NUR 302 Final Exam (Dementia & Alzheimer’s Disease Insights)
with all Correct & 100% Verified Answers |Already Graded A+
(Sheridan College)
, LAB FINAL EXAM
DEMENTIA AND ALZHEIMERS (application)
MILD AND MAJOR NEUROCOGNITIVE DISORDERS
DEMENTIA
• Broad term used to describe progressive deterioration of cognitive functioning and global impairment of intellect
• Not a specific disease, a collection of symptoms
• Insidious (slow) progressive onset
• Interferes with routine, personal, social, and occupational activities
• Loss of multiple abilities – memory deficits and one of the following:
o Problems with motor activities (apraxia)
o Difficulties with object identification (agnosia)
o Language deficits (aphasia)
o Ability to think and understand (executive functioning)
Types of Dementia
• Vascular dementia – post CVA/stroke, lack of nutrients in brain
• Parkinson’s dementia –dopamine producing cells develop lesions
• Frontotemporal dementia (FTD) – degenerative process in frontal and temporal lobes
• Huntington’s disease –genetic defect, late 30s or 40s progressive degeneration of cognition, mood and movement
• Alzheimer’s disease (AD)- progressive, degenerative disorder that affects brain cells and results in impaired memory,
thinking, behavior
ALZHEIMERS DISEASE (AD)
• Canadians 1 in 11 over age of 65 years
• Number of people with AD will double every 20 years
• AD 70% of all dementias in Canada
• Effects all groups
• 72% of those effected are women
• Majority late onset 65 or older.
Etiology of Alzheimer’s Disease
1. Neurobiological Factors
Neuronal Degeneration
✓ Brain atrophy begins in hippocampus and spreads into cerebral cortex.
✓ Beta-amyloid plaques-protein deposits or sticky clumps outside between neurons interferes with synapses.
✓ Neurofibrillary tangles-accumulation of tau protein inside the neurons which forms tangles that block the flow of nutrients.
✓ Results in Neurotransmitter deficiencies (ACh) – decreased availability to the cells. Results in changes in
memory, ability to learn and mood.
2. Genetic
✓ Higher risk of acquiring if a family member has AD
✓ Three known genetic mutations guarantee development in 1% of all cases. Early onset before age 65 and as young as
30 yrs.
✓ Susceptibility gene for late onset has been identified
3. Head Injury and Traumatic Brain Injury
✓ Greater risk of developing AD
4. Cardiovascular Disease
✓ Related to inactivity, high cholesterol, smoking
✓ Diabetes, obesity, high blood pressure
5. Environmental Factors
▪ Some evidence that brain health is affected by modifiable factors.
▪ Seven key modifiable risk factors being studied: diabetes, high blood pressure, obesity, smoking, depression,
cognitive inactivity and physical inactivity.
Clinical Stages
Mild (early), Moderate (middle), Severe (late)
, LAB FINAL EXAM
Two categories
1. Early onset (before 65yrs)
2. Late onset
Alzheimer’s disease preclinical
• No impairment
• Prior to symptoms
• Identified through AD biomarkers including MRI, PET scans, and proteins in the cerebrospinal fluid (CSF)
• Recent research focusing on presence of tau protein
DSM5 CRITERIA NEUROCOGNITIVE DISORDERS (AD)
Mild Neurocognitive Disorder
• Mild to moderate cognitive decline.
• Insidious changes in intellectual ability.
• Loss of energy, drive and initiative with
difficulty learning new things.
• May continue to work. Becomes evident in new
or demanding situations.
• Self-awareness often leads to depression.
Major Neurocognitive Disorder (Dementia)
• Memory and cognitive decline increases
• (4A’s-Amnesia, Aphasia, Agnosia and Apraxia)
• Impaired independence and assistance required
• Behavior problems
• Self-care deficit, incontinence
• Poor judgment, sleep disturbance, paranoid delusions
COGNITIVE SCREENING TOOLS
Standardized Mini-Mental State Exam (MMSE)
• Commonly used for screening cognitive impairment.
• Used alone will NOT diagnose dementia.
• Quantify cognitive function and screen for cognitive loss.
• Tests the individual’s orientation, attention, calculation, recall, language and motor skills.
Geriatric Depression Scale (GDS)
▪ Depression is a common cause of mental illness with the aging population.
▪ Screening for depression is important.
▪ Need to know if it overlaps the diagnosis of dementia.
▪ Ask for suicidal thoughts/plan of harming oneself.
Geriatric Depression Scale: Short Form
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
, LAB FINAL EXAM
15. Do you think that most people are better off than you are? YES / NO
SCORING THE GDS
• Answers in bold indicate depression.
• Score 1 point for each bolded answer.
• A score > 5 points is suggestive of
depression. Follow-up assessment needed.
• A score ≥ 10 points is almost always indicative of depression
DEPRESSION VS. DELIRIUM AND DEMENTIA
• Variable onset that is abrupt and reversible with treatment.
• Clear sensations and perceptions of environment.
• Normal attention span but easily distracted.
• Selective memory impairment.
• Intact thinking but displays:
o Hopelessness
o Helplessness
o Negative thought content
• Changes in sleep patterns, appetite, increased fatigue
NEUROCOGNITIVE DISORDER GOALS
Consider:
• Short-term goals -preoperative or postoperative care. Stabilization of medical, health, and safety needs.
• Long-term goals-maintaining patient’s highest functional level
• Educating the caregiver about effective and realistic outcomes/interventions
• Referral for community resources
INTERVENTIONS
• Keep all interactions calm, reassuring and pleasant.
• Set up structured routines with some flexibility.
• Validate patient’s feelings with words, body language, and actions.
• Simplify the verbal message using no more than 5 or 6 words at a time.
CATASTROPHIC REACTIONS
• Disorganized behavior due to a threatening situation.
• Displayed as verbal or physical aggression, worry, mood swings, pacing, paranoia, crying or hysteric laughter.
• Reassure the patient that they are safe. Maintain personal space. Do not touch without asking permission.
• Eliminate or reduce stimulation. Identify and remove the source of the problem or the patient.
• Redirect to a less demanding activity, soft nonthreatening.
• Be patient and allow the patient to calm down.
INTERVENTIONS FOR CATASTROPHIC REACTIONS
Recommended intervention if the reaction cannot be stopped or minimized:
• Leave the patient alone for a while in a quiet safe place within view
• Have one person address the patient
• When talking to the client again act as if nothing has happened
TREATMENT
Interdisciplinary team:
▪ Informal support groups
▪ Formal support groups
▪ Care-giver support required
Therapeutic activities:
• Goal: to keep the person functioning at the highest possible level
• Building on strengths
PHARMACOTHERAPEUTICS
with all Correct & 100% Verified Answers |Already Graded A+
(Sheridan College)
, LAB FINAL EXAM
DEMENTIA AND ALZHEIMERS (application)
MILD AND MAJOR NEUROCOGNITIVE DISORDERS
DEMENTIA
• Broad term used to describe progressive deterioration of cognitive functioning and global impairment of intellect
• Not a specific disease, a collection of symptoms
• Insidious (slow) progressive onset
• Interferes with routine, personal, social, and occupational activities
• Loss of multiple abilities – memory deficits and one of the following:
o Problems with motor activities (apraxia)
o Difficulties with object identification (agnosia)
o Language deficits (aphasia)
o Ability to think and understand (executive functioning)
Types of Dementia
• Vascular dementia – post CVA/stroke, lack of nutrients in brain
• Parkinson’s dementia –dopamine producing cells develop lesions
• Frontotemporal dementia (FTD) – degenerative process in frontal and temporal lobes
• Huntington’s disease –genetic defect, late 30s or 40s progressive degeneration of cognition, mood and movement
• Alzheimer’s disease (AD)- progressive, degenerative disorder that affects brain cells and results in impaired memory,
thinking, behavior
ALZHEIMERS DISEASE (AD)
• Canadians 1 in 11 over age of 65 years
• Number of people with AD will double every 20 years
• AD 70% of all dementias in Canada
• Effects all groups
• 72% of those effected are women
• Majority late onset 65 or older.
Etiology of Alzheimer’s Disease
1. Neurobiological Factors
Neuronal Degeneration
✓ Brain atrophy begins in hippocampus and spreads into cerebral cortex.
✓ Beta-amyloid plaques-protein deposits or sticky clumps outside between neurons interferes with synapses.
✓ Neurofibrillary tangles-accumulation of tau protein inside the neurons which forms tangles that block the flow of nutrients.
✓ Results in Neurotransmitter deficiencies (ACh) – decreased availability to the cells. Results in changes in
memory, ability to learn and mood.
2. Genetic
✓ Higher risk of acquiring if a family member has AD
✓ Three known genetic mutations guarantee development in 1% of all cases. Early onset before age 65 and as young as
30 yrs.
✓ Susceptibility gene for late onset has been identified
3. Head Injury and Traumatic Brain Injury
✓ Greater risk of developing AD
4. Cardiovascular Disease
✓ Related to inactivity, high cholesterol, smoking
✓ Diabetes, obesity, high blood pressure
5. Environmental Factors
▪ Some evidence that brain health is affected by modifiable factors.
▪ Seven key modifiable risk factors being studied: diabetes, high blood pressure, obesity, smoking, depression,
cognitive inactivity and physical inactivity.
Clinical Stages
Mild (early), Moderate (middle), Severe (late)
, LAB FINAL EXAM
Two categories
1. Early onset (before 65yrs)
2. Late onset
Alzheimer’s disease preclinical
• No impairment
• Prior to symptoms
• Identified through AD biomarkers including MRI, PET scans, and proteins in the cerebrospinal fluid (CSF)
• Recent research focusing on presence of tau protein
DSM5 CRITERIA NEUROCOGNITIVE DISORDERS (AD)
Mild Neurocognitive Disorder
• Mild to moderate cognitive decline.
• Insidious changes in intellectual ability.
• Loss of energy, drive and initiative with
difficulty learning new things.
• May continue to work. Becomes evident in new
or demanding situations.
• Self-awareness often leads to depression.
Major Neurocognitive Disorder (Dementia)
• Memory and cognitive decline increases
• (4A’s-Amnesia, Aphasia, Agnosia and Apraxia)
• Impaired independence and assistance required
• Behavior problems
• Self-care deficit, incontinence
• Poor judgment, sleep disturbance, paranoid delusions
COGNITIVE SCREENING TOOLS
Standardized Mini-Mental State Exam (MMSE)
• Commonly used for screening cognitive impairment.
• Used alone will NOT diagnose dementia.
• Quantify cognitive function and screen for cognitive loss.
• Tests the individual’s orientation, attention, calculation, recall, language and motor skills.
Geriatric Depression Scale (GDS)
▪ Depression is a common cause of mental illness with the aging population.
▪ Screening for depression is important.
▪ Need to know if it overlaps the diagnosis of dementia.
▪ Ask for suicidal thoughts/plan of harming oneself.
Geriatric Depression Scale: Short Form
Choose the best answer for how you have felt over the past week:
1. Are you basically satisfied with your life? YES / NO
2. Have you dropped many of your activities and interests? YES / NO
3. Do you feel that your life is empty? YES / NO
4. Do you often get bored? YES / NO
5. Are you in good spirits most of the time? YES / NO
6. Are you afraid that something bad is going to happen to you? YES / NO
7. Do you feel happy most of the time? YES / NO
8. Do you often feel helpless? YES / NO
9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO
10. Do you feel you have more problems with memory than most? YES / NO
11. Do you think it is wonderful to be alive now? YES / NO
12. Do you feel pretty worthless the way you are now? YES / NO
13. Do you feel full of energy? YES / NO
14. Do you feel that your situation is hopeless? YES / NO
, LAB FINAL EXAM
15. Do you think that most people are better off than you are? YES / NO
SCORING THE GDS
• Answers in bold indicate depression.
• Score 1 point for each bolded answer.
• A score > 5 points is suggestive of
depression. Follow-up assessment needed.
• A score ≥ 10 points is almost always indicative of depression
DEPRESSION VS. DELIRIUM AND DEMENTIA
• Variable onset that is abrupt and reversible with treatment.
• Clear sensations and perceptions of environment.
• Normal attention span but easily distracted.
• Selective memory impairment.
• Intact thinking but displays:
o Hopelessness
o Helplessness
o Negative thought content
• Changes in sleep patterns, appetite, increased fatigue
NEUROCOGNITIVE DISORDER GOALS
Consider:
• Short-term goals -preoperative or postoperative care. Stabilization of medical, health, and safety needs.
• Long-term goals-maintaining patient’s highest functional level
• Educating the caregiver about effective and realistic outcomes/interventions
• Referral for community resources
INTERVENTIONS
• Keep all interactions calm, reassuring and pleasant.
• Set up structured routines with some flexibility.
• Validate patient’s feelings with words, body language, and actions.
• Simplify the verbal message using no more than 5 or 6 words at a time.
CATASTROPHIC REACTIONS
• Disorganized behavior due to a threatening situation.
• Displayed as verbal or physical aggression, worry, mood swings, pacing, paranoia, crying or hysteric laughter.
• Reassure the patient that they are safe. Maintain personal space. Do not touch without asking permission.
• Eliminate or reduce stimulation. Identify and remove the source of the problem or the patient.
• Redirect to a less demanding activity, soft nonthreatening.
• Be patient and allow the patient to calm down.
INTERVENTIONS FOR CATASTROPHIC REACTIONS
Recommended intervention if the reaction cannot be stopped or minimized:
• Leave the patient alone for a while in a quiet safe place within view
• Have one person address the patient
• When talking to the client again act as if nothing has happened
TREATMENT
Interdisciplinary team:
▪ Informal support groups
▪ Formal support groups
▪ Care-giver support required
Therapeutic activities:
• Goal: to keep the person functioning at the highest possible level
• Building on strengths
PHARMACOTHERAPEUTICS
