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3.5.1 Identification of Dementia Symptoms in the Elderly课程教案、知识点、字幕

同学们大家好

今天为大家介绍老年期痴呆症状的识别

老年期痴呆是指

发生在老年期由于大脑退行性病变

脑血管性病变

感染 外伤 肿瘤

营养代谢障碍等多种原因引起的

以认知功能损害为主要临床表现的一组综合症

在美国精神病学会

《精神障碍诊断与统计手册》第5版中有介绍

痴呆被描述为

神经认知障碍

老年期痴呆主要包括阿尔茨海默症

又称AD

血管性痴呆

又称为VD

混合性痴呆和其他类型的痴呆

如额叶痴呆 帕金森病痴呆

路易体痴呆 HIV感染 酒精依赖

外伤等引起的痴呆

其中

AD占所有类型痴呆的50%~70%

而VD约占痴呆患者中的15%~20%

老年期痴呆是一种综合症

其识别诊断需要根据病史

一般及神经系统体格检查

神经心理评估

实验室和影像学检查结果综合分析

由于个体存在差异性

痴呆症对人的影响也各不相同

没有两个人的症状及发展会完全相同

这主要取决于个体的性格

健康状况和社会状况

而决定痴呆症对他们的影响

阿尔茨海默病

和其他类型的痴呆症的症状各不相同

但它们之间有广泛的相似性

国际阿尔兹海默症协会

将以下症状判定为

可能是痴呆症发生的早期表现

第一点

记忆力的衰退尤其是短期记忆

是痴呆最常见的早期症状

一般健忘的人

还能记住

与他们遗忘的事情有关的其他事实

例如

他们可能会暂时忘记他们隔壁邻居的名字

但他们仍然知道和他们谈话的人

是他们的隔壁邻居

但患有痴呆症的人不仅会忘记邻居的名字

还会忘记周围的环境

第二点

难以完成熟悉的任务

患有痴呆症的人经常发现

完成日常任务很困难

而我们通常不考虑如何完成这些日常任务

患有痴呆症的人可能不知道穿衣服的顺序

或准备一顿饭的步骤

这对他们来说都是一种挑战

三 语言的问题

每个人偶尔都很难找到正确的词语去表达

但患有痴呆症的人

经常会忘记简单的单词

或替换不寻常的单词

使演讲或者写作难以理解

第四

对时间和地点的迷失

我们有时会忘记一周中的哪一天

或者我们要去哪里

但是痴呆症患者

可能会在熟悉的地方迷路

比如他们住的路

忘记他们在哪里

或者他们是如何到达那里的

也不知道如何回家

患有痴呆症的人可能会日夜混淆

或日夜颠倒

再者判断力差或下降

痴呆症的患者可能着装不当

在暖和的日子里穿好几层衣服

或者在寒冷的日子里只穿薄薄的几层

理解困难或执行任务问题

患有老年期痴呆症的人

可能会发现很难听懂别人的谈话

或者无法及时地支付账单

忘记东西放在哪里

任何人都可能

暂时把钱包或者钥匙放错地方

但是痴呆症的患者

可能会把东西放在不寻常的地方

比如冰箱里的熨斗

或者糖碗里的手表

情绪或者行为的变化

每个人都会时不时地变得悲伤或者喜怒无常

而患有痴呆症的人可能会变得异常情绪化

无缘无故地经历快速的情绪波动

另一种情况是

痴呆症患者可能会表现出

比以往更少的情绪

性格的变化

患有痴呆症的人可能在某些方面

与他平时的表现不太相同

但这一点很难确定

患者通常会变得多疑

易怒 抑郁 冷漠或焦虑不安

尤其是在记忆力问题造成困难的情况下

表现更为明显

对事物失去兴趣

我们在有些时候可能会对家务

商务活动或社会责任感到疲乏或者厌倦

然而

痴呆症患者可能会变得非常的被动

例如会坐在电视机前数小时

比平时睡得更多

或表现出

对原本感兴趣的业余爱好失去了兴趣

值得注意的是

在关注痴呆认知障碍同时

也应该注意对出现的

精神行为症状进行鉴别

它不仅在痴呆患者中较为常见

在老年期的其他精神障碍中也比较常见

如谵妄 老年期抑郁 老年期焦虑障碍

老年期精神分裂症等

这些疾病也常常伴有认知功能损害

因此

当患者出现

认知功能损害和精神行为症状时

仍需与这些常见的精神障碍进行鉴别

此外由于患者本人有认知损害

缺乏自知力

病人常表现为否认他的病情

虚构自己的出色表现

因此痴呆的病史采集需要有

知情者的在场和确认

应进行详细的体格检查

有助于鉴别诊断痴呆的病因

认知评估是痴呆诊疗的重要环节

对所有的老年人群

都应该进行相应的认知功能评估

尤其是记忆力

注意力和执行功能等方面的结果

此外

认知障碍导致的

日常能力减退是痴呆的前提条件

应当会晤患者本人和知情者

综合评价患者的认知活动能力

总之

我们针对有认知主诉的就诊者

分为2个阶段进行评估

第1阶段

是初步筛查的阶段

除了详细地病史采集与生物标志物检查

认知评估方面

常可以选用多种神经心理学

测量量表组合进行测试

第2阶段

主要目的是临床的分类和诊断

针对不同的认知领域

选择标准化的测验进行一个评估

有助于绘制不同脑易感区病变

所致痴呆的认知损害廓图

好了

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谢谢大家

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-1.1 Human Life Expectancy and Age Classification of the Elderly

--Human Life Expectancy and Age Classification of the Elderly

--【Vedio Recommendation】 How do we measure life expectancy ?

-1.2 Population Aging

--Population Aging

--【Literature Recommendation】World Report on Ageing and Health: 2015

-1.3 Influence and Countermeasures of Population Aging

--Influence and Countermeasures of Population Aging

--【Literature Recommendation】World Population Ageing Highlights:2019

-1.4 Goals and Principles of Elderly Care

--Goals and Principles of Elderly Care

--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice

-1.5 Theories Related to Elderly Care

--1.5.1 Personality Development Theory and Life Review

--1.5.2 Disengagement Theory and Activity Theory

--1.5.3 Self-efficacy and Chronic Disease Management

--【Vedio Recommendation】8 Stages of Development by Erik Erikson

--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging

--【Book Recommendation】Self-Efficacy in Changing Societies

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-1.6 Elderly Support and Elderly Care

--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care

--1.6.2 Home-based Elderly Care Model

--1.6.3 Institutional Elderly Care Model

--1.6.4 Integrated Medical and Nursing Care Model

--【Vedio Recommendation】Day in the Life of Home Care

--【Website Recommendation】Official Website of the National Institutes of Health

-Concept Map

--【Concept Map】General Introduction to Geronological Nursing

-【Test】CHAPTER 1

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-2.1 Aging Changes in the Elderly

--2.1.1 Aging of the Respiratory System

--2.1.2 Aging of the Cardiovascular System

--2.1.3 Aging of the Digestive System

--2.1.4 Aging of the Urinary System

--2.1.5 Aging of the Endocrine System

--2.1.6 Aging of the Motor System

--2.1.7 Aging of the Nervous System

--2.1.8 Aging of the Sensory System

--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging

--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology

-2.2 Comprehensive Health Assessment of the Elderly

--Comprehensive Health Assessment of the Elderly

--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review

-2.3 Principles of Elderly Health Assessment

--Principles of Elderly Health Assessment

-2.4 Assessment of the Functional Status of the Elderly

--Assessment of the Functional Status of the Elderly

--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale

-2.5 Assessment of Cognitive Function in the Elderly

--Assessment of Cognitive Function in the Elderly

-2.6 Assessment and Adjustment of the Living Environment for the Elderly

--Assessment and Adjustment of the Living Environment for the Elderly

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-3.1 Overview of the Psychological Characteristics of the Elderly

--Overview of the Psychological Characteristics of the Elderly

-3.2 Influencing Factors of Psychological Changes in the Elderly

--Influencing Factors of Psychological Changes in the Elderly

-3.3 Common Psychological Issues and Their Management in the Elderly

--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)

--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)

--【Book Recommendation】Development Through the Lifespan

-3.4 Depression in the Elderly

--3.4.1 Overview of Depression in the Elderly

--3.4.2 Clinical Symptoms of Depression in the Elderly

--3.4.3 Caring for Elderly Patients with Depression

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-3.5 Elderly Patients with Dementia

--3.5.1 Identification of Dementia Symptoms in the Elderly

--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia

--3.5.3 Safety Care of Elderly Patients with Dementia

--【Website Recommendation】The Global Voice on Demaentia

-Concept Map

--【Concept Map】Elderly Mental Health and Mental Health Care

-【Test】CHAPTER 3

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-4.1 Precautions for Daily Care of the Elderly

--Precautions for Daily Care of the Elderly

-4.2 General Care of Elderly Skin

--4.2.1 Characteristics and General Care of Elderly Skin

--4.2.2 Skin Itching and Its Management in the Elderly

--【Website Recommendation】American Academy of Dermatology

-4.3 Clothing Hygiene for the Elderly

--Clothing Hygiene for the Elderly

--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly

-4.4 Dietary Care for the Elderly

--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs

--4.4.2 Dietary Care for the Elderly

--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics

--【Website Recommendation】Nutrition for older persons

-4.5 Sleep Guidance for the Elderly

--4.5.1 Sleep Characteristics of the Elderly

--4.5.2 Sleep Guidance for the Elderly

--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems

--【Website Recommendation】American Academy of Sleep Medicine

-4.6 Exercises Guidance for the Elderly

--4.6.1 Evaluation of Exercise Intensity in the Elderly

--4.6.2 Precautions Elderly Undertaking Exercises

--【Website Recommendation】American College of Sport Medicine

--【Book Recommendation】Handbook of Activities for the Elderly

-Concept Map

--【Concept Map】Elderly Daily Care

-【Test】CHAPTER 4

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--【Website Recommendation】How Drugs Work In the Elderly

-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly

--Common Adverse Drug Reactions and Their Causes in the Elderly

-5.3 The Principles of the Use of Medications in the Elderly

--The Principles of the Use of Medications in the Elderly

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-5.5 Medication Compliance in the Elderly

--Medication Compliance in the Elderly

-Concept Map

--【Concept Map】Medication Safety and Care for the Elderly

-【Test】CHAPTER 5

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-6.1 Falls in the Elderly

--6.1.1 Epidemiological Characteristics of Elderly Falls

--6.1.2 Risk Factors for Falls in the Elderly

--6.1.3 Prevention of Falls in the Elderly

--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)

-6.2 Dysphagia in the Elderly

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--Dry Mouth in the Elderly

--【Website Recommendation】Academy of Nutrition and Dietetics

-6.6 Elderly Nutritional Deficiencies

--Elderly Nutritional Deficiencies - emaciation

-6.7 Visual Impairment in the Elderly

--Visual Impairment in the Elderly

--【Website Recommendation】Senior Eye Exams

-6.8 Senile Deafness

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【Book Recommendation】The Meaning of Death by Herman Feife

-7.3 Nursing for Pain in the Dying Elderly

--Nursing for Pain in the Dying Elderly

--【Journal Recommendation】

-7.4 Nursing for Major Bleeding in the Dying Elderly

--Nursing for Major Bleeding in the Dying Elderly

-7.5 Nursing for Delirium in the Dying Elderly

--Nursing for Delirium in the Dying Elderly

-7.6 Nursing for Dyspnea in the Dying Elderly

--Nursing for Dyspnea in the Dying Elderly

--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA

-7.7 Psychological Problems and Nursing in the Dying Elderly

--Psychological Problems and Nursing in the Dying Elderly

--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross

-7.8 Grief Counseling for the Widowed Elderly

--Grief Counseling for the Widowed Elderly

--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela

-Concept Map

--【Concept Map】Hospice Care for the Elderly

-【Test】CHAPTER 7

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

3.5.1 Identification of Dementia Symptoms in the Elderly笔记与讨论

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