Question

you are the nurse working triage in the emergency department. this afternoon, a woman brings in her
father, K.B., who is 74 years old. the daughter reports that over the past year she has noticed her father has
progressively had problems with his mental capacity. these changes have developed gradually but seem
to be getting worse. at times he is alert and at other times he seems disoriented, depressed, and tearful.
He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and
sugar in the refrigerator. K.B. reports that he has been having memory problems for the past year and
at times has difficulty remembering the names of family members and friends. His neighbor found him
down the street 2 days ago, and K.B. did not know where he was. this morning he thought it was nighttime
and wondered what his daughter was doing at his house. He could not pour his own coffee, and he
seems to be getting more agitated. a review of his past medical history is significant for hypercholesterolemia
and coronary artery disease. He had a myocardial infarction 5 years ago. K.B.'s vital signs today are
all within normal limits.
1. What are some cognitive changes seen in a number of elderly patients?
2. You know that physiologic age-related changes in the elderly can influence cognitive
functioning. Name and discuss one.

3. For each behavior listed, specify whether it is associated with delirium (DL) or dementia (DM).
_____ a. Gradual and insidious onset
_____ b. Hallucinations or delusions
_____ c. A sudden, acute onset of symptoms
_____ d. Progressive functional impairment
_____ e. Inability to perform activities of daily living (ADLs)
_____ f. Incoherent interactions with others
_____ g. Possible wandering behavior
_____ h. Behavioral disorders that often worsen at night

4. Based on the information provided by the daughter, do you think K.B. is showing signs of
delirium or dementia? Explain.
5. You know that there are several types of dementia that result in cognitive changes. List two of
these types of dementia.
6. How can the level or degree of the dementia impairment be determined?
7. A number of diagnostic tests have been ordered for K.B. From the tests listed, which would
be used to diagnose dementia?
______ Mental status examinations
______ Toxicology screen
______ Mini-Mental State Examination
______ Electrocardiogram
______ Electroencephalogram
______ Complete metabolic panel
______ Complete blood count with differential
______ Thyroid function tests
______ Colonoscopy
______ Rapid plasma reagin (RPR) test
______ Serum B12 level
______ Bleeding time
______ Human immunodeficiency virus screening
______ Liver function tests
______ Vision and hearing evaluation
______ Magnetic resonance imaging (MRI)

After review of K.B.'s history and diagnostic test results, K.B. is diagnosed with Alzheimer's dementia. The
physician calls a family conference to discuss the implications with K.B. and his daughter.

8. What neuroanatomic changes are seen in individuals with Alzheimer's disease?
9. List at least three interventions you would plan for K.B.

K.B. is discharged and sees his primary care physician 2 days later. K.B. receives a prescription for donepezil
(Aricept) 5 mg PO per night. As you review the prescription with K.B.'s daughter, she tells you that she is
"excited" because she did not know there were medications that could cure Alzheimer's disease.
10. How do you respond?

Two weeks later, K.B.'s daughter calls the physician's office and states, "I realize that the Aricept will not
cure my dad, but there has been no improvement at all. Are we wasting our money?"
11. What is the best answer for her question?

12. K.B.'s daughter mentions that she has found him out in the front yard and once in the
neighbor's yard. What are some interventions that you can suggest to promote safety
for K.B.?

Answer 1

1. In general, however, the symptoms of cognitive decline that are associated with aging include: Slower inductive reasoning / slower problem solving. Diminished spatial orientation. Declines in perceptual speed

2.  Measurable changes in cognition occur with normal aging. The most important changes are declines in cognitive tasks that require one to quickly process or transform information to make a decision, including measures of speed of processing, working memory, and executive cognitive function.

Sustained Attention

Sustained attention refers to the ability to maintain concentration on a task over an extended period of time. Typically, vigilance tasks are used to measure sustained attention, in which people must monitor the environment for a relatively infrequent signal, such as a blip on a radar screen. In general, older adults are not impaired on vigilance tasks

3. ADEG related to dementia rest delerium

4. DEMENTIA. Forgetting things , poor decision makings, forgetting proper places of objevcts all are features of dementia

5.

The most common types of dementia include:

• Alzheimer's disease. The most common type of dementia, Alzheimer's disease makes up 60 to 80 percent of dementia cases.
• Vascular dementia. This type of dementia is caused by reduced blood flow in the brain. ...
• Lewy body dementia. ...
• Parkinson's disease. ...
• Frontotemporal dementia.

6.

• a thorough medical history
• a careful physical exa m
• laboratory tests, including blood tests
• a review of symptoms, including changes in memory, behavior, and brain function
• a family history

7. Mental status examinations
______ Mini-Mental State Examination
______ Electroencephalogram
______ Complete metabolic panel
______ Thyroid function tests
______ Serum B12 level
______ Vision and hearing evaluation
______ Magnetic resonance imaging (MRI

8. The neuropathological hallmarks of Alzheimer disease (AD) include “positive” lesions such as amyloid plaques and cerebral amyloid angiopathy, neurofibrillary tangles, and glial responses, and “negative” lesions such as neuronal and synaptic loss.

9.

Two types of medication are used to treat symptoms of Alzheimer’s disease:

• Cholinesterase inhibitors. These drugs increase a chemical called acetylcholine. This chemical may help form memories and improve judgment. It may also delay worsening symptoms of Alzheimer’s disease (AD).
• Memantine. This drug is used to delay the onset of cognitive and behavioral symptoms in people with moderate or severe AD. It may let people with AD maintain normal mental functions for a longer period of time.

These two drugs may also be prescribed together. Side effects can occur, so learn more about the possible complications of these medications.

Non-drug therapies

These therapies may help reduce symptoms of dementia and alleviate some of the manageable complications of the diseases. Common non-drug treatments for dementia include:

• Modifying your environment. Clutter, noise, and overstimulation may reduce focus.
• Modifying common tasks. You can work with a therapist or other health care provider to break down everyday tasks, such as showering or grooming, into manageable tasks.
• Occupational therapy. These specialized health care providers can help you learn to be safer and more secure with tasks including walking, cooking, and driving.

10 and 11  Medication will never improve the condition but it may slow down the process of worsining the condition