Minor cognitive alteration: intellectual decrease of clinical appearance but there isn’t functional incapacity. If would be this last, it will denominate dementia.
Petersen’s Rules to include minor cognitive alteration:
- Memory fails.
- Normal general cognitive efficiency.
- Absence of functional defects in day – to – day activities.
DETERIORATION COGNITIVE EVALUATION
- Memory: it loss the work memory, episodic and free memory.
- Language: it loss the denomination and decreased the verbal fluency.
- Decreased the reasoning, capacity to resolve problems and the velocity to process the information.
- It preserves the attention.
- Neurologic evaluation: level of attention, orientation, collaboration, senses, muscle tone, trembling or other moves.
It’s important to identify the:
- Delirium: alterations in the attention and the level of conscience.
- Depression: loss of memory, psychomotor slowing – down, less motivation to do the tests.
- Mini mental state examination de Folstein (MMSE): examine the orientation, attention, calculation, memory, language and constructive ability.
- Memory impairment screen (MIS): explore de memory.
- 7 minutes test: explore the aspects has been altered in the Alzheimer.
DEMENTIA
Decrease of memory and psychological alterations.
Primary degenerative dementia
- Alzheimer, Pick disease, Parkinson disease, Huntington…
Vascular dementia
- Because of ischemic, heart attack, hemorrhage…
Secondary dementia
- Metabolic, endocrine, infection, drugs, psychiatric…
ALZHEIMER
Deterioration of memory, destruction of intellectual function and change of personality. It is classifies in 3 states:First state:
- Memory: loss of memory, difficulty to remember nouns or words, loss in family ways…
- Language: decrease of communication, reduction in vocabulary, without facial expression, to say impertinences…
- Behavior and mood: change of mood, depression, facility to distraction, necessity to look for people or places families…
- Coordination: slowing – down of reaction time, incapacity to drive.
Second state:
- Memory: unknowing about all the recent events.
- Language: repeat the same words and phrases, to speak slowly, decrease demonstration of affection, shaking, hallucination, dream alteration.
- Coordination: loss of coordination and equilibrium, difficulty to walk and write.
- Own care: necessity of help to wash, choose the cloth, fecal and urinary incontinence.
Final state:
- Memory and language: incapacity to learn new concepts, loss of memory of recent and past events, reduction of vocabulary, incapacity to read and comprehension and repeat words or phrases.
- Behavior and mood: frequently shaking, incapacity to remember the career, difficulty to walk, write, sit down, smile or swallow.
- Own care: necessity to most help to realize the daily activities life.
Treatment
First state: antidepressant, stimulants or other drugs, do exercises in group or individually like puzzle, read... or physical activities.
Final state: morphine and counsel.
Global deterioration scale de Reisberg
This scale evaluates the patients with Alzheimer and classifies them in 7 states.
Communication and organization in home
Communication
- Verbal: short and less words and simple phrases.
- Nonverbal: gesture, smile, silence, corporal posture, facial expression.
Organization:
Sign the rooms with draws or simple words and remodel the rooms if is necessary.
Video about the Alzheimer, his symptoms, how to communicate with the patient…
It’s a
syndrome with alteration in the level of conscience, attention, memory,
orientation, thought, language or perception. The patients also have illusion
and hallucination because he/she misunderstand the reality.- Serious disease, depression, alcohol, dehydration, malnutrition.
- Iatrogenic, physical restriction, use of urinary catheter.
Non pharmacology treatment
- The patient has to have a mater, help
in the orientation, lit room…
Pharmacology treatment
- Haloperidol, tioridacina,
levopromacina…
Video. How to
recognize the delirium.
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