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CSI > Cognitive Impairment CSI > Flashcards

Cognitive Impairment CSI Flashcards

1
Q

What are the symptoms of dementia

A 
Memory disorders, 
personality change, 
personal care deterioration, 
impaired reasoning, 
disorientation, 
deterioration in emotional control, social behaviour and motivation
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2
Q

What can reduce the risk of developing dementia

A

Physical activity (as reduces risk of stroke and heart disease)
Mediterranean diet (antioxidants red. Damage to cerebral neurones and reduce b-amyloid plaques)
Not smoking
Not drinking to excess
Remaining socially active
Cognitive stimulation
Prompt treatment of infections and depression

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5
Q

What is the 6CIT

A

Six item Cognitive Impairment Test is a screening test for cognitive impairment and dementia.
Simple and quick
0-7= normal
8-9= mild cognitive impairment
10-28= severe cognitive impairment (refer)

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6
Q

What do each of the 6CIT questions test for

A

Orientation: Q1,2,4
Attention: Q5,6
Short term memory: Q3,7

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7
Q

What members of the multidisciplinary team (MDT) can aid someone with dementia

A 
Dementia social worker (ensure safety and support at home)
Dietician
Carers
Volunteers
Specialist nurse
Consultant
Occupational therapist
Physiotherapist
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8
Q

How is dementia diagnosed

A 
Referral to Memory clinic
MRI and CT scans
Identify causation of memory loss
Blood tests (pathology)
Neurological examinations
Physical examinations (test motor functions)
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9
Q

What must a person be able to do if they have capacity

A

Understand the info relevant to decision
Retain that info (recall and communicate back)
Use or weigh up info to make a decision

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10
Q

Outline the mental capacity act

A

Independent decisions unless proven otherwise Actions in their best interest; inc patient opinion (autonomy)
appoint a trusted person to make decision on their behalf
independent advocate to support when rights and freedoms are restricted

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11
Q

What is the 2 stage test of capacity set out my the MCA

How must capacity be withdrawn

A
  1. Mind or brain impairment due to illness or ext factor eg drug use?
  2. Unable to make specific decision when needed?

Two doctors must assess and agree, decision lasts 24 hours before needing review

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12
Q

How will fluctuating mental capacity affect the decision making process

A

May be delayed to a point where mental capacity has been regained or improved

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13
Q

How do the medical team decide what is in the patients best interest

A

Input from family and friends

Attempt to discover pre existing values, belief systems and ideals

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14
Q

What is an advance statement

A

Written statement with persons preferences, wishes, beliefs and values for future care
Not legally binding

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15
Q

What is an advance decision

A

A legally binding decision that allows an over 18 to refuse specified medical treatment for a time in the future where they may lack capacity to consent to or refuse

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16
Q

What is Legal Power of Attorney

A

Enables another person to make decisions for a person should they lose capacity
Health, welfare, property, financial affairs

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17
Q

Describe the pathophysiology of Alzheimer’s in regards to extracellular plaques

A

Amyloid precursor protein (transmemb assist in neur growth +repair), cleaved abnorm by beta and gamma secretases (rather than alpha). Surplus of amyloid beta
Amyloid beta proteins aggreg = oligomers +fibrils, diffuse out of cell and deposit as insoluble plaques, form amyloid plaques, interfere w neuronal comm, causes inflammation
Mutation in amyloid precursor protein coding genes incr risk

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20
Q

What are the 5 As of Alzheimer’s

What are other symptoms of AD

A

Amnesia (memory loss)
Aphasia (impaired communication)
Apraxia (loss in voluntary motor skills)
Agnosia (inability to name and recognise nouns)
Anomia (difficulty finding right world)
Misplacing items
Forgetting recent events, faces and names
uncertain about time and date and misdirection
Becoming repetitive
Increased anxiety and irritability

21
Q

What are the symptoms of vascular dementia

A 
Stepwise progression (vs gradual of AD)
Slower thinking
Personality changes
Movement problems
Bladder problems
Similar to stroke and dementia
22
Q

Describe the pathophysiology of Alzheimer’s in regards to intracellular tangles

A

Tau proteins (microtubuke assemb., neur growth+devel) are hyper-phosphorylated, undergo oligomerisation, aggreg into filamentois neuroanatom-fibrillary tangles (NFTs)
S
Disrupt microtubular system= x neuronal growth, transp and comm
Deposit in hippocampus, medial temporal lobe, frontal cornices, lateral pariotemporal regions

23
Q

What is the correlation between disease severity alpha location- density of NFTs

A

Amyloid beta plaques trigger phosphor of tau, dissociating from microtubles and accumulating into NFTs
Reduction in neuronal function and apoptosis (atrophy)
Degen of chol inertia nuclei, reduc in acetylcholine

24
Q

What is neuronal atrophy

A

Loss of synapses and neurones, macroscopically= cerebro-cortical atrophy particular loss of neurones in nucleus basalis of Meynert- rich in acetylcholine, supply hippocampus, amygdala and neocortex
Neuronal atrophy subsequently causes Ach deficiency

25
Q

What causes the mood and sleep effects of Alzheimer’s

A

Loss of neurones in the brain stems median rapid and locus ceruleus neurones cause serotonin and noradrenaline reduction

26
Q

What drug treatments are available for Alzheimer’s and why do they help symptoms of the disease

A

Cholinesterase inhibitors, replace acetylcholine deficit. Acetylcholine is involved in memory function

27
Q

What causes cardiovascular dementia

A

Reduced blood supply to brain due to diseased vessels, multiple infants within minor blood vessels of brain, linked with cardiovascular disorders

28
Q

What causes dramatic changes to deterioration in vascular dementia

A

Strokes
Atherosclerosis contributes to vascular occlusion and transient ischaemic attacks (TIA strokes); deterioration of cognition

29
Q

What is the cause of Lewy Body dementia

A

Aberrant deposits of alpha-synuclein protein, predominantly in cortex and midbrain; within the primary motor complex, aka LEWY BODIES

30
Q

What are the symptoms of Lewy Body dementia

A 
Progressive and insidious onset
Hallucinations
Sleep problems (REM sleep affected)
Memory loss
Parkinsonian-like feature; movement impairment (cogwheel like rigidity) and tremor
31
Q

What are treatments for Lewy Body Dementia

A

Acetylcholinesterase inhibitors

32
Q

What causes frontotemporal dementia

A

Neuronal atrophy of frontal and temporal lobes due to presence of abnormal proteins, predom phosphorylase tau or TDP-43

33
Q

What is the genetic component of Frontotemporal Dementia

A

Autosomal dominant inheritance pattern in 1/3 of cases

Mutation in tau protein or progranulin genes

34
Q

What are the symptoms of frontotemporal dementia

A

Chronic and progressive, earlier and faster onset than other forms
Frontal lobe- regulates social behaviour; speech problems, behaviour changes, emotional problems and disinhibition (in appropriate behaviour)
Temporal lobe- areas for understanding language and factual knowledge; semantic dementia, non fluent aphasia
Unusual beliefs, interests and obsessions
Diet; sweet, overeating, over drinking
Lack of interest and personal hygiene

35
Q

What comprises the limbic system

A

Cingulate gurus, amygdala, hippocampus, mamilliary body

Cingulate gurus connected to temporal lobe by connecting bundle of neurones ; the Cimgulum

36
Q

What is the posterior cingulate cortex concerned with

A

Orientation; time, place and memory

37
Q

What is the hippocampus concerned with

A

Short term memory (further to memory encoding)

38
Q

What is the anterior thalamus concerned with

A

Attention

39
Q

What type of dementia involves white matter lesions

A

Vascular

40
Q

What types of dementia involve generalised atrophy

A

Alzheimer’s and Lewy body

41
Q

What are the similarities and differences between mild cognitive impairment and dementia

A

Similarities: both impact cognitive abilities, neither impact consciousness

Differences: Dementia not directly a normality of ageing, MCI set of symptoms not disease and may not always have causative pathophysiology, dementia is a chronic syndrome arising from many patholophysiologies, MCI doesn’t interfere with normal daily function, dementia has number of drug treatments available esp Alzheimer’s

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