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CSI > 4- Dementia > Flashcards

4- Dementia Flashcards

1
Q

Define mild-cognitive impairment

A

cognitive decline beyond expected for that age and education, without significantly interfering with normal daily function

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2
Q

what is amnestic MCI?

A

MCI that primarily affects memory
frequently seen s early stage of Alzheimers disease

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3
Q

What percentage of patients with MCI progress to dementia annually?

A

10-15%

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4
Q

What percentage of patients over the age of 65 are affected by MCI?

A

5-20%

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5
Q

What score on the 6CIT qualifies for MCI?

A

8-9

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6
Q

List some cognitive deficits of MCI?

A

memory, language, thinking, attention, visual depth, perception and judgement

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7
Q

define dementia

A

the chronic and progressive gradual deterioration of behaviour and higher intellectual function due to organic brain disease.

associated w old age, umbrella term for memory loss impairment

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8
Q
  • What score on the 6CIT is used as a screening as a basis of referral?
A

8+

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9
Q

What are some typical manifestations of dementia?

A

memory disorders
personality changes
deterioration in personal care
impaired reasoning ability
disorientation
deterioration in emotional control, sociaal behaviours and motivation

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10
Q

What are the differences between MCI and dementia?

A

MCI = normal ageing, doesnt interfere with normal daily function, no approved drug treatment

MCI doesnt always haave causative underlying pathophysiology. dementia = chronic syndrome arising from mnay pathophysiologies

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11
Q

What are some similarities between MCI and dementia?

A

both impact a persons cognitive abilities
neither impact a persons consciousness

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12
Q
  • What can be done to reduce the risk of developing dementia?
A

exercise
no smoking/excessive drinking
social activities
engage in cognitive stimulation
prompt treatment of depression
mediterranean diets (high in fruits, veg, low met, sugar, saturated fat)

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13
Q

What are the score-breakdowns of the 6CIT test?

A

normal : 0-7
MCI : 8-9
severe cognitive impairment (refer) : 10-28

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14
Q

What are the advantages and the disadvantages of the 6CIT test?

A

adv: high sensitivity without compromising specificity
accessible and simple to control

dis: scoring and weighting of test can initially be confusing

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15
Q

List the members of an MDT and their describe their respective roles

A

dementia social worker
dietician
carers
volunteer
specialist nurse
consultant
OT
physiotherapist

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16
Q

what does a dementia social worker do?

A

makes sure a patient is safe and well supported at home

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17
Q

what does an occupational therapist do?

A

optimises the working and living environment of the patient and suggesting modifications to improve patients ADLs

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18
Q

Define capacity

A

ability to use and understand information to make a decision and communicate any decision made

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19
Q
  • According to MCA when is an individual unable to make a decision for themselves?
A

can’t:
- understand info relevant to discussion
- retain that info
- use or weigh-up the info as part of the decision-making process

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20
Q

How can you assess capacity?

A

Does the person have an impairment of their mind or brain, whether as a result of an illness or external factor?

Does the impairment mean the person is unable to make specific decision when they need to?

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21
Q

What happens if the patient lacks capacity?

A

patient’s medical team decides what’s. in their best interest, including input from family and friends

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22
Q

How many doctors must independently asses and agree capacity should be withdrawn?

A

2

23
Q

What is the most common type of dementia?

A

Alzheimer’s disease

24
Q

what is Alzheimer’s disease?

A

chronic neurogenerative disease with progressive and gradual onset

language deficits, impaired visuospatial skills, loss of judgement and inability to conduct daily activities

25
Q

give symptoms of Alzheimer’s disease

A

amnesia- loss of short-term memory
anomia- inability to name objects
apraxia- loss of dexterity
agnosia- inability to recognise things, unable to understand the function of objects
aphasia- inability to talk

26
Q

what causes Alzheimer’s disease?

A

extracellular amyloid plaques
intracellular neurofibrillary tangles
synaptic deterioration and neuronal death

27
Q

explain synaptic deterioration and neuronal death

A

neuronal atrophy caused by loss of synapses and neurones (cerebro-spinal atrophy)

neurones are rich in acetylcholine, supplying the hippocampus, amygdala and neucortex

28
Q
A

in the cell membrane there’s a protein called amyloid precursor protein (APP)
one end is inside the cell, the other end outside

29
Q

what does APP do?

A

helps neuron grow and repair
gets used and broken down and recycled

30
Q

what is meant to breakdown APP?

A

alpha secretase and gamma secretase

31
Q

what happens when alpha and gamma secretase breakdown APP?

A

get a soluble peptide which is taken away

31
Q

what happens if beta secretase teams up with gamma secretase instead?

A

leftover fragment isnt ssoluble
get a monomer called amyloid beta

31
Q

describe amyloid beta

A

sticky, bind together outside the neurone
form beta amyloid plaques

32
Q

how do beta amyloid plaques cause problems?

A

plaques can get in between neurones, disrupt neuronal communication
brain functions like memory impaired

plaques can also initiate an immune response, damage surrrounding neurones

can deposit around blood vessels in brain, weaken walls of blood vessels, inc risk of haemhoragge

33
Q

where are tangles found?

A

inside the cell

34
Q

what does tau do?

A

protein that stabilises the internal skeleton of neurons in brain

35
Q

how can tau proteins cause problems?

A

beta amyloid plaque build up outside neurone initiates pathways inside the neurone
leads to activation of kinase (transfers phosphate to tau protein)
tau protein changes shape
stops supporting the microtubules
clumps up with other tau proteins, gets tangled

may undergo apoptosiss, neurronal communication dissurpted

36
Q

what happens to the brraain when apoptosis of neurones occurs?

A

atrophy, gyri (ridges) get narrower
sulci (grooves) het wider
ventricles get larger

37
Q

what do neurofibrillarry tangles do?

A

disrupt the microtubular system resulting in impaired neuronal growth, transport and communication

deposit in the hippocampus, medial temporal lobe, frontal cortices, lateral parietotemporal regions

38
Q

what are the symptoms of vascular dementia?

A

slower thinking
personality changes
movement problems
bladder problems

39
Q

what is vascular dementia associated with?

A

cardiovascular diseases

40
Q

Describe the onset of vascular dementia

A

stepwise progression

41
Q

What percentage of people does vascular dementia affect?

A

5-10%

42
Q

What is Lewy Body dementia associated with?

A

abnormal deposits of alpha-synuclein protein within the brain, mostly within primary motor cortex
deposits = Lewy bodies

43
Q

Describe the onset of LBD

A

progressive and graduaal

44
Q

What are the symptoms of LBD?

A

hallucinations, sleep problems (REM sleep affected), memory loss
parkinson like features: movement impairments (cogwheel like rigidity) and tremor

45
Q

What does treatment of LBD involve?

A

acetylcholinesterase inhibitors

46
Q

What causes fronto-temporal dementia?

A

neuronal atrophy of the frontal and temporal lobes due to presence of abnormal proteins within them
predominantly phosphorylated tau or TDP-43

47
Q

Describe the onset of FTD

A

chronic and progressive disease
onset of symptoms can be more rapid than other forms

48
Q

What are the symptoms of FTD?

A

frontal lobe: speech problems, behavioural changes, disinhibition, emotional problems

temporal lobe: semantic dementia: dont understand language and factual knowledge –> progressive non-fluent aphasia

obsessions: unusual beliefs/interests

diet: over eating/drinking

lack of interest: reduced personal hygiene

49
Q

What does the limbic system comprise of?

A

cingulate gyrus, amygdala, hippocampus, mamillary body

50
Q

whats the function of hippocampus?

A

Concerned with short-term memory

51
Q

whats the function of anterior thalamus?

A

concerned w attention

52
Q

whats the function of posterior cingulate gyrus?

A

concerned w orientation (time, place, identity)

CSI (5 decks)

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