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Week 7 Concept Map: Cognitive Impairment in Geriatric Patients, Group 15:…

- - - - Being widowed or divorced
      - Social disadvantage, low social support
    - - Female
      - Brain changes due to vascular problems
      - Taking medications
      - Major physical and chronic disabling illnesses
      - Genetics
      - Cardiovascular disease, diabetes, dementia, neurologic disorders
    - - Caregiver burnout
      - Hx of depression and/or anxiety
      - Personality type (avoidant or dependent personality)
    - - Recent bereavement
      - Moving to a nursing home
      - Declining health
      - Adverse life events
      - Family or marital problems
      - Persistent sleep difficulties
  - - - Interest: Loss of pleasure/lack of feeling
      - Concentration: Distractibility
      - Guilt: Often unrealistic
      - Energy: Fatigue
      - Appetite: Decreased or increased
      - Sleep: Insomnia/hypersomnia
      - Psychomotor: Retardation/agitation
      - Suicide: Intent or plan
  - - - For cognitive impairment: MoCA, MMSE
      - For depression: See screening tools section
- - - - Hypertension
      - Smoking, alcohol consumption
      - Diabetes
      - Obesity
      - Lack of physcial activity
      - Poor diet
      - Depression, traumatic brain injury
      - Low levels of cognitive engagement
      - Hearing loss
      - Air pollution
    - - Age
      - Gender
      - Genetics
  - - - Change in cognition
      - Impairment in one or more
        cognitive domains
      - Preservation of independence in
        functional domains
      - Subjective change
  - - - Medication review:
        Minimize poly pharmacy
      - Cholinesterase inhibitors:
        Prevent breakdown of acetylcholine in synapse
      - NMDA receptor antagonists:
        Increases levels of glutamate to reduce damage to nerve cells
    - - Being physically active
      - Being socially active
      - Challenging your brain
      - Eating healthily (Mediterranean diet)
      - Managing stress
      - Cognitive stimulation therapies
      - Plan for the future (advanced directives, POA, applications for LTC)
      - Ensure safety at home (home assessment, fire prevention)
      - Provide caregiver resources
- - - - Age: Over 75 Years old
      - Pre-existing cognitive Impairment
      - Chronic Illness Ex. Heart disease, Lung disease, kidney disease, or liver disease
      - Hearing or visual impairment
      - Polypharmacy: Taking multiple medications, especially psychoactive drugs. Alcohol use
      - Living in an institution (ex. LTC)
      - History of delirium
      - Male
    - - Infections, drug withdrawal
      - Surgery: Postoperative states, especially following major surgeries like hip fractures or cardiac surgery.
      - Metabolic Disturbances: Hypoglycemia, hypercalcemia, or electrolyte imbalances (e.g., hyponatremia).
      - Sleep Deprivation: Poor sleep in hospitalized patients.
      - Environmental Changes: A sudden change in environment, such as hospital admission.
      - Urinary retention, consipation, pain
    - - Depression: Patients with depression or anxiety may be more prone to delirium.
      - Stressful Life Events: Bereavement or other major stressors can trigger episodes.
  - - - It assesses the presence of four features: Acute onset and fluctuating course, Inattention, Disorganized thinking, altered level of consciousness (need training to administer CAM)
  - - - Agitation, restlessness, aggressive, inattention
    - - Lethargy, quiet, less responsive, decreased motor activity, inattention
    - - Hyperactive/hypoactive features, overarching inattention
  - - - Confusion Assessment Method (CAM)
      - 4-AT screening tool (bedside tool)
  - - - Reorientation and Cognitive Stimulation: Frequently reorient the patient to time, place, and person. Use clocks, calendars, and familiar objects from home. Family involvement can help provide cognitive support.
      - Environment: Ensure the patient is in a calm, well-lit, and familiar environment. Reduce sensory overload (e.g., noise, lights) and provide sensory aids like glasses and hearing aids.
      - Mobility: Encourage early mobilization and physical activity to prevent deconditioning, which can worsen delirium.
      - Communication: Use simple, clear communication and establish rapport. Speak slowly and avoid confusing or complex statements.
      - Vision and Hearing: Address sensory deficits by providing glasses or hearing aids if needed.
      - Promote sleep and rest
    - - Antipsychotics and sedatives as a last resort to manage behaviour (not preferred as can worsen cognition)