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4. Mild Cognitive Impairment 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

When impairment manifests as memory loss frequently seen as an early stage of Alzheimer’s 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

Dementia is the chronic and progressive insidious deterioration of behaviour and higher intellectual function due to organic brain disease. Dementia is a condition associated with old age and is referred to as an 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
Changes in personality
Deterioration in personal care
Impaired reasoning ability
Disorientation
Accompanied by deterioration in emotional control, social behaviour and motivation.

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10
Q

What are the differences between MCI and dementia?

A

MCI associated with normality of ageing whereas dementia isn’t directly a normality of the ageing process

MCI describes a set of symptoms and there may not always be a causative underlying pathophysiology whereas dementia is a chronic syndrome arising from a multitude of pathophysiologies

MCI doesn’t interfere with normal daily function whereas dementia does

MCI has no approved drug treatment whereas dementia has a number of available treatments (particularly for Alzheimer’s disease)

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11
Q

What are some similarities between MCI and dementia?

A

Both impact a person’s cognitive abilities

Neither impacts a person’s consciousness

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12
Q

What can be done to reduce the risk of developing dementia?

A

Physical activity (aerobic and resistance activities)

Mediterranean diets (traditionally high in fruits, vegetables and cereals + low in meat, sugar and saturated fat)

Not smoking

Not drinking to excess

Remaining socially active

Engaging in cognitive stimulation

Prompt treatment of depression

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13
Q

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

A

0-7 Normal

8-9 - MCI

10-28 - Severe cognitive impairment (refer)

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14
Q

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

A

Adv: Test has high sensitivity without compromising specificity. It is an accessible and simple test to conduct.

Dis: Scoring and weighting of the 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- Makes sure a patient is safe and well supported at home
  • Dietician- Assess a patient’s diet and suggest necessary modifications
  • Carers- Update staff on how a patient is on a day to day basis
  • Volunteer- offered by charities to support and give company to patients
  • Specialist nurse- creates treatment plans for patients with dementia, and tracks cognitive tests - evaluating the results and providing practical advice - flagging activity groups to help support the carers and the family
  • Consultant- Responsible for diagnosing patients with dementia and monitors clinical progression
  • OT- Optimises the working and living environment of the patient and suggesting modifications to improve patients ADLs (activities of daily living).
  • Physiotherapists- Assess the patient’s mobility and suggesting modifications to support this.
    Prescribes an exercise regime to minimise the risk of dementia
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16
Q

Define capacity

A

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

17
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

18
Q

How can you assess capacity?

A
  • 2 stage test

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?

19
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

20
Q

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

A

2 doctors

21
Q

What is the most common type of dementia?

A

Alzheimer’s disease

22
Q

What is Alzheimer’s disease?

A

Chronic neurodegenerative disease with progressive and an insidious onset.

Characterised by memory impairment and as the disease progresses changes include: Language deficits, impaired visuospatial skills, loss of judgement and inability to conduct daily activities

  • Symptoms
    • 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 object
    • Aphasia- inability to talk
23
Q

What causes Alzheimer’s disease?

A

Extracellular amyloid plaques
Intracellular neurofibrillary tangles
Synaptic deterioration and neuronal death

24
Q

What are the symptoms of vascular dementia?

A

Slower thinking
Personality changes
Movement problems
Bladder problems

25
Q

What is vascular dementia linked with?

A

Cardiovascular diseases

26
Q

Describe the onset of vascular dementia

A

Stepwise progression; progressively worsen as time proceeds; progresses over several years, with the speed of change fluctuating and varying between individuals

27
Q

What percentage of people does vascular dementia affect?

A

5-10%

28
Q

What is Lewy Body dementia associated with?

A

Aberrant deposits of alpha-synuclein protein within the brain, predominantly within the primary motor cortex > deposits referred to as Lewy bodies

29
Q

Describe the onset of LBD

A

Progressive and insidious over time

30
Q

What are the symptoms of LBD?

A

Hallucinations, sleep problems (REM sleep is affected) and memory loss.
Parkinson like features (Movement impairments (cogwheel like rigidity) and tremors)

31
Q

What does treatment of LBD involve?

A

acetylcholinesterase inhibitors

32
Q

What causes fronto-temporal dementia?

A

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

33
Q

Describe the onset of FTD

A

Chronic and progressive disease; however the onset of symptoms can occur more rapidly than other forms

34
Q

What are the symptoms of FTD?

A
  • Frontal lobe
    FTD associated with speech problems, behavioural changes, emotional problems and disinhibition
  • Temporal lobe
    Semantic dementia (understanding of language and factual knowledge are affected) leading to progressive non-fluent aphasia
  • Obsessions
    Develop unusual beliefs or interests
  • Diet
    Changes in food preference, increasing sweet, over-eating or over-drinking
  • Lack of interest
    Withdrawn or lose interest in looking after themselves, failure of normal level of personal hygiene
35
Q

What does the limbic system comprise of?

A

Cingulate gyrus, amygdala, hippocampus and mamillary body

36
Q

Function of the Posterior cingulate gyrus

A

concerned with orientation (Time, place and identity)

37
Q

Function of the Hippocampus

A

Concerned with short-term memory

38
Q

Function of the Anterior thalamus

A

Concerned with attention

CSI (9 decks)

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