Unformatted text preview: The 3D Lecture
Lisa Zaynab Killinger, DC
Healthy What are the 3Ds?
What 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. Depression
• Acute or chronic
• Often precipitate by life events, chronic
pain, or chemical imbalance
• 80% of depressions are totally reversed
• Important to detect/screen for to
prevent suicide (the worst outcome of
• Often confused with dementia; can’t Causes of Depression
Social change or psychological stress
Organic brain disorders
Immunological disease-RA, Lupus, etc. Assessment/Management
• Mini-mental status exam
• Geriatric Depression Scale-score > 8 ?
• Ask about life events, trauma,
• 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 Dementia
• Chronic confusion
• Loss of memory, language, judgement,
• Alzheimer’s is most common type
• Slow, gradual onset (years to decades)
• Changes in behavior and personality
• No known cure Dementia Etiologies
• Alcoholic or toxic
• Degenerative-neurofibrilar tangles
• Epileptic or apoplectic-w/
• Paralytica-pt becomes paralyzed
• Syphilis, AIDs or Post-febrile
• Trauma Alzheimer’s:
• *Memory impairment (progressive
• *Language prob: Aphasia, Apraxia, etc.
• *Impairment of social or occupation fx.
• *Age 40-90
• *No disturbance of consiousness
• Also may wander, inapprop.
(Maletta; 1995) 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) Management: Alzheimer’s
• Adjust: then refer for further eval.
• Reminiscence….remember when
• Prevention: Regular interaction with
• Also: Mental exercises, crosswords,
math, brain teasers, puzzles Alz: Common Drug Therapies
• Risperodone (newer)
Quetiapine, Clozapine, Ziprasidone
(Schneider; 1990) 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) Delirium
• Acute confusion
Sudden, rapid onset
Cause: Drug reaction, infection, trauma
Difficulties w/attention, thinking,
• Disturbances in sleep, psychomotor
• Often confused with Alzheimer’s
• Completely reversible if treated Delirium-Types
• Alcoholic or drug induced
suicidal tendencies,(pt needs constant
• Mini-mental status exam
• Physical exam-check for fever/infection
• Medication evaluation (drugs are
• Ask about alcohol-More than 6
• Manage: adjust, care for infection, refer
for reconsideration of drugs, alcohol
rehab. Ramifications of
Misclassification 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? 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?
What 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? TAKE HOME MESSAGES:
1. Some of your patients will
2. Know the different types, and
3. Have a plan of action, some
resources, and another health
professional to confer with
4. Don’t be afraid/keep your pts safe! Thank you for your attention!
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- Summer '09
- Neurology, Mental confusion, Mini-Mental Status Exam