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CSI > CSI 4: Dementia > Flashcards

CSI 4: Dementia Flashcards

1
Q

What is mild cognitive impairment?

A

condition causing minor problems w/cognition + mental abilities e.g. memory + thinking worse than expected at that age BUT not severe enough to interfere w/daily life significantly

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2
Q

What sorts of problems might a person w/MCI have?

A
  • memory
  • reasoning, planning or problem-solving
  • attention
  • language
  • visual depth perception
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3
Q

What are some potential causes of MCI?

A
  • ‘pre-dementia’
  • depression, anxiety or stress
  • physical illness e.g. constipation, infection etc.
  • poor eyesight or hearing
  • vitamin or thyroid deficiencies
  • side effects of medication
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4
Q

What is dementia?

A

syndrome (chronic or progressive) with deterioration in cognitive function beyond expected from normal ageing that impacts on daily life.

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5
Q

What sorts of cognitive function can dementia affect?

A
  • memory
  • thinking
  • orientation
  • comprehension
  • calculation
  • learning capacity
  • language
  • judgement
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6
Q

What is not affected by dementia?

A

consciousness

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7
Q

What may cognitive decline in dementia be accompanied by?

A

deterioration in emotional control, social behaviour or motivation

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8
Q

What are the 3 stages for signs and symptoms of dementia?

A

EARLY STAGE –> gradual onset often overlooked e.g. forgetfulness
MIDDLE STAGE –> more restricting e.g. becoming lost, forgetting people’s name + recent events
LATE STAGE –> near total dependence + inactivity

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9
Q

What are the 4 most common types of dementia?

A
  • Alzheimer’s disease
  • Vascular dementia
  • Dementia w/Lewy bodies
  • Frontotemporal dementia
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10
Q

What type of onset does Alzheimer’s disease have?

A

gradual progressive onset

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11
Q

Which type of dementia has the following signs + symptoms?

  • memory loss, esp. names + recent events
  • language deficits
  • rapid forgetting
  • impaired visual spatial skills
  • normal gait and neuro exam early
  • later affective disturbance, behavioural systems like aggression
A

Alzheimer’s disease

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12
Q

What is amnesia?

A

forgetting events that have happened

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13
Q

What is anomia?

A

can’t remember names of things/objects

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14
Q

What is apraxia?

A

difficulty in simple mobility e.g. can’t tie shoelaces, progressive to can’t write

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15
Q

What is agnosia?

A

can’t recognise things e.g. family members + friends

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16
Q

What is aphasia?

A

can’t speak/unable to speak

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17
Q

What is the pathophysiology behind Alzheimer’s disease?

A
  • cerebral-cortical atrophy
  • beta amyloid plaques
  • neurofibrillary tangles
  • synaptic deterioration and neuronal death
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18
Q

What are beta amyloid plaques + how do they form?

A

Amyloid precursor protein (APP) –> transmembrane protein that helps neurone growth + repair, gets used, broken down and recycled.
Goes wrong when it’s degraded the wrong way to produce amyloid beta.
Amyloid beta can’t be degraded so neurones push it out.
This forms hard insoluble accumulation of B-amyloid proteins that clump together to form toxic aggregates between nerve cells

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19
Q

What are neurofibrillary tangles + how do they form?

A

Tau = protein that supports microfilaments within the neuron (component of microtubules).
Amyloid beta triggers phosphorylation of tau, causing it to disassociate from the MF and accumulate into neurofibrillary tangles
Tangles + weakened microfilaments → ↓neuronal function and apoptosis → atrophy

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20
Q

What type of onset does vascular dementia have?

A

Abrupt or gradual onset –> stepwise progression (multiple mini infarcts)

21
Q

What are the symptoms of vascular dementia?

A
  • step-wise decline
  • personality changes
  • history of vascular disease (e.g. look for words like cholesterol, ischaemia etc)
22
Q 
Which type of dementia has the following symptoms?
•	Fluctuating cognition 
•	Visual hallucinations 
•	Neuroleptic sensitivity
•	Shuffling gait
•	Increased tone
•	Tremors
•	Falls
A

Dementia with Lewy Bodies

23
Q

What are Lewy Bodies?

A

Protein aggregates of alpha-synuclein which form clumps in neurones in cortex and midbrain (Basal ganglia, cerebellum –> struggle for initiation of movement + fluidity)

24
Q

Which type of dementia has the following symptoms?

  • Disinhibition - act impulsively, say/do inappropriate things
  • Socially inappropriate behaviour
  • Poor judgement
  • Apathy, decreased motivation
  • Poor executive function
  • Acting selfishly and differently- imbalances in behaviour
A

Frontotemporal dementia

25
Q

Which 2 types of dementia involve tauopathies?

A
  • Alzheimer’s disease –> hyper phosphorylated tau causes neurofibrillary tangles
  • Frontotemporal dementia –> abnormal clumps of tau proteins called pick bodies
26
Q

What 2 features are common across all types of dementia?

A

Irritability and depression can be common features of all

27
Q

What test is used to assess cognitive ability?

A

6-CIT - six item cognitive impairment test

28
Q

Which questions on the 6-CIT assess orientation and what area of the brain is this associated with?

A

POSTERIOR CINGULATE CORTEX

  1. What year is it? (incorrect =4)
  2. What month is it? (incorrect = 3)
  3. About what time is it? (incorrect = 3)
29
Q

Which questions on the 6-CIT assess memory and what area of the brain is associated with this?

A

HIPPOCAMPUS

  1. Give patient address phrase to remember eg. John, Smith, 42, West St, Bedford (should be 5 components)
  2. Repeat address phrase from Q3. (each error = 2 points/all wrong = 10 points)
30
Q

Which questions on the 6-CIT assess attention and what area of the brain is associated with this?

A

THALAMUS

  1. Count backwards from 20-1 (1 error, 2pts, >1 error, 4 pts)
  2. Say months of year in reverse (1 error, 2pts, >1 error, 4 pts)
31
Q

What is a normal score on the 6-CIT?

A

0-7

32
Q

What score on the 6-CIT may indicate MCI?

A

8-9

33
Q

What score indicates significant cognitive impairment on the 6-CIT?

A

10-28 (max)

34
Q

What would most likely happen is patient scored 8 or above on the 6-CIT?

A

Referral to memory clinics run by geriatric services so more tests can be done to confirm a diagnosis

35
Q

What are some preventative interventions for cognitive decline and dementia?

A
  • interventions addressing ‘intermediate disease precursors’ e.g. raised blood pressure, raised cholesterol, obesity, diabetes, screening + early detection
  • regular physical exercise
  • offering services directly to older people which engage them to participate in healthy lifestyle choices
  • look at protective factors associated w/cognitive reserve e.g. educational level, intellectual and social engagement
36
Q

What are some post-diagnostic interventions for cognitive decline and dementia?

A
  • drug treatments –> still not found, mainly used to manage other conditions associated w/dementia
  • cognitive interventions –> stimulation, training, rehabilitation
  • physical exercise
  • other cognitively-stimulating activities
  • improving living environments
37
Q

Who might be part of an MDT team in cognitive impairment?

A
  • occupational therapist
  • nurse
  • neurologist, radiologist, pathologist
  • psychiatrist, psychologist
  • geriatrician
  • social worker
  • carers
  • district nurse
  • dietician
  • speech and language therapist
  • physiotherapist
  • advanced practice nurse
  • GP
  • volunteers
38
Q

What is the mental capacity act?

A

Act designed to protect and empower people who may lack mental capacity to make own decisions about their care and treatment (applies to people aged 16 or over)

39
Q

What kind of decisions does the mental capacity act cover?

A
  • day-to-day things like what to wear or buy to serious life-changing decisions like moving into a care home or having surgery.
40
Q

What does the mental capacity act state?

A
  • assume person has capacity unless proved otherwise
  • help people make own decisions where possible
  • unwise decision doesn’t = lack of capacity
  • decisions made for those who lack capacity must always be in best interests for person
  • treatment and care provided should be least restrictive of basic rights and freedom
41
Q

What must a person be unable to do if they are deemed to lack capacity?

A

Can’t:

  • understand info relevant to decision
  • retain that information
  • use of weigh up that info
  • communicate decision
42
Q

Capacity is _______ and ________-specific?

A

decision and time-specific

43
Q

How is mental capacity assessed?

A

1) Does person have impairment of mind or brain - whether result of illness, or external factors such as alcohol or drug use?
2) Does impairment mean person is unable to make a specific decision when needed?

44
Q

How is a decision made is someone lacks capacity?

A
  • Consult with others for views about person’s best interests
  • Should always find least restrictive option (do we need to make a decision, interfere less w/basic rights + freedoms, minimising interference)
  • team decides in patients best interests
45
Q

Who can help to decide a patient’s best interests?

A
  • doctor/medical team
  • patient
  • anyone engaged w/caring for patient
  • family, close relatives and friends
  • Lasting Power of Attorney/ independent advocates (official decision makers)
46
Q

To identify a patient’s best interests, the MCA says we should…?

A
  • encourage participation
  • identify all relevant circumstances
  • find out person’s views
  • avoid discrimination
  • assess whether person might regain capacity
47
Q

What are the 6 components to the ethical framework for dementia?

A

1) Care-based approach to ethical decisions
2) Belief about nature of dementia
3) Belief about quality of life
4) Importance of promoting interests of person w/dementia and of those who care for them
5) Requirement to act in accordance w/solidarity
6) Recognising personhood, identity and value

48
Q

What are the 4 pillars of ethics?

A
  • autonomy
  • beneficence
  • non maleficence
  • justice
49
Q

What are the key differentiators between normal ageing and dementia/MCI?

A

Normal aging preserves temporal orientation, visuospatial skills and insight.

Dementia/MCI tend to lose these.

Both tend to lose verbal recall, mental flexibility and sustained attention.

CSI (5 decks)

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