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Year 4 - OPIC > 7. Older Persons Mental Health > Flashcards

7. Older Persons Mental Health Flashcards

1
Q

Which assessment tools can be used to assess cognitive ability?

A
  • AMTS
  • MMSE
  • 4AT
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2
Q

What is implicit memory?

A

Unconscious memory systems, such as that responsible for conditioning and for motor tasks.

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3
Q

What is explicit memory?

A

Consciously learnt memory

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4
Q

What is working memory?

A

The amount of information that can be held by the brain ‘online’.

Causes lapses in short term memory if affected (e.g. forgetting why you opened the refrigerator door).

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5
Q

What is semantic memory?

A

The brain’s knowledge of objects and word meanings.

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6
Q

What is episodic memory?

A

Event-based memories, our own recollection of personally experienced episodes.

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7
Q

What is the prevalance of dementia in over 65s?

A

7%

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8
Q

What are some causes of dementia?

A
  • Alzheimer’s disease (most common)
  • Parkinson’s disease dementia
  • Dementia with Lewy bodies
  • Frontotemporal dementia
  • HIV infection
  • alcoholic dementia
  • vascular dementia
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9
Q

What are the risk factors for Alzheimer’s disease?

A
  • familial history
    • increasing age
  • hypertension
  • depression
  • low education
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10
Q

What are the pathological hallmarks of Alzheimer’s disease?

A

1) deposition of amyloid b-plaques in the cerebral cortex.

2) Tau proteins form neurofibrillary tangles, which replace the neuronal cytoskeleton.

3) Neuronal atrophy in the medial temporal lobes (ie. hippocampus).

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11
Q

Clinical features of Alzheimer’s disease.

A
  • impairment of episodic memory
  • severe forgetfulness
  • problems managing day-to-day activities
  • language impairments
  • behavioural problems (e.g. anxiety, delusions)
  • incontinence

As the disease progresses, symptoms become more disabling.

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12
Q

MRI findings in Alzheimer’s disease.

A
  • symmetrical medial temporal lobe volume loss
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13
Q

What is the non-pharmacological treatment of Alzheimer’s disease?

A

Social support and increasing assistance with day-to-day activities:

  • information and education
  • carer support groups
  • community dementia team
  • community services (e.g. meals on wheels)
  • day centre
  • respite care
  • residential home
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14
Q

What is the pharmacological management of Alzheimer’s disease?

A
  1. AChE inhibitors (e.g. donepezil, gelantamine, rivastigmine)
  2. NMDA antagonists (e.g. memantine)
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15
Q

What is the evidence behind

  1. AChE inhibitors
  2. NMDA antagonists

in the treatment of Alzheimer’s?

A
  1. Modest improvements of cognitive function, but no evidence they alter the overall cause of the disease.
  2. Combined with AChE provides benefit in some patients.
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16
Q

What is the pathology of frontotemporal dementia (FTD)?

A

Frontotemporal lobar degeneration:

  • cortical and subcortical gliosis
  • widened sulci
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17
Q

What are the risk factors for FTD?

A
  • positive family history
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18
Q

Clinical features of behavioural FTD (bvFTD).

A
  • socially inappropriate behaviour
  • impulsive, careless decisions
  • apathy
  • loss of sympathy
  • binge eating
  • increased consumption of alcohol or cigarettes
  • abnormal sexual behaviour with disinhibition
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19
Q

CT / MRI findings of bvFTD.

A
  • frontal / anterior temporal atrophy
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20
Q

Clinical features of primary progressive aphasia.

A

Type of FTD:

  • aphasia most prominent deficit
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21
Q

How can FTD be differentiated from Alzheimer’s disease?

A
  • neurological signs more common in FTD
  • CT/MRI findings showing atrophy in different brain regions
22
Q

Management of FTD.

A

No curative treatment at present - general management of person with dementia and family is prime importance.

23
Q

Pathology of dementia with Lewy Bodies’ (DLB) and Parkinson’s disease dementia (PDD).

A

Lewy bodies deposited across the brain, causing pallor of the substantia nigra and dopamine depletion in the basal ganglia.

This gives rise to Parkinsonian symptoms.

Features of Alzheimer’s are also present.

24
Q

Clinical features of DLB / PDD.

A
  • spontaneous fluctuations in cognitive abilities, particularly alertness and attention
  • visual hallucinations and illusions
  • cholinergic deficit (rigidity, gait disturbance, bradykinesia)
25
Q

How can DLB and PDD be differentiated?

A

A patient must have either developed dementia before, or within one year of, the onset of Parkinsonian syndromes for DLB to be diagnosed.

If more than a year passes before the onset of dementia following parkinsonism, a diagnosis of PDD is made.

26
Q

How can DLB / PDD be managed?

A
  • minimise medications that worsen condition (e.g. dopamine antagonists, anticholinergics)
  • appropriate lighting at night will improve hallucinations

DLB sensitive to side-effects of dopamine-enhancing medications for treatment of motor symptoms.

Cholinesterase inhibitors give symptomatic benefit in DLB and PDD.

27
Q

Presentation of vascular dementia (VaD).

A
  • relationship between vascular disease and cognitive impairment
  • no history of gradually progressive cognitive deficit
28
Q

Treatment of VaD.

A

Aim to remove the underlying cause of the vascular disorder.

Symptomatic treatment with cholinesterase inhibitors have modest benefits.

29
Q

What is HIV-associated neurocognitive syndrome (HAND)?

A

A type of HIV that arises due to HIV infection, characterised by:
-psychomotor slowing
- personality change

30
Q

How can delirium be differentiated from dementia?

A

Note it is possible for dementia and delirium to coexist; any new confusion should prompt consideration of delirium.

31
Q

What are the basic activities of daily living (ADLs)?

A

Basic self-care tasks:

  • walking
  • feeding
  • dressing and grooming
  • toileting
  • bathing
32
Q

What are the instrumental activities of daily living (IADLs)?

A

Require more complex thinking skills:

  • managing finances
  • managing transportation
  • shopping and meal preparation
  • housecleaning and home maintenance
  • managing medications
33
Q

What is the difference between implied and expressed consent?

A

Expressed consent is directly and clearly given with explicit words.

Implied consent is the agreement given by a person’s action or inaction, or when consent is inferred.

34
Q

Define mental capacity.

A

The ability for a person to make their own decision, being time specific and decision specific.

35
Q

Why may people lack capacity?

A
  • dementia
  • severe learning disability
  • brain injury
  • alcohol intoxication
  • delirium
36
Q

What are the five principles of the Mental Capacity Act (2005)?

A

(1) A person must be assumed to have capacity unless it is established that he lacks capacity.

(2) A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

(3) A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

(4) An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

(5) Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

37
Q

What is the Two-stage capacity test?

A

Stage 1

Is the person unable to make a particular decision?

Stage 2

Is the inability to make a decision caused by an impairments of a person’s mind or brain. Can they:

1) understand information given to them
2) retain information long enough to make a decision
3) weigh up the information available to make the decision
4) communicate their decision

38
Q

What is the ReSPECT form?

A

‘Recommended Summary Plan for Emergency Care and Treatment’

Summary of personalised recommendations for a patient’s clinical care in a future emergency, in which they do not have capacity to make or express choices.

39
Q

What is an Advanced Decision to Refuse Treatment (ADRT)?

A

Allows patient to refuse life sustaining treatment when they do not have capacity, provided:

  • written down
  • signed by a patient
  • signed by a witness

Legally binding document if it complies with the Mental Capacity Act (2005), valid (age >18yrs) and applies to the situation.

40
Q

What is a Lasting Power of Attorney (LPA)?

A

A legal document whereby a patient can nominate a person to make decisions about their health and care, coming into effect if the patient loses mental capacity.

41
Q

What is a deputy appointed by the Court of Protection?

A

When a patient loses capacity and does not have a LPA, a deputy can be appointed to make decisions on the patient’s behalf.

42
Q

What are Liberty Protection Safeguards (LPS)?

A

Safeguards the rights of people who are under high levels of care and supervision, but lack the mental capacity to consent to those arrangements for their care.

LPS applies to everyone from the age of 16 years, in:
- care homes
- hospitals
- supported accommodation
- Shared Lives accommodation
- their own homes

43
Q

Define ‘mental disorder’.

A

Any disorder or disability of the mind

44
Q

What is Section 135 of the Mental Health Act (1983)?

A

Police have powers to enter a patient’s home, if need be by force, to take the patient to a place of safety for an assessment by an approved mental health professional and a doctor. It is used in an emergency when someone seems to be at serious risk of harming themselves or others.

You can be kept there until the assessment is completed, or up to 36 hours.

45
Q

What is Section 136 of the Mental Health Act (1983)?

A

Police have the power to take a person from a public space to a place of safety and detain you there, for assessment by an approved mental health professional and a doctor. It is used in an emergency when someone seems to be at serious risk of harming themselves or others.

You can be kept there until the assessment is complete, or up to 36 hours.

46
Q

What is Section 5(4) of the Mental Health Act (1983)?

A

Nurses can prevent a patient leaving the hospital until the doctor in charge of their care, or their nominated deputy, can make a decision about whether to detain you there.

You can be detained for up to 6 hours.

47
Q

What is Section 5(2) of the Mental Health Act (1983)?

A

Gives doctors the ability to detain someone in hospital for up to 72 hours, during which time you should receive an assessment that decides if further detention under the Mental Health Act is necessary.

48
Q

What is Section 2 of the Mental Health Act (1983)?

A

Allows the court to permit detention for up to 28 days if there are concerns about a person’s mental health.

49
Q

What is Section 3 of the Mental Health Act (1983)?

A

Allows the court to permit detention for up to 6 months if there are concerns about a person’s mental health.

50
Q

What is a Community Treatment Order (CTO)?

A

Under the Mental Capacity Act (1983), CTO allows patients to be discharged earlier with conditions to support their stability, and prevent relapse.

This can last for up to 6 months.

51
Q

What is Section 117 of the Mental Health Act (1983)?

A

Ensures patients who have been kept in hospital under the Mental Health Act can get free help and support after they leave hospital, including:
- healthcare
- social care
- supported accommodation

Aftercare services under Section 117 are provided until the local health board and local authority are satisfied they are no longer required.

Year 4 - OPIC (11 decks)

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