LPN Nursing · Cognitive Disorders · Practice question
A long-term care resident is suffering with Lewy Body dementia. The nurse will find which of the following on assessment? Select ALL that apply.
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✓
REM sleep disorder
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Muscle flaccidity
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✓
Paranoia and distrust of others
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✓
Tremor or shaking at rest
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Excessive appetite
Answer & explanation
Correct: REM sleep disorder · Paranoia and distrust of others · Tremor or shaking at rest
Lewy body dementia (LBD) is characterized by a specific cluster of clinical features that distinguish it from other dementias. REM sleep behavior disorder is a hallmark of LBD, in which the normal muscle atonia during REM sleep is absent, causing patients to act out their dreams, sometimes violently. Tremor or shaking at rest is another defining feature, reflecting the parkinsonian motor symptoms — including rigidity, bradykinesia, and resting tremor — that occur in LBD due to alpha-synuclein deposits in the substantia nigra and other brain regions. Paranoia and distrust of others commonly occur in LBD because of the vivid, recurrent visual hallucinations and fluctuating cognition that characterize this condition; patients may misinterpret their environment and become suspicious. Muscle flaccidity is not a feature of LBD; instead, patients typically exhibit muscle rigidity (increased tone), which is a parkinsonian characteristic. Excessive appetite is not associated with LBD; appetite changes, if present, tend to involve decreased intake related to swallowing difficulties or reduced interest in food. The combination of cognitive fluctuations, visual hallucinations, parkinsonian features, and REM sleep disorder form the diagnostic core of Lewy body dementia, and nurses should assess for all of these signs when caring for affected residents.
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