Cognition

Question 1

Multi-store model of memory?

Answer 1

Input > sensory memory > attention > goes to short term memory > by connecting a rehearsal loop can keep that in short term memory, but doing rehearsal over time can move to long term memory > when want to recall something you retrieve it from long term into short term

Question 2

3 types of long term memory?

Answer 2

episodic, semantic and procedural

Question 3

Define episodic memory?

Answer 3

memory of experiences- things that have happened as you, actively remember and think about, the more significant the more you remember it

Question 4

Define semantic memory?

Answer 4

remembering facts (you recall the facts but you don’t remember when you learn the facts specifically) 
ideas and concepts not learned from experience

Question 5

Define procedural memory?

Answer 5

memory on specific procedures usually motor skills
dont necessarily think about it “muscle memory”
e.g. walking, riding a bike, driving

Question 6

What things do we tend to remember?

Answer 6

those that are meaningful and interesting

Question 7

What is meant by primacy and recency effects?

Answer 7

Theprimacyeffect refers to recalling the items from the beginning of the list, and therecencyeffect refers to recalling items from the end of the list
we tend to remember first and last and forget the stuff in between

Question 8

Describe how retrieval cues can help with memory?

Answer 8

context- external environment triggers
state- similar state e.g. drunk more likely to remember when drunk
organisation- organising information into for example pneumonic helps

Question 9

Explain pro-active and retro-active interference?

Answer 9

Proactive interference (pro=forward) occurs when you cannot learn a new task because of an old task that had been learnt. … Retroactive interference (retro=backward) occurs when you forget a previously learnt task due to the learning of a new task

Question 10

Diagnostic criteria for delirium?

Answer 10

• clouding of consciousness
• disturbance of cognition
• psychomotor disturbance
• disturbance of sleep wake cycle
• rapid onset and fluctuation of symptoms over the course of the day
• underlying disease process responsible although that disease process does NOT need to be found for diagnosis
• emotional disturbance

Question 11

Describe consciousness in delirium?

Answer 11

fluctuating with lucid intervals

Question 12

Describe cognition in delirium?

Answer 12

• disorientation in time, place and person
• impaired memory and attention
• perceptual disturbances > hallucinations and illusions (hallucinations tend to be visual)

Question 13

Hallucinations in delirium vs functional mental disorders?

Answer 13

hallucinations in delirium tend to be visual whereas in functional mental disorders they are more commonly auditory

Question 14

Describe psychomotor disturbance in delirium?

Answer 14

3 presentations

• hyperalert > agitation, disorientation, hallucinations, sometimes aggressive
• hypoalert > confusion, sedation, often confused for depression
• mixed > fluctuating symptoms of both

Question 15

Describe sleep in delirium?

Answer 15

• insomnia
• sleep loss
• reversal of sleep cycle
• nocturnal worsening of symptoms
• disturbing dreams and nightmares

Question 16

Describe emotional disturbance in delirium?

Answer 16

• depression
• anxiety
• fear
• irritability
• euphoria
• apathy
• perplexity
• aggression

Question 17

Onset of delirium is ___1___
It has a ____2_______ course
It lasts ____3_______
This is in contrast to dementia which is _____4____

Answer 17

1) rapid
2) transient and fluctuating course
3) days to months depending on the underlying cause
4) slow onset but gradually progressive

Question 18

Causes of delirium?

Answer 18

endless list, ultimately anything but here’s some common causes

Drugs, HF, PE, ICH, MI, UTI, renal failure, hypoxia, intoxication, hepatic failure, pancreatitis, diabetic complications, thyroid problems, trauma, surgery, infection, epilepsy, tumours, encephalitis, intoxication, withdrawal

Question 19

Describe age and likelihood of developing delirium?

Answer 19

Delirium can occur at age but the more old and frail and comorbidities the less it takes to cause delirium
very frail can be caused by environmental factors alone

Question 20

Risk factors for delirium? (9)

Answer 20

• increased age
• cognitive deficit e.g. dementia
• existing sensory deficits (makes orientation worse so perpetuates delirium)
• previous episode
• hypo/hyperthermia
• long or emergency surgery
• immobility
• social isolation
• new environment

Question 21

Investigations for delirium?

Answer 21

• 4AT is a short test for delirium
• history and full physical exam
• investigations are guided by emerging underlying cause:

urinanalysis, FBCs, U and Es, LFTs, thyroid function, blood glucose, CRP, B12 and folate, CXR, MRI/ CT brain

Question 22

Overview of management of delirium?

Answer 22

identify and treat cause
manage environment and provide support
prescribe
review

Question 23

Describe management of environment and providing support in delirium?

Answer 23

• educate staff
• reality orientation: clear communication, clock and calendar in room
• correct sensory impairments: glasses and hearing aids from home
• bright side room with unnecessary noise reduced
• ensure basic needs are met

Question 24

Describe prescribing in delirium?

Answer 24

• sedating drugs can worsen delirium by increasing confusion
• alcohol withdrawal requires reducing scale of benzodiazepines
• otherwise anti-psychotics are standard treatment, usually haloperidol
• in parkinsons disease or lewy body demntia should give lorazepam instead (dont want to be blocking dopamine receptors with haloperidol)

Question 25

Describe review in delirium?

Answer 25

Patients need to be reviewed frequently as they may no longer need their medication. Patients can also worsen quickly with seizures, injuries and sudden death. Follow up is important.

Question 26

Describe Moca what a normal score is?

Answer 26

total score is 30

26 or above is normal

Question 27

Describe MMSE and normal scores vs dementia?

Answer 27

The maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia.

Question 28

Describe scoring of ACE 2/ adenbrookes?

Answer 28

The results of each activity are scored to give a total score out of 100 (18 points for attention, 26 for memory, 14 for fluency, 26 for language, 16 for visuospatial processing). The score needs to be interpreted in the context of the patient’s overall history and examination, but a score of 88 and above is considered normal; below 83 is abnormal; and between 83 and 87 is inconclusive.

Question 29

Define dementia?

Answer 29

progressive global cognitive decline
Irreversible
Associated decline in functioning
Caused by many different diseases- dementia is a syndrome not a disease!

Question 30

Describe two drugs given for Alzheimers?

Answer 30

acetylcholinesterase inhibitors (to increase nerve signalling) e.g. Donepezil, rivastigmine and galantamine
memantime (blockade of nmda receptors, a type of glutamate receptor)

Question 31

Dementia rules and driving?

Answer 31

dementia Must be reported to DVLA
Patient fills in CG1 form
DVLA request report from doctor
Doctor decides if patient can drive while investigations ongoing (if any concerns from patient or someone else would say no- anyone in family wont go in car with them? Bumps or scrapes on the car? Spatial issues in addenbrookes)
Rookwood Driving Battery (written test that shows how likely they are to pass an on road test)
On road test if necessary
If DVLA happy they get a one year licence which is renewed every year

Question 32

Mediation for agitation in alzheimers?

Answer 32

Only RCT evidence base in Alzheimers is for antipsychotics, citalopram, memantine, analgesia, dextromethorphan (not in BNF)

Question 33

Visual hallucinations in dementia can give?

Answer 33

cholinesterase inhibitors or antipsychotics

Question 34

What type of dementia do you need to be careful of prescribing antipsychotics?

Answer 34

dementia with lewy bodies

parkinsons dementia

Question 35

Pharmacological treatment of insomnia in dementia?

Answer 35

melatonin, Z drugs, benzodiazepines, sedating antidepressants