Dementia

Dementia related behaviors, symptoms, etc.

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Dementia by Mind Map: Dementia

1. SPEECH/LANGUAGE/COMPREHENSION

1.1. incoherent, nonsensical, irrelevant, or rambling, lacking in semantic content (i.e. meaningless)

1.2. empty speech (using ambiguous referents, i.e. use of pronouns where it hasn't been established who/what the pronouns refer to)

1.3. spontaneous versus nonspontaneous i.e. does vs doesn't initiate much speech

1.4. speech latency (pauses between questions and answers)

1.5. PARAPHASIAS

1.5.1. Verbal Paraphasia

1.5.1.1. confusions of words or the replacement of one word by another real word

1.5.2. Neologistic Paraphasia

1.5.2.1. substitution of words with non-words

1.5.3. Literal/phonological paraphasia

1.5.3.1. where more than half of the spoken word is said correctly; substitution of a word with a nonword that preserves at least half of the segments and/or number of syllables of the intended word

1.6. APHASIA

1.6.1. i) Broca's (expressive) aphasia -- characterized by non-fluent or telegraphic-type speech - where articles, conjunctions, prepositions, auxiliary verbs, pronouns and morphological inflections (plurals, past tense) are omitted. The word substitutions are infrequent and distortion of consonants and simplification of consonant clusters is frequent. Content words such as nouns, verbs and adjectives may be preserved. Typically, unaware of their errors in speech and do not realize their speech lacks meaning. Effortful speech output.

1.6.2. ii) Wernicke's (receptive) aphasia -- characterized by fluent (spontaneous, grammatically shaped sentences, preserved prosody) language with made up or unnecessary words with little or no meaning to speech … difficulty understanding others speech and are unaware of their own mistakes…when corrected they will repeat their verbal paraphasias and have trouble finding the correct word. Effortless speech output.

1.7. Issues related to speech intelligibility

1.7.1. unintelligible speech due to post-stroke dysarthria

1.7.2. unintelligible speech due to oral facial dyskinesia

1.7.2.1. speech impairment accompanying TD -- deficits common in timing, phonation and articulation

1.7.3. unintelligible speech due to edentulous orodyskinesia

1.7.3.1. Older adult patients can exhibit choreic-like movements of the lips, tongue, and jaw associated with ill-fitting dentures or lack of dentures

1.7.4. unintelligible speech due to Parkinson's disease

1.7.4.1. dysarthria

1.7.4.1.1. A motor speech disorder or impairment in speaking due to PD affecting the muscles required for speech

1.7.4.2. hypophonia

1.7.4.2.1. Soft speech or an abnormally weak voice caused by the weakening muscles

1.7.4.3. tachyphemia

1.7.4.3.1. Also known as “cluttering,” this is characterized by excessively fast talking and rapid stammering that can be difficult to understand

2. BEHAVIORS

2.1. PHYSICALLY NONAGGRESSIVE BEHAVIORS

2.1.1. Verbal - Vocally Disruptive Behavior

2.1.1.1. aka over-vocalizing, verbal agitation, inappropriate vocalizations, disruptive vocalizing

2.1.1.2. abusive/threatening speech

2.1.1.3. perseveration, repetitive and inappropriate requests, persistent screaming/moaning, repetitive speech, repetitious questioning

2.1.1.4. perseverative speech

2.1.1.4.1. continuous chattering, muttering, singing or humming

2.1.1.5. profane/vulgar speech

2.1.1.6. nonverbal emotional vocalizations

2.1.1.6.1. grunting and bizarre noise-making

2.1.2. Motor Behaviors

2.1.2.1. Involunatary

2.1.2.1.1. Chorea

2.1.2.1.2. Athetosis

2.1.2.1.3. Choreoathetosis

2.1.2.2. Voluntary

2.1.2.2.1. hyperactivity

2.1.2.2.2. falls

2.2. PHYSICALLY AGGRESSIVE

2.2.1. combativeness

2.2.1.1. combative behavior, seemingly unmotivated/untriggered, i.e. random

2.2.1.1.1. e.g. patient who randomly strikes another patient

2.2.1.2. combative with care

2.2.1.2.1. i.e. striking, kicking, biting, etc. caregivers in response to hands-on care

2.2.1.2.2. sometimes specific to type of care, e.g. combative in response to peri-care or showering; sometimes non-specific, i.e. will become combative with any hands-on care

2.2.1.3. combative with hands-on attempts to prevent falling

2.2.1.3.1. some patients with dementia and poor safety awareness will become combative with any touching by caregivers, including caregivers who attempt to grab or hold patient who appears to be falling or at risk of falling

2.2.2. physical resistance

2.2.2.1. physical resistance to care

2.2.2.1.1. i.e. physical resistance to care, but without attempting to harm caregiver(s)

2.2.2.1.2. sometimes specific to a certain type of care; sometimes non-specific, i.e. will resist any hands-on care

2.2.2.2. physical resistance to redirection, e.g. physically resisting redirection from entering others rooms or personal space

2.3. INAPPROPRIATE SEXUAL BEHAVIOR

2.3.1. sex talk

2.3.1.1. making explicit sexual comments, overt requests for sexual activity

2.3.1.2. making obscene gestures

2.3.2. sexual acts

2.3.2.1. exhibitionism

2.3.2.2. assault - touching body parts of another person

2.3.2.3. masturbating in inappropriate times/settings

2.3.2.3.1. intentionally exposing genitals, breasts (female), or buttocks, to another person - behavior appears premeditated and deliberate (versus non-sexual disrobing)

2.3.3. implied sexual acts

2.3.3.1. openly reading pornographic material

2.3.3.2. requesting unnecessary genital care

2.4. Feeding

2.4.1. refusal to eat

2.4.2. inability to self-feed

2.4.2.1. often 2/2 apraxia

2.5. Hygiene

2.5.1. refusal to bathe/shower

2.5.2. toileting behaviors

2.5.2.1. urinating or defecating in places other than the bathroom

2.6. “Sundowning” AKA nocturnal delirium, various definitions include:

2.6.1. temporal pattern of agitation, temporally associated agitation

2.6.2. recurring pattern of psychomotor agitation, confusion, and wandering in the evening

2.6.3. temporally specific pattern of recurring disruptive behaviors

2.6.4. disrupted sleep-wake cycle

3. Thought Process

3.1. confused, bewildered, disorganized

3.2. bradyphrenia, slowed thoughts (often manifest with speech latency)

3.3. circumstantial, tangential, loose associations, flight of ideas

4. PSYCHOTIC FEATURES

4.1. SENSORY MISPERCEPTIONS

4.1.1. AUDITORY MISPERCEPTIONS

4.1.1.1. AUDITORY HALLUCINATIONS

4.1.1.1.1. CAUSES

4.1.1.1.2. Subtypes

4.1.1.2. Auditory release hallucinations (Auditory Charles Bonnet syndrome)

4.1.1.2.1. hallucinatory auditory perception stemming from hypacusis

4.1.2. VISUAL MISPERCEPTIONS

4.1.2.1. VISUAL HALLUCINATIONS

4.1.2.1.1. CAUSES

4.1.2.2. Visual Release Hallucinations (Charles Bonnet syndrome)

4.1.2.2.1. Podoll's criteria

4.1.2.2.2. Gold and Rabins' criteria

4.1.2.3. Dementia-Related Visual Impairment

4.1.2.3.1. Cortical Visual Dysfunction

4.1.2.4. Illusion

4.1.2.4.1. a mistaken sense perception (visual or auditory); the sensory input is there, but it is misinterpreted

4.2. DELUSIONS

4.2.1. Feeling of Presence (FP)

4.2.1.1. Common in patients with Parkinson's disease

4.2.1.2. a.k.a. "extracampine hallucination"

4.2.1.3. the vivid sensation that somebody (distinct from oneself) is present nearby; presence of a silent, emotionally neutral human, perceived not as a visual hallucination but as a vague feeling of somebody being near

4.2.2. Deficits of Recognition

4.2.2.1. Capgras (“imposter”) syndrome

4.2.2.1.1. belief that someone they know has been replaced by an impostor

4.2.2.2. Mirrored-Self Misidentification

4.2.2.2.1. personal images in a mirror is a different person

4.2.3. persecutory/paranoid

4.2.3.1. 73% of delusions in AD

4.2.3.2. common --> someone is stealing things/money

4.2.3.3. phantom boarder

4.2.3.3.1. someone being present in the room, living inappropriately in the home

4.2.4. delusions of infidelity

4.2.4.1. 9.5 of delusions in AD

4.2.5. hypochondriasis/somatic

4.2.5.1. 1.4 of delusions in AD

4.2.6. dead relatives being still alive

4.2.6.1. consider d/t temporal disorientation vs. primary psychosis

4.2.7. Temporal Disorientation

4.2.7.1. misremember remote events as recent OR revert to themselves in a previous time (of note temporal disorientation can masquerade as AVH to caregivers, as patients describe remote events as recent, caregivers often minutes interpret that as patient having recently heard or seen someone, when in fact the patient was simply recalling a remote memory

4.2.8. fluctuating temporal disorientation is considered as the hallmark of delirium

4.2.9. delusional perception (linking a normal sensory perception to a bizarre conclusion, e.g. seeing an airplane means the patient is the president)