 on MMSE
E. Patient’s self-rating of driving ability