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3 Psych > Clinical Aspects of Dementia > Flashcards

Clinical Aspects of Dementia Flashcards

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1
Q

what is dementia

A

Progressive, global, irreversible cognitive decline

associated decline in functioning

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2
Q

what is involved in post diagnostic support for those with a dementia diagnosis

A 
Planning for future decision making 
Supporting community connections 
Peer support 
Planning for future care 
Understanding the illness and managing symptoms
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3
Q

diagnostic criteria for demential

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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4
Q

what cognitive tests are used to diagnose dementia

A

Addenbrookes cognitive assessment (ACE III)

Montreal cognitive assessment (MoCA) - shorter, several versions

Frontal Assessment Battery

Detailed neuropsychological testing

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5
Q

how do you get a collateral history

A

speak to family members/partners/ friends with a structured history

Short informant questionnaire on cognitive decline in the elderly ( short IQCODE)

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6
Q

what do occupational therapy asses for those with dementia

A

Cognitive performance tests

  • observations of activities eg. dressing, washing, using a phone etc
  • estimates level of supervision required for daily living
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7
Q

what are some reversible causes of cognitive impairment

A 
DELERIUM 
Depression 
Alcohol 
Brain lesions 
Medications 
Metabolic disorder 
Neuro infection/inflammation
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8
Q

what’s the criteria for a MILD cognitive impairment

A

Noticeable impairment with little deterioration of function

ACE-III - 75-90
MoCA 24-26

repeat testing regularly
may benefit from home based memory rehabilitation

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9
Q

what is a SUBJECTIVE cognitive impairment

A

patient feels they are cognitively impaired but cognitive testing and day-day function are normal

associated with anxiety, depression or stress

often those with a relative or friend with dementia

difficult to convince patient they dont have dementia

cycle of increasing anxiety about memory causing more memory lapses

normal lapses interpreted as sinister

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10
Q

what are the most common type of dementia

A 
Alzheimers 
Vascular dementia 
Frontotemporal dementia 
Dementia with lewy bodies 
Dementia in Parkinsons disease
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11
Q

what are the characteristics of Alzheimer’s dementia

A

Memory loss (particularly short term)
Dysphasia (difficulty using language)
Dyspraxia (difficulty with physical co-ordination)
Agnosia (loss of ability to recognise people/objects)

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12
Q

what is seen on imaging of Alzheimer’s dementia

A

CT/MRI - normal, medial temporal lobe atrophy or temporoparaital atrophy

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13
Q

what are the characteristics of vascular dementia

A 
Dysphasia 
Dyscalculia (difficulty understanding numbers) 
Frontal lobe symptoms 
Affective symptoms 
Focal neurological signs 
Vascular risk factors

Step wise decline

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14
Q

what is seen on imagine in vascular dementia

A

moderate - severe small vessel disease or multiple lacunar infarcts

SPECT - patchy reduction in tracer uptake throughout brain

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15
Q

What are the 3 syndromes of frontotemporal dementia

A

Behavioural
Primary progressive aphasia
Semantic dementia

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16
Q

what is the behavioural syndrome of frontotemporal dementia

A 
behavioural chances 
executive dysfunction 
disinhibition 
impulsivity 
loss of social skills 
apathy 
obsessions 
change of diet
17
Q

what is the primary progressive aphasia syndrome of frontotemporal dementia

A

effortful, non-fluent speech
speech sound/articulatory errors
lack of grammar
lack of words

18
Q

what is the semantic dementia syndrome of frontotemporal dementia

A

impaired understanding of meaning of words, empty speech, difficulty retrieving names

19
Q

what is seen in imaging for frontotemporal dementia

A

CT/MRI - frontotemporal atrophy

SPECT- frontotemporal reduction in tracer uptake

20
Q

what are the characteristics of dementia with Lewy bodies

A

really involvement of reduced attention,
executive function an visuospacial skills

Two of: 
-visual hallucinations 
-fluctuating cognition (delerium like) 
- REM sleep behaviour disorder 
-Parkinsonism (not more  than 1 year prior to onset of dementia) 
Positive DAT scan
21
Q

what are the characteristics of dementia in parkinsons disease

A

80% after 15-20 years of Parkinson’s disease

Must have Parkinsonism for at least 1 year prior to dementia

Similar to DLB but different pathology

positive DAT scan

22
Q

what imaging is used in dementia

A 
CT 
Single photon emission CT 
DaT scan (dopamine active transporter) 
Magnetic resonance imaging 
SPECT
23
Q

when do you use MRI

A

young
fast progression
other atypical features

24
Q

when do you use SPECT

A

most useful in suspicion of frontotemporal dementia

25
Q

when do you use DAT scans

A

suspicion of DLB/DPD is patient doesn’t have enough supporting features to be sure of diagnosis

26
Q

when do you use CT

A

currently standard

dont use for patient over 80 with typical Alzheimers presentation

27
Q

what drugs are used for Alzheimers

A

Cholinesterase inhibitors

Memantine

28
Q

what cholinesterase inhibitors are used in Alzheimers

A

Donepezil
Revastigmine
Galantamine

29
Q

what cholinesterase inhibitors are used in DLB and DPD

A

Rivastigmine

Donepezil

30
Q

what do cholinesterase inhibitors do in dementia

A

Slow cognitive decline

more effective in DLB/DPD than Alzheimers

31
Q

side effects of cholinesterase inhibitors

A 
GI (nausea and diarrhoea) 
Headache 
Muscle cramps 
Bradycardias 
Worsen COPD/Asthma

do not prescribe if peptic ulcer or severe asthma/COPD

32
Q

what does memantine do for dementia

A

slows cognitive decline
prevents behavioural and psychological symptoms of dementia

start in moderate dementia

33
Q

side effects of memantine

A 
well tolerated 
may cause hypertension 
sedation 
dizziness
headache 
constipation
34
Q

what post-diagnostic care is provided for dementia

A

support for patient and family
assistance with practicalities as well as counselling
lasts for 1 year
provided by Alzheimer Scotland dementia link worker or community mental health nurse

35
Q

how does dementia impact driving

A

Must be discussed at diagnosis
Must be reported to DVLA
Doctor decides if patient can drive while investigations are ongoing

on road test
Rookwood driving battery - gives simple tests to see if someones road safe

36
Q

what tends to happen in the late stages of dementia

A

behavioural and psych symptoms become more prominent

physical co-morbidity increases

reduced ability to carry out activities of daily living

loss of independence

37
Q

what are behavioural and psychological symptoms of dementia

A 
Delusions 
Insomnia 
Anxiety 
Disinhibition 
Agitation 
Depression 
Hallucinations
38
Q

how do you initially manage BPSD

A 
review physical symptoms 
further investigation 
consider medication side effects 
comfort - thirsty, hungry, uncomfortable 
give sensory aids 
environment 
activities 
exercise 
sleep hygiene
39
Q

what pharmacological interventions can be used for agitation

A

Antipsychotics

  • citalopram
  • memantine
  • analgesia
  • dextromethorphan

trazodone for frontotemporal dementia

3 Psych (31 decks)

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