Psychiatric Medications Q 61
Nurse Kate would expect that a client with vascular dementia would experience:
A. Loss of remote memory related to anoxia.
B. Loss of abstract thinking related to emotional state.
C. Inability to concentrate related to decreased stimuli.
D. Disturbance in recalling recent events related to cerebral hypoxia.
Correct Answer: D. Disturbance in recalling recent events related to cerebral hypoxia.
Cell damage seems to interfere with registering input stimuli, which affects the ability to register and recall recent events; vascular dementia is related to multiple vascular lesions of the cerebral cortex and subcortical structure. Second only to Alzheimer disease (AD), vascular dementia (VD) is one of the most common causes of dementia affecting the elderly (aged greater than 65 years), with a variable presentation and unpredictable disease progression. The diagnosis of VD is obtained by a thorough history and physical examination, including a measure of cognitive performance. VD is diagnostically challenging and not precise given the many causes of dementia, including the potential for a mixed dementia syndrome
Option A: A thorough history should be obtained from the patient, focusing on cognitive and functional deficits, onset, and progression of symptoms. Interviewing family members and caregivers is important as patients with cognitive decline rarely have insight into their cognitive and functional limitations. Caregivers may report an abrupt or stepwise onset of cognitive decline, or the appearance of symptoms may be subtle without connection to an ischemic event.
Option B: The functional assessment should evaluate for impairments in instrumental activities of daily living (IADLs), such as cooking, driving, and financial and medication management, and basic activities of daily living (ADLs), such as dressing, bathing, and toileting. Additionally, patient past medical history, current medications, and surgical history should be obtained. Regarding physical examination, one should assess patients for focal neurologic deficits.
Option C: VD is preventable by modifying the risk factors like diabetes, hypertension, smoking, and hyperlipidemia. The one very important risk factor that should be modified is hypertension. Countless studies show that the use of antihypertensive medications can reduce the risk of vascular dementia. In addition, the patient’s coronary artery disease, atrial fibrillation, and ischemic heart disease have to be appropriately managed.