Dementia Flashcards
what is the yerkes-dodson curve
low anxiety have poor arousal/performance
moderate stress and anxiety have correlation to good arousal and persormance
high levels of anxiety impair performance significantly
how long does the short term memory last
<1min
what is the implicit long term memory
unconscious memory leading to procedural memory
what is the explicit long term memory
conscious memory split into semantic and episodic
4 stages of memory processign
attention
encoding
storage
retrieval
what is anterograde memory loss
difficulty acquiring new material and remembering since injury/disease
what is retrograde memory loss
difficulty remembering info prior to onset of illness/injury
true/false - dementia leads to clouding of consciousness
FALSE!!
questions to ask patients with memory loss
does this affect day to day functioning? any kitchen issues? follow the news? use appliances? recent accidents? enjoy hobbies? lost or disorientated?
assessment of orientation of patient?
name
address
where are we
day, date, month, year, time
assessment of attention of patient?
can you read or watch tv
assess attention formally
assessment of memory of patient?
why are you here? how long have you been here? do you forget conversations? do you forget names? do you repeat yourself? name of doctor?
assessment of mood of patient?
do you feel anxious or worried
how has your mood been
what is the 4AT test
assessment for delirium
moderate to severe cognitive impairment
components of the 4AT
alertless - normal, sleepy, abnormal
AMT-4 - age, DOB, place, year
attention by months backwards
acute/fluctuating
bedside cognitive tests?
GPCOG
6CIT
clock drawing
MMSE scoring and advantages
at least 24/30
quick
blank pen and paper
memorised by clinician
MMSE disadvantages
not age adjusted
poor for exec function
poor in severe impairment
may not address early issues
ACE-III scoring?
100 with 5 domains
cut off 88/82
uses for neuropsychological assessment
areas of deficit and preserved functioning in cog profile
info regarding prognosis
baseline functioning assessment
inform and facilitate intervention and strategies
monitor cognitive function
indicator of recovery
effectiveness of intervention
what is dementia
progressive and irreversible global cognitive decline with associated loss of functioning
diagnostic testing for dementia?
hx of global decline of months to years cognitive test corroborating hx no reversible cause collateral hx OT assessment
what test is the standard cognitive test in diagnosis of dementia
ACE-III
what test can be used in patients unable to do the addenbrookes
MoCA
when would detailed neuropsychological testing be indicated in a patient
those expected to do well in addenbrookes or younger patients with no radiological features on CT/MRI/SPECT
what is often assessed at OT assesment of dementia
activities washing dressing using phone shopping basic cooking
possible reversible causes of cognitive impairment?
delirium alcohol substance misuse neurological infection or inflammation brain lesions and SOLs depression medications thyroid or other metabolic/endocrine
what is mild cognitive impairment
cognitive impairment with little deteriration of function
MoCA 24-26 and ACE-III 75-90
repeat annually
what is subjective cognitive impairment
patients feels they have an impairment but testing and day to day function and normal
association to anxiety/depression or friend/relative with dementia
increased anxiety about memory causes more lapses
what is the general outpatient pathway for someone with dementia
referral to any >55 with suspected dementia
nurse led memory clinic for MSE and cognitive tesing
consultant review and imaging
follow up
diagnosis
CMHT and post diagnostic support
clinical features of AD?
memory loss - short term
dysphasia
dyspraxia
agnosia
CT/MRI features of AD
normal
medial temporal atrophy
temporoparietal atrophy
variants of AD
frontal
posterior cortical atrophy
clinical features of vasc dementia ?
dysphasia dyscalculia frontal lobe and affective symptoms focal neuro signs vascular risk factors stepwise decline
CT/MRI and SPECT features of vascular dementia
CT/MRI - medium to severe vascular disease or multiple lacunar infarcts
SPECT - patchy reduction in tracer uptake through brain
clinical features of behavioural FTD?
behavioural change executive dysfunction impulsive lost social skills apathy diet change obsessive
clinical features of primary progressive aphasia FTD?
effortful non fluent speech
lack of grammar
lack of words
articulatory error
clinical features of semantic FTD?
impaired understanding of word meaning, fluent but empty speech, difficulty with names
CT/MRI and SPEDCT features of FTD
CT/MRI have frontotemporal atrophy
reduced frontotemporal tracer uptake
clinical features of DLB?
two of the following visual hallucination flux in cognition REM sleep disorder parkinsonism but not >1y to dementia onset \+ve dat scan
features of dementia with parkinsons disease
parkinsonism >1yrs to dementia onset
similar to lewy body but different pathology
+ve DAT scan
when to suspect a less common cause dementia
fast progression younger patient neurological signs FHx of a rare cause clues in med Hx - HIV something just isnt fitting right
who to scan and with what with dementia
CT standard but not really advised if >80 and typical hx AD
MRI if young, fast progressing or atypical
SPECT for FTD or certain types AD
DAT scan for DPD/DLB when there arent enough supporting features
cholinesterase inhibitors used in AD
donezepil
rivastigmine
galanramine
cholinesterase inhibitors used in DLB and DPD
rivastigmine
donezepil
how do cholinesterase inhibitors act to treat dementia and what types are they more effective in
slow cognitive decline
DLB/DPD over AD
side effects of anticholinesterase inhibitors
nausea diarrhoea muscle cramp bradycardia worsening COPD/asthma
what should you check before prescribing cholinesterase inhibitors and what is a contraindication
check pulse before prescription and dose increases
not for active PUD or severe asthma/COPD
what is memantine, what dementia is it used for and what does it do
AD
slow cognitive declin and prevent BPSD
what can memantine cause and what are possible side effects
HTN
sedation, dizziness, headache, constipation
describe conditions surrounding dementia and driving
discuss at diagnosis
report to DVLA and allow pt to fill out form
doctor decides if pt can drive whilst DVLA investigates
in middle and later stage dementia what aspects become more prevalent
behavioural and psychiatric
greater need for support and possible institutionalised care
behavioural/psychological symptoms associated with dementia
hallucination delusion insomnia anxiety disinhibition agitation agression depression
initial management of dementia within paitnets
chart behaviours review physical symptoms, examine, investigate side effects of drugs? comfort patient environment activity and exercise sleep hygiene carer education
pharmacological management of FTD for agitation
trazodone
pharmacological mx of agitation for AD
antipsychotics
citalopram, memantine, analgesia, dextromorphan
drugs for depression in dementia
antidepressant and adjunct
drugs for anxiety in dementia
antidepressant, BZD, pregabalin
drugs for visual hallucination in dementia
cholinesterase inhibitors/antipsychotics
drugs for insomnia in dementia
melatonin
z drugs
BZD
sedating antidepressants
drugs for agitation/aggression in dementia
BZD antipsychotic sedating antidepressants cholinesterase inhibitors memantine pregabalin
