1 the three d’s an overview session 9. 2 objectives to review the definitions of dementia,...
TRANSCRIPT
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The Three D’san overview
SESSION 9
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Objectives
To review the definitions of Dementia, Depression, and Delirium.
To understand in what ways these cognitive disorders are similar
To understand which features help define or distinguish one from the other.
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Definitions
DEMENTIA DEPRESSION
DELIRIUM
cognitive decline due to brain disease.
acute change in mental status
change in mood with feelings of worthlessness.
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Common Presentation
DEMENTIADEPRESSION
DELIRIUM
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Case A
75F widowed 1 year ago, now living with her son, increasingly more forgetful, increasingly dependent with IADLs, losing weight and getting weaker over the past year, sustained a fall and hip fracture 2 weeks ago, but now not eating well, sleeps all day, restless at night, and not participating well in rehabilitation efforts.
The son is upset about this and wants to know why she is not improving and what you are doing about it.
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Distinguishing Features
Distinguishing Feature
Associated Symptoms
TimeCourse
Delirium
Dementia
Depression
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Case A
75F widowed 1 year ago, now living with her son, increasingly more forgetful, increasingly dependent with IADLs, losing weight and getting weaker over the past year, sustained a fall and hip fracture 2 weeks ago, but now not eating well, sleeps all day, restless at night, and not participating well in rehabilitation efforts.
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DELIRIUM: The Acute History
The son says… Mother confusing him
for her deceased husband
Picks in the air Falls asleep while he’s
trying to talk to her New behavior since
the surgery
The nurse says… Restless at night Placed in hallway by
nurses station because trying to climb out of bed
Pulled out foley and IV once already
Only new med is Acetaminophen
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DEMENTIA: a Chronic and Progressive History The son says…
More forgetful during past year, but not THIS bad!
Previously independent in all ADLsDependent in Shopping, Transportation,
Finances (husband used to do this before)Cooks basic meals (less frequent, less fancy)Complains of fatigue, naps a lot, TV, dosen’t
leave house anymore.
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DEPRESSION: episodic, recurrent The son says…
History of depression in past, on antidepresants intermittently in her lifetime.
On Zoloft 75mg since death of her husband one year ago.
Longtime insomnia, takes ativan 2 mg qhs prn (average 3x per week), awakens 4am
Appetite fair in past year No longer reads books Feelings of despair, thoughts of dying, no suicidal GDS score 7/15
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PMHHTNDepression InsomniaB Knee Arthritis
MEDICATIONSLisinopril 10 mg qdZoloft 75 mg qdAtivan 2 mg qhs prnTylenol 650 mg q4h prn
painCelebrex 100 mg po qd Percocet one tablet po
q4h prn severe pain
NEW
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Physical Exam
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Mini-mental Status Exam Orientation: 2/5 Date: 0/5 Registration: 1/3 Attention: serial
sevens 0/5, WORLD backwards 2/5
Naming: 2/2 Short-term memory:
0/3 3-step command: 1/3 Read and Obey: 1/1 Sentence: 1/1 Visualspatial: 0/1
SCORE=10/30
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Clock-Drawing Task
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Assessment and Plan
DX:DeliriumDepressionmaybe Dementia
PLAN:NonpharmacologicPharmacologic