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Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Omar is a 72-year-old male Asked to retire due to erratic performance at work No appetite or energy since wife’s death Recently lost his car downtown Unable to recognize surroundings Unshaven with oversized slacks and worn shirt Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Dementia? Delirium? Depression? Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Three most common in adults Dementia Delirium—acute confusion Depression ▪ Often associated with dementia and delirium Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Syndrome characterized by dysfunction or loss of Memory Orientation Attention Language Judgment Reasoning Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Other characteristics that can manifest Personality changes Behavioral problems such as ▪ Agitation ▪ Delusions ▪ Hallucinations Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Problems disrupt individual’s Work Social responsibilities Family responsibilities Physicians usually diagnose when 2 or more brain functions are significantly impaired Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Not a normal part of aging Affects 15% of older Americans Half of the patients in long-term care facilities have dementia ~100 causes of dementia Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Due to treatable and nontreatable conditions Two most common causes Neurodegenerative conditions Vascular disorders Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Alzheimer’s Disease 60% Vascular Dementia 20% Lewy Body Disease 10% Other Types Pick’s disease Normal pressure hydrocephalus Creutzfeldt-Jakob disease Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Important risk factors Advanced age Family history Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Infectious diseases can result in vascular and neurodegenerative changes that can lead to dementia Bacterial meningitis Viral encephalitis Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Dementia sometimes caused by treatable conditions can be reversed But prolonged exposure may make dementia irreversible Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Vascular dementia Loss of cognitive function due to brain lesions caused by cardiovascular disease Result of decreased blood supply from narrowing and blocking of arteries that supply brain Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Vascular dementia (cont’d) Predisposed risks of vascular dementia ▪ Smoking ▪ Cardiac dysrhythmias ▪ Hypertension ▪ Hypercholesterolemia ▪ Diabetes mellitus ▪ Coronary artery disease Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Onset of dementia depends on cause Insidious and gradual ▪ Neurologic degeneration dementia is usually gradual and progressive over time Abrupt ▪ Vascular dementia tends to be abrupt or progress in a stepwise pattern Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Classifications Mild Moderate Severe Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Early Stage (Mild) Forgetfulness beyond what is seen in a normal person Short-term memory impairment Geographic disorientation Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Initial symptoms are related to changes in cognitive function Family members often report to doctor Memory loss Mild disorientation Trouble with words and/or numbers Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Middle Stage (Moderate) Impaired ability to recognize close friends and family Wandering, getting lost Forgets how to do simple tasks Delusions, hallucinations Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Late Stage (Severe) Little memory, unable to process information Difficulty eating, swallowing Cannot understand words Incontinence Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Depression often mistaken for dementia and vice versa Manifestations of depression, especially in older adults Sadness Difficulty thinking and concentrating Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Manifestations of Depression (cont’d) Fatigue Apathy Feelings of despair Inactivity Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Dementia and depression occurring together can cause extreme intellectual deterioration Depression alone or with dementia is treatable Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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First focused on determining cause Reversible or nonreversible Thoroughly evaluate patient history Medical Neurologic Psychologic Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Physical examination to rule out other medical conditions Screen for Cobalamin (vitamin B 12 ) deficiencies Hypothyroidism Possibly neurosyphilis Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Mental status testing is important Those with mild dementia may be able to compensate, making diagnosis difficult through just conversation The Mini-Mental State Examination is most commonly used tool for assessing cognitive function Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Computed tomography (CT) Magnetic resonance imaging (MRI) To monitor changes: Single-photon emission computed tomography (SPECT) Positron emission tomography (PET) Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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What is Omar’s diagnosis? Dementia Depression Delirium Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Chronic, progressive, degenerative disease of the brain ~5.3 million Americans suffer from AD Most live 8-10 years after being diagnosed Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Incidence slightly higher is African and Hispanic Americans May be related to socioeconomic status or access to health care, not ethnicity Women more likely to develop AD Have longer life expectancy than men Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Exact etiology is unknown Age of onset determines type: Early onset Late onset Familial Alzheimer’s disease Earlier onset More rapid disease course Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Changes in brain structure and function Amyloid plaques Neurofibrillary tangles Loss of connections between cells and cell death Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Pathologic changes precede clinical manifestations by 5 to 20 years Alzheimer’s Association has developed a list of 10 warning signs Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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1.Memory loss that affects job skills Frequent forgetfulness or confusion that goes beyond forgetting names or phone numbers 2.Difficulty performing familiar tasks Such as cooking a meal then forgetting that they made it Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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3.Problems with language Forget simple words or substitute inappropriate words, making speech hard to understand 4.Disorientation to time and place Become lost on their own street: not know where they are, how they got there, or how to get back home Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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5.Poor or decreased judgment May dress inappropriately in noticeable ways, such as wearing a bathrobe to the store or sweater on a hot day 6.Problems with abstract thinking Difficulty recognizing numbers or doing basic calculations Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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7.Misplacing things May put items in inappropriate place (such as eating utensils in a clothing drawer) and have no memory of how they got there 8.Changes in mood or behavior Exhibit rapid mood swings for no apparent reason Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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9.Changes in personality Such as an easygoing person becoming angry, suspicious, or fearful Can change dramatically, either suddenly or over time 10.Loss of initiative May become and remain uninterested in many of their usual pursuits Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Progression is variable from person to person and ranges from 3 to 20 years Initial sign is subtle deterioration in memory Inevitably progresses to more profound memory loss Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Recent events and new information cannot be recalled Behavioral manifestations are not intentional or controllable because of ongoing loss of neurons Some develop psychotic manifestations Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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In AD that has progressed Dysphasia Apraxia Visual agnosia Dysgraphia Some long-term memory loss Wandering Aggression Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Late stages Unable to communicate Cannot perform activities of daily living Patient may be unresponsive and incontinent, requiring total care Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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Early findings show people who engage in activities that involve information processing have a decreased risk of developing AD Reading Crossword puzzles Learning a new language Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
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