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.
• 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
(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
Causes of Depression
• Drugs/alcohol
• Dietary inadequacy
• Neoplasias
• 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,
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
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
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
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)
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
people
• Also: Mental exercises, crosswords,
math, brain teasers, puzzles
Alz: Common Drug Therapies
• Risperodone (newer)
• Olanzapine (newer)
• Chlorpromazine
• Thioridazine
• Haloperidol
• Loxapine
• 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,
memory
• Disturbances in sleep, psychomotor
activity
• Often confused with Alzheimer’s
• Completely reversible if treated
Delirium-Types
• Alcoholic or drug induced
• Febrile
• Traumatic
• Delirium Tremens-hallucinations,
suicidal tendencies,(pt needs constant
supervision)
Restraints?
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.
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?
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
experience confusion
2. Know the different types, and
differentials
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!