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The 3D Lecture

The 3D Lecture. Lisa Zaynab Killinger, DC Healthy Aging . What are the 3Ds?. D’s: There are 3. Depression-A mental state characterized by dejection, lack of hope, and absence of cheerfulness. Delirium-A state of mental confusion, with disorientation to time and place.

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The 3D Lecture

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  1. The 3D Lecture Lisa Zaynab Killinger, DC Healthy Aging

  2. What are the 3Ds?

  3. D’s: There are 3 • Depression-A mental state characterized by dejection, lack of hope, and absence of cheerfulness. • Delirium-A state of mental confusion, with disorientation to time and place. • Dementia-Irrecoverable deteriorative mental state, the common end of many health conditions or scenarios.

  4. Depression • Acute or chronic • Often precipitate by life events, chronic pain, or chemical imbalance (drugs/alcohol) • 80% of depressions are totally reversed with treatment • Important to detect/screen for to prevent suicide (the worst outcome of depression) • Often confused with dementia; can’t focus

  5. Causes of Depression • Drugs/alcohol • Dietary inadequacy • Neoplasias • Social change or psychological stress • Organic brain disorders • Immunological disease-RA, Lupus, etc.

  6. Assessment/Management • Mini-mental status exam • Geriatric Depression Scale-score > 8 ? • Ask about life events, trauma, drugs/alcohol • Drink more than 6 alcoholic bev/day? ! • Management: Adjust, identify support network, refer for counselling/support, drug therapies (prevent suicide !) • Address patient pain-esp. chronic pain

  7. Dementia • Chronic confusion • Loss of memory, language, judgement, etc • Alzheimer’s is most common type • Slow, gradual onset (years to decades) • Changes in behavior and personality • No known cure

  8. Dementia Etiologies • Alcoholic or toxic • Degenerative-neurofibrilar tangles • Epileptic or apoplectic-w/ hemorrhage/tumors (vascular) • Paralytica-pt becomes paralyzed • Syphilis, AIDs or Post-febrile (Infectious) • Trauma

  9. Alzheimer’s: Patient Presentation • *Memory impairment (progressive worsening) • *Language prob: Aphasia, Apraxia, etc. • *Impairment of social or occupation fx. • *Age 40-90 • *No disturbance of consiousness • Also may wander, inapprop. verbalizing/actions, sadness/crying, anorexia, non-responsive (Maletta; 1995)

  10. Assessment/Management • Mini-Mental Status Exam • Rule out delirium, depression, B12 def. • Review history-ask new questions • Neuroimaging: CT or MRI • (AAN, American Academy of Neurology, Practice Parameters: Neurology, 2001)

  11. Management: Alzheimer’s • Adjust: then refer for further eval. • Reminiscence….remember when • Prevention: Regular interaction with people • Also: Mental exercises, crosswords, math, brain teasers, puzzles

  12. Alz: Common Drug Therapies • Risperodone (newer) • Olanzapine (newer) • Chlorpromazine • Thioridazine • Haloperidol • Loxapine • Quetiapine, Clozapine, Ziprasidone • (Schneider; 1990)

  13. Snoezelen • Multisensory environmental therapy • Stimulates the senses of touch, hearing, taste, smell, and sight • Soft music, favorite foods, photos, aromatherapy, textured objects, etc. • Used widely in UK/Europe; now in US (J Geront Nursing; March 2002)

  14. Delirium • Acute confusion • Sudden, rapid onset • Cause: Drug reaction, infection, trauma • Difficulties w/attention, thinking, memory • Disturbances in sleep, psychomotor activity • Often confused with Alzheimer’s • Completely reversible if treated

  15. Delirium-Types • Alcoholic or drug induced • Febrile • Traumatic • Delirium Tremens-hallucinations, suicidal tendencies,(pt needs constant supervision) Restraints?

  16. Assessment/Management • Mini-mental status exam • Physical exam-check for fever/infection • Medication evaluation (drugs are confusing) • Ask about alcohol-More than 6 drinks/day? • Manage: adjust, care for infection, refer for reconsideration of drugs, alcohol rehab.

  17. Ramifications of Misclassification

  18. Florence, 75, a long standing pt of yours comes to you after a 6 month break from care, and has trouble filling out the intake forms. She seems to be less lucid than when you saw her last, and doesn’t seem to care about the missing answers on the form.What do you do?

  19. Harry, an 83 yr old patient, has always been sharp as a tack. This time, his daughter, who drives him to his appointment, tells you she’s very worried. She states that Harry has been very confused for a couple of days. He just recently saw his MD. What do you do?

  20. You are worried about Charlie. He has been a patient of yours for almost a decade. You have observed a gradual decline in his memory. He states that he got lost coming to your office, even though his been there hundreds of times. He has no living family members;he’s a loner.What do you do?

  21. TAKE HOME MESSAGES:1. Some of your patients will experience confusion2. Know the different types, and differentials3. Have a plan of action, some resources, and another health professional to confer with4. Don’t be afraid/keep your pts safe!

  22. Thank you for your attention!

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