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Psychiatry > Clinical Aspects and Management of Memory Problems > Flashcards

Clinical Aspects and Management of Memory Problems Flashcards

1
Q

What is dementia?

A

Irreversible and progressive global cognitive decline

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2
Q

What are some features of the post diagnostic support for dementia?

A

Management should start as soon as possible
Time of uncertainty = tailored info and support needed
Should include practical and legal advice
May need postdiagnostic counselling

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3
Q

Why is advanced planning needed in patients with dementia?

A

To allow patients to make decisions while they still have capacity

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4
Q

What are some features of dementia in general hospital?

A

People with dementia aged >65 currently take up 1/4 of hospital beds at any given time
47% of carers said that being in hospital had a significant negative impact on physical health

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5
Q

How common is it for patients with dementia to be discharged into care after hospital admittance?

A

Over 1/3 of people with dementia who go into hospital from living in their own homes are discharged to a care home

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6
Q

What is needed to diagnose dementia?

A

History consistent with global cognitive decline over months-years
Cognitive testing consistent with history
Decline in level of function
No evidence of reversible cause

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7
Q

What are some methods of cognitive testing?

A

Addenbrookes Cognitive Assessment III = standard test
Montreal Cognitive Assessment = shorter test
Frontal Assessment Battery
Detailed neuropsychiatry testing = standardised according to premorbid testing

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8
Q

What is the short IQCODE?

A

Collateral history = 16 questions scored from 1-5, compares patient to how they were 10 years ago

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9
Q

How does occupational therapists assess patients with memory problems?

A

By doing a cognitive performance test = observations of activities like washing, estimates cognitive level and level of supervision needed for daily living

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10
Q

What are some reversible causes of cognitive impairment?

A

Delirium, alcohol, brain lesions, depression, medication, thyroid/metabolic disorders, brain infection

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11
Q

What are some features of mild cognitive impairment?

A

Noticeable cognitive impairment with little deterioration of function = ACE III usually 75-90 ad MoCA usually 24-26

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12
Q

What is the management of mild cognitive impairment?

A

Annual conversion of 10-15% so repeat cognitive testing yearly
May benefit from home based memory rehabillitation

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13
Q

What is subjective cognitive testing?

A

Patient feels they are cognitively impaired but testing and everyday function are normal

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14
Q

What are some features of subjective cognitive testing?

A

Often associated with anxiety, depression or stress
Usually have relative or friend with dementia
Normal memory lapses are interpreted as sinister

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15
Q

What are the symptoms and signs of Alzheimer’s disease?

A

Memory loss (especially short term), dysphagia, dyspraxia and agnosia
CT/MRI normal
Medial temporal lobe or temporoparietal atrophy

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16
Q

What are the variants of Alzheimer’s disease?

A

Frontal, posterior cortical atrophy

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17
Q

What are the symptoms of vascular dementia?

A

Dysphagia, dyscalculia, frontal lobe symptoms, affective symptoms, focal neurological signs

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18
Q

What are some features of vascular dementia?

A

May have vascular risk factors or step wise decline
CT/MRI = moderate-severe small vessel disease, multiple lacunar infarcts
SPECT = patchy reduction in tracer uptake

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19
Q

What are the three types of frontotemporal dementia?

A

Behavioural type, primary progressive aphasia and semantic dementia

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20
Q

What are the features of behavioural type frontotemporal dementia?

A

Behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills, apathy, obsessions

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21
Q

What are the features of primary progressive aphasia?

A

Effortful non-fluent speech, articulatory errors, lack of grammar and words

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22
Q

What are the features of semantic dementia?

A

Impaired understanding of word meaning, fluent but empty speech, difficulty retrieving names

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23
Q

What are the imaging results of frontotemporal dementia?

A 
CT/MRI = frontotemporal atrophy
SPECT = frontotemporal reduction in tracer uptake
24
Q

What is the dementia of lewy body dementia like?

A

Common early involvement of reduced attention, executive function and visuospatial skills

25
Q

What is needed to diagnose lewy body dementia?

A

Two of = visual hallucinations, fluctuating cognition, REM sleep behaviour disorder, positive DAT scan, parkinsonism (not >1 year prior to dementia onset)

26
Q

What are some features of the dementia that occurs in Parkinson’s disease?

A

80% have dementia after 15-20 years of Parkinson’s
Similar presentation to lewy body dementia
Positive DAT scan
Must have had parkinsonism for at least 1 year prior to dementia onset

27
Q

What imaging can be done for dementia?

A

CT, single photon emission CT, DAT scan, MRI

28
Q

What patients get a CT scan?

A

Standard investigation = useful for excluding tumour or bleed, quantifying vascular changes or identifying structural changes

29
Q

What patients get MRI scans?

A

Young patients, fast progression or other atypical features

30
Q

What type of dementia are SPECT scans best for?

A

Frontotemporal dementia

31
Q

When are DAT scans done?

A

Suspected lewy body or Parkinson’s dementia when patient doesn’t have enough supporting features to be sure of diagnosis

32
Q

What effect do cholinesterase inhibitors have?

A

Slow cognitive decline

33
Q

What types of dementia are cholinesterase inhibitors used for?

A

Alzheimer’s disease, lewy body dementia and dementia in Parkinson’s disease = less effective in treating Alzheimer’s

34
Q

What are the side effects of cholinesterase inhibitors?

A

Nausea and vomiting, headache, muscle cramps, worsen COPD and asthma
Bradycardia = check pulse before prescribing or increasing dose

35
Q

What are the contraindications of cholinesterase inhibitors?

A

Active peptic ulcer

Severe COPD or asthma

36
Q

What is memantine used for?

A

Licensed for Alzheimer’s disease = slows cognitive decline and prevents BPSD, start for moderate dementia

37
Q

What are the side effects of memantine?

A

Generally well tolerated = hypertension, sedation, dizziness, headache, constipation

38
Q

What professions make up the dementia MDT?

A

Doctors, nurses, PDS workers, support workers, OT, physiotherapists, dietician, speech and language therapy, psychology, social workers

39
Q

What role doe medical staff have in dementia?

A

Diagnosis, medical management, medication, mental health/capacity law

40
Q

What role do nursing staff have in dementia?

A

Mental health assessment and therapies

41
Q

What role do social workers have in dementia?

A

Care management, housing, adult protection, mental health/capacity law

42
Q

What people tend to become informal carers?

A

60% are spouses and 30% are adult children = provide 70% or more of total home care costs

43
Q

Why does dementia impose an objective burden on carers?

A

Leads to high levels of dependency and problematic behaviours

44
Q

What effect does being a carer have on people?

A

Increased psychological and physical morbidity, social isolation and financial burden

45
Q

What effect do psychological interventions for dementia have?

A

Have capacity to reduce carer distress and delay nursing home admission

46
Q

What implications does dementia have on driving?

A

Must be reported to DVLA = doctor decides if patient can drive while investigations are ongoing

47
Q

What paperwork must be filled in for a patient with dementia who drives?

A

Patient must fill in CGI form

Doctor fills out DVLA request form

48
Q

What happens as dementia progresses?

A

Behavioural and psychiatric aspects of dementia become more prominent = reduced ability to carry out normal activities independently

49
Q

What tends to cause the requirement of institutional care in dementia?

A

Loss of independence and BPSD

50
Q

What are some behavioural and psychological symptoms of dementia?

A

Hallucinations, delusions, insomnia, anxiety, disinhibition, agitation, aggression, depression

51
Q

What is the initial management of dementia?

A

Antecedents, behaviours and consequences = can use chart
Review physical symptoms and consider medication side effects
Consider comfort, environment and sleep hygiene

52
Q

What are some treatments for aggression?

A

Alzheimer’s = antipsychotics, citalopram, memantine, analgesia
Frontotemporal dementia = trazodone

53
Q

How are comorbid depression and anxiety treated?

A 
Depression = antidepressant +/- adjuncts
Anxiety = antidepressants, benzodiazepines, pregabalin
54
Q

How are visual hallucinations and insomnia treated?

A 
Hallucinations = cholinesterase inhibitors, antipsychotics
Insomnia = melatonin, Z drugs, benzodiazepines, sedating antidepressants
55
Q

How is aggression treated?

A

Benzodiazepines, antipsychotics, sedating antidepressants, cholinesterase inhibitors, memantine, pregabalin

Psychiatry (36 decks)

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