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Dementia is not a disease in and of itself, but a collection of:
symptoms
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According to DSM, the diagnostic criteria for dementia is:
- loss of intellectual abilities severe enough to interfere w/ function
- memory impairment including recent and remote memory
- plus at lease one of the following
- -impaired abstract thinking
- -impaired judgement
- -other disturbances of higher cortical function including aphasia, apraxia, agnosia, constructional difficulty, inability to perform self-care, emotional and personality changes
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Reversible dementias include:
- psychiatric disorders (depression, anxiety, and psychosis)
- medication side affects/polpharmacy
- nutritional disorders
- metabolic disorder
- obstructive or normal pressure hydrocephalus
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Irreversible dementias include:
- Alzheimer's
- Vascular dementia
- multi infarct dementia
- AIDS Dementia
- MS Dementia
- Parkinson's dementia
- frontotemporal dementia
- Huntington's dementia
- Pick's disease
- Lewy Body dementia
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What is Alzheimer's disease?
irreversible, progressive brain disease that slowly destroys memory and thinking skills
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Neurons:
- the brain has billions of neurons, each w/ an axon and many dendrites
- to stay healthy, neurons must communicate w/ each other, carry out metabolism, and repair themselves
- AD disrupts all three of these essential jobs
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The hallmarks of AD:
plaques and tangles
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beta-amyloid plaques:
dense deposits of protein and cellular material that accumulate outside and around nerve cells
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neurofibrillary tangles:
twisted fibers that build up inside the nerve cell
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What is the precursor to amyloid plaque?
amyloid precursor protein (APP)
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Amyloid precursor protein:
- sticks through the neuron membrane
- enzymes cut the APP into fragments of protein, including beta-amyloid
- beta-amyloid fragments come together in clumps to form plaques
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In AD, many beta-amyloid clumps form, disrupting the work of neurons. This affects the:
hippocampus and other areas of the cerebral cortex
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Neurons have an internal support structure partly made up of microtubules. A protein called tau helps stabilize microtubules. In AD, tau changes, causing...
microtubules to collapse, and tau proteins clump together to form neurofibrillary tangles
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Epidemiologic studies:
- mentally stimulating activity protects the brain in some ways
- exercise has equally protective highlights
- in early life, higher skills in grammar and density of ideas are associated w/ protection against AD in late life
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Early diagnosis has advantages:
- doctors can rule out other conditions that may cause dementia
- if it is AD, families have more time to plan
- tx can start earlier, when they may be more effective
- helps scientists learn more about the causes and development of AD
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Physicians today use a number of tools to diagnose AD:
- a detailed pt history
- info from family and friends
- physical and neurological exams and lab tests
- neuropsychological tests
- imaging tools such as CT scan, or MRI. PET scans are used primarily for research purposes
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Drugs used to treat mild to moderate AD symptoms include:
- aricept
- exelon
- reminyl
- namenda (mod-severe)
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Signs of preclinical AD are first noticed in the...
entorhinal cortex, then proceed to hippocampus
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Preclinical AD affected regions begin to shrink as...
nerve cells die
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Preclinical AD changes can begin ___-___ years before symptoms appear.
10-20
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what is the first sign of preclinical AD?
memory loss
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What are the stages of AD?
- preclinical
- mild
- moderate
- severe
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In mild AD, the cerebral cortex begins to shrink as more and more neurons stop working and die. Goals are:
to help the person cope w/ the changes and maintain their independence
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Mild AD deficits can include:
- impaired learning and recent memory
- impaired ability to attend to a specific stimulus in a complex environment
- misplacing/losing personal possessions
- word finding/anomia
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Intervention for mild AD may include:
- memory aids
- central and same location for possessions
- use of routine and habit
- ask simple questions
- allow extra time
- avoid correcting errors
- respect denial as a coping skill
- protect safety
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Mild Cognitive Impairment (MCI)
- research indicates that improved performance is possible, but no standardized intervention approach
- skill-building through task-oriented motor practice (STOMP)
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Skill-building through Task-Oriented Motor Practice (STOMP):
- motor learning approach using mass practice
- preliminary results indicate improvement in everyday tasks that is maintained three months post intervention
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Moderate AD intervention is focused on:
changing the environment and helping caregivers to cope while helping the person live in as least restrictive environment possible
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Moderate AD deficits:
- confusion and disorientation
- safety concerns
- difficulties w/ self-care
- perservation
- sleep disturbances
- angry outbursts and agitation
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Moderate AD intervention:
- use repetition
- minimize distractions
- focus on big picture v. detail
- change environment for safety
- simple one step instructions
- use humor
- use distraction when appropriate
- encourage regular exercise and sleep habits
- be calm
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In severe AD, extreme shrinkage occurs in the brain. Pts are completely dependent on other for care. this stage ultimately results in:
death as the person's brain can't support bodily functions
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Symptoms of severe AD:
- decreased recognition of family and familiar places
- unable to dress
- eating problems
- incontinence
- immobility
- skin breakdown
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Severe AD intervention:
- use routine
- links from the past and environmental cues
- promote automatic overlearned movement
- use reassurance and repetition
- avoid correcting
- avoid rushing
- eliminate safety hazards
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B/w 70-90% of people w/ AD eventually develop behavioral symptoms, including:
sleeplessness, wandering and pacing, aggression, agitation, anger, depression, and hallucinations and delusions
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Experts suggest theses general coping strategies for managing difficult behaviors:
- stay calm and be understanding
- be patient and flexible. Don't argue or try to convince
- acknowledge requests and respond to them
- try not to take behaviors personally. Remember: it's the disease talking, not your loved one
- medical tx is available if needed
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Common Behavioral issues:
- losing important things
- getting lost
- repeated calls
- refusing help
- bad mouthing
- making up stories
- resisting/refusing care
- making 911 calls
- not sleeping
- emotional meltdowns
- swearing, sex talk, racial slurs, insulting
- paranoid/delusional
- threatening
- shadowing
- wandering
- getting into things
- striking out
- not doing personal care
- not following care plan
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List in order the most common caregivers:
- spouses
- daughters
- grandchildren
- daughters-in-law
- sons
- brothers and sisters
- other
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