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YEAR 1: CSI > Case 4: Dementia > Flashcards

Case 4: Dementia Flashcards

1
Q

What is dementia?

A

A syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing.

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2
Q

What can dementia affect?

A
  • memory
  • thinking
  • orientation
  • comprehension
  • calculation
  • learning capacity
  • language
  • judgement
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3
Q

What doesn’t dementia affect contrary to popular belief?

A

Consciousness

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4
Q

What are the different forms of dementia?

A

1) Alzheimer’s (60-70%)
2) Vascular dementia (5-10%)
3) Lewy body disease (5%)
4) Frontotemporal dementia (5%)

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5
Q

What is the hypothesised cause of Alzheimer’s?

A
  • Build up of amyloid plaques outside of neurones, interfering with neuronal communication.
  • Hyperphosphorylation of Tau protein which aggregates into filamentous neuro-fibrillary tangles in the neurones. This results in impaired neuronal growth, transport and communication.
  • Death of cholinergic neurones in limbic system leads to a deficiency of acetylcholine which can lead to memory loss.
  • Brain atrophy
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6
Q

What are the common symptoms of Alzheimer’s?

A 
Early symptoms 
• Memory problems
• Becoming increasingly repetitive
• Regularly misplacing items
• Confusion about date/time
• Communication problems

Later symptoms
• Ability to remember/think/make decisions worsens
• Difficulty recognising familiar faces
• Common day-to-day tasks become harder (i.e. using remote controls/phones/dressing/eating)
• Mood changes
• Loss of sleep
• Hallucinations

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7
Q

Describe the onset of Alzheimer’s

A

Gradual-progressive onset

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8
Q

What drugs can a person with Alzheimer’s be treated with?

A
  • Acetylcholinesterase inhibitors (Donepezil) to allow more retention of Ach and thus slow down the progression of the disease
  • Mermantine inhibits NMDA receptors to reduce glutamate activity (excess glutamate in Alzheimer’s causes overstimulation of nerve cells leading to neuronal cell death).
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9
Q

What is the hypothesised cause of vascular dementia?

A

Ischaemia/ infarcts in the brain leading to strokes

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10
Q

What are the common symptoms of Vascular dementia?

A
  • Memory loss
  • Disorientation
  • Aphasia
  • Impaired motor function
  • Mood changes
  • Hypertension/ high cholesterol/ existing co-morbidities like Type 2 diabetes
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11
Q

Describe the onset of Vascular dementia

A

Step wise progression

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12
Q

How can the progression of vascular dementia be slowed down?

A

By taking medication used to treat cardiovascular diseases

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13
Q

What is the hypothesised cause of Lewy Body dementia?

A

Formation of clumps of protein (α-Synuclein which make up Lewy bodies) build up inside nerve cells typically in the motor cortex. This damages them and affects the way they communicate.

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14
Q

What are the common symptoms of Lewy Body dementia?

A
  • Visual hallucinations
  • Tremors and other features of parkinson’s disease
  • Changes in attention
  • Anosmia
  • Falls
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15
Q

Describe the onset of Lewy Body dementia

A

Insidious onset, progressive

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16
Q

What does insidious onset describe?

A

A disease that comes on slowly and does not have obvious symptoms at first.

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17
Q

What is the hypothesised cause of Frontotemporal dementia?

A

Damage to neurones in the frontotemporal regions of the brain caused by the build up of mutated tau protein.

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18
Q

What are the common symptoms of Frontotemporal dementia?

A
  • Aphasia
  • Disinhibition
  • Apathy
  • Behavioural/emotional problems
19
Q

Describe the onset of Frontotemporal dementia

A

Insidious onset, rapid progession, more likely to run in families, affects adults between the ages of 50 and 60.

20
Q

How are amyloid plaques formed?

A

Amyloid precursor proteins are usually cleaved by a-secretases but if they are aberrantly cleaved, they can aggregate into fibrils/plaques.

21
Q

What causes the mood/sleep changes?

A

Loss of neurones in brain stem can lead to a reduction in serotonin and noradrenaline.

22
Q

What are the 3 components of the limbic system?

A

1) Posterior cingulate gyrus
2) Hippocampus
3) Thalamus

23
Q

What is the posterior cingulate gyrus concerned with?

A

Orientation (knowing date/time)

24
Q

What is the thalamus concerned with?

A

Attention (counting backwards, saying the months of the year backwards)

25
Q

What is the hippocampus concerned with?

A

Short term memory (remembering an address)

26
Q

Give an example of a test that can be used to screen for cognitive impairment

A

6 item cognitive impairment test (screening not diagnosis)

27
Q

What are the rough boundaries for referral?

A

1-7: No need for referral
8-9: Probably refer
10-28: Refer

28
Q

What is mild cognitive impairment?

A

A condition in which someone has minor problems with cognition - their mental abilities such as memory or thinking are affected.
MCI progresses into Dementia 10-20% of the time.

29
Q

What are some of the differences between MCI and dementia?

A
  • MIC consists of minor problems that don’t really interfere with daily life whereas dementia does affect day-to-day life.
  • MIC describes a set of symptoms whereas dementia is a chronic condition.
  • There are no drugs available for MIC whereas there are drugs to slow down the progression of dementia.
30
Q

What are the similarities between MCI and dementia?

A
  • Both common in the elderly
  • Both impact cognitive abilities
  • Neither affects consciousness
31
Q

What are some of the modifiable factors for Dementia/MCI?

A
  • Exercise
  • Diet (more mediterranean like)
  • Socialising/interacting with others
  • Stopping smoking
  • Cognitive stimulation (crosswords etc.)
  • Reducing alcohol intake
32
Q

What are some of the pros of the 6-item cognitive impairment test?

A
  • Quick to apply which is useful in GP surgeries where appointments are quite short.
  • No cultural knowledge is needed beforehand
33
Q

What is a con of the 6-item cognitive impairment test?

A

It is new so there is not as much supporting evidence for it compared to the older screening tests.

34
Q

What are some non-drug therapies used to manage/ameliorate dementia?

A
  • Music/Art therapy
  • Reminiscence therapy
  • Sustained physical activity
  • Cognitive training
35
Q

What are some of the symptoms of MCI?

A
  • Memory (e.g. forgetting to pay bills, managing medication, driving)
  • Struggling to pay attention
  • Struggling to express themselves
  • Having trouble with reasoning/ problem solving
  • Trouble with visual-depth perception
36
Q

What does the 2 stage assessment of capacity entail?

A

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?
2) Does the impairment mean that the person is unable to make a specific decision when they need to?

37
Q

You should always assume that a person ________ capacity to make a decision themselves unless proven otherwise.

A

has the

38
Q

What are you testing when testing for capacity?

A

That they can understand, retain and weigh up the information before they make a decision.
Also that they can communicate this decision to the medical team coherently.

39
Q

What is the lasting power of attorney?

A

Enables a person to make decisions about a patient’s health and welfare, their property and financial affairs on their behalf should they lose capacity.

40
Q

What is the difference between an advance statement and an advance decision?

A
  • AS is not legally binding and just sets down a person’s preferences and beliefs regarding their future care. It acts as a guide for the medical professionals.
  • AD is legally binding that allows a person ≥ 18 to refuse a medical treatment for a time in the future when they may lack capacity to consent.
41
Q

What happens if person lacks capacity?

A

The medical team needs to come up with a treatment plan that’s least restrictive of their basic rights and freedoms, and discuss is with any family.

42
Q

What conditions can you treat without consent from the individual?

A

Mental health conditions if they’re a risk to themselves or others, under the Mental health Act.

43
Q

What is a multidisciplinary team?

A

A combination of professionals from different clinical disciplines and with specific expertise, that work together to optimise a patient’s care.

44
Q

Who are some of the health care professionals who would need to be part of the MDT looking after dementia patients?

A

1) Dementia social worker: making sure the patient is safe and supported at home.
2) Dietician
3) Carers: updates staff on how a patient is on a day-to-day basis.
4) Volunteer: giving company to the patients
5) Specialist nurse
6) Occupational therapist: ensures safety of patient’s home environment.
7) Consultant
8) Physiotherapist: helps with mobility issues

YEAR 1: CSI (9 decks)

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