COTE

Question 1

Cognitive Fx of Alzheimer’s disease: 4As

Answer 1

Amnesia: recent memory, disorientation for time>place

Apraxia: clothes, using appropriate cutlery

Agnosia: (inability to interpret sensations) and hence recognise parts of the body

Aphasia: late, mixture of receptive & expressive speech

Question 2

RF vascular dementia

Answer 2

Hypertension, hypercholesterolaemia, DM, peripheral vascular disease

Question 3

Focal neurology signs of vascular dementia

Answer 3

CVA

Expressive dysphasia

Question 4

Receptive dysphagia definition

Answer 4

Difficulty in comprehension

Question 5

Expressive dysphagia definition

Answer 5

Difficulty in putting words together to make meaning

Question 6

What personality changes do you see in fronto-temporal lobe dementia / PICKS

Answer 6

Apathy, disinhibition, emotional blunting, coarsening of sociability

Question 7

Onset + progression of LBD

Answer 7

Onset and progression
Fluctuating onset and progression with a more rapid decline
Visual Hallucinations
	Small children, animals, complex scenes
Parkinsonian signs

Question 8

Other feature of LBD?

Answer 8

REM sleep disorders

Frequent falls

Question 9

MSE elements (7)

Answer 9

Appearance
Behaviour
Mood
Speech
Thoughts
Perception
Insight

Question 10

Elements of Addenbrookes Cognitive Examination 100/100

Answer 10

Attention/Orientation 18/18
Memory 26/26
Language 26/26
Visuospatial 16/16
Fluency 14/14

Question 11

Physical Ix for dementia

Answer 11

Bloods
FBC
U+E
LFT
TFT
B12+Folate
Ca2+
ESR/CRP
MSU
CXR
ECG

Question 12

Treatment (Alzheimer’s)

Answer 12

NMDA Antagonist- Memantine
Acetyl-cholinesterase inhibitors (cognitive enhancers)
		Reduce intra-synaptic breakdown of   	acetylcholine
Donepezil, Rivastigmine, Galantamine
Not a cure
Slow rate of decline??
Life expectancy is the same
Allow functioning at a higher level

Question 13

Treatment (vascular dementia)

Answer 13

Statin
Antihypertensive medication
Aspirin
Treat diabetes
Not Ache-I’s

Question 14

What are the BPSD?

Answer 14

The behavioural and psychological symptoms of dementia

• anxiety
• depression
• agitation
• psychosis
• disinhibition

Question 15

What causes BPSD?

Answer 15

Always rule out treatable causes such as infection

P ain
I   nfection
N utrition
C onstipation
H ydration
M edication
E nvironment

Question 16

Main Tx of dementia?

Answer 16

INFORMATION
Carer Support
Life story
Psychological
Target symptoms Mood etc
Occupational therapy
Physiotherapy
Social Inclusion
Social activity

Question 17

The 4 domains of the geriatric assessment

Answer 17

1. Medical Assessment
2. Functional Assessment
3. Psychological Assessment
4. Social and environmental Assessment

Question 18

3 things to consider in an advanced care plan

Answer 18

1. the patients wishes
2. their important values or personal goals for care
3. their understanding of their illness and prognosis

Question 19

Pharmacological Tx Dyspnoea in palliative care

Answer 19

Opiod - oral morphine

Question 20

Non-pharmacological Tx dyspnoea in palliative care

Answer 20

Controlled breathing techniques