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MB3 Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

what is the yerkes-dodson curve

A

low anxiety have poor arousal/performance
moderate stress and anxiety have correlation to good arousal and persormance
high levels of anxiety impair performance significantly

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2
Q

how long does the short term memory last

A

<1min

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3
Q

what is the implicit long term memory

A

unconscious memory leading to procedural memory

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4
Q

what is the explicit long term memory

A

conscious memory split into semantic and episodic

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5
Q

4 stages of memory processign

A

attention
encoding
storage
retrieval

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6
Q

what is anterograde memory loss

A

difficulty acquiring new material and remembering since injury/disease

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7
Q

what is retrograde memory loss

A

difficulty remembering info prior to onset of illness/injury

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8
Q

true/false - dementia leads to clouding of consciousness

A

FALSE!!

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9
Q

questions to ask patients with memory loss

A 
does this affect day to day functioning?
any kitchen issues?
follow the news?
use appliances?
recent accidents?
enjoy hobbies?
lost or disorientated?
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10
Q

assessment of orientation of patient?

A

name
address
where are we
day, date, month, year, time

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11
Q

assessment of attention of patient?

A

can you read or watch tv

assess attention formally

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12
Q

assessment of memory of patient?

A 
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?
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13
Q

assessment of mood of patient?

A

do you feel anxious or worried

how has your mood been

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14
Q

what is the 4AT test

A

assessment for delirium

moderate to severe cognitive impairment

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15
Q

components of the 4AT

A

alertless - normal, sleepy, abnormal
AMT-4 - age, DOB, place, year
attention by months backwards
acute/fluctuating

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16
Q

bedside cognitive tests?

A

GPCOG
6CIT
clock drawing

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17
Q

MMSE scoring and advantages

A

at least 24/30
quick
blank pen and paper
memorised by clinician

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18
Q

MMSE disadvantages

A

not age adjusted
poor for exec function
poor in severe impairment
may not address early issues

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19
Q

ACE-III scoring?

A

100 with 5 domains

cut off 88/82

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20
Q

uses for neuropsychological assessment

A

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

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21
Q

what is dementia

A

progressive and irreversible global cognitive decline with associated loss of functioning

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22
Q

diagnostic testing for dementia?

A 
hx of global decline of months to years 
cognitive test corroborating hx 
no reversible cause 
collateral hx 
OT assessment
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23
Q

what test is the standard cognitive test in diagnosis of dementia

A

ACE-III

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24
Q

what test can be used in patients unable to do the addenbrookes

A

MoCA

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25
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
26
what is often assessed at OT assesment of dementia
``` activities washing dressing using phone shopping basic cooking ```
27
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 ```
28
what is mild cognitive impairment
cognitive impairment with little deteriration of function MoCA 24-26 and ACE-III 75-90 repeat annually
29
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
30
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
31
clinical features of AD?
memory loss - short term dysphasia dyspraxia agnosia
32
CT/MRI features of AD
normal medial temporal atrophy temporoparietal atrophy
33
variants of AD
frontal | posterior cortical atrophy
34
clinical features of vasc dementia ?
``` dysphasia dyscalculia frontal lobe and affective symptoms focal neuro signs vascular risk factors stepwise decline ```
35
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
36
clinical features of behavioural FTD?
``` behavioural change executive dysfunction impulsive lost social skills apathy diet change obsessive ```
37
clinical features of primary progressive aphasia FTD?
effortful non fluent speech lack of grammar lack of words articulatory error
38
clinical features of semantic FTD?
impaired understanding of word meaning, fluent but empty speech, difficulty with names
39
CT/MRI and SPEDCT features of FTD
CT/MRI have frontotemporal atrophy | reduced frontotemporal tracer uptake
40
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 ```
41
features of dementia with parkinsons disease
parkinsonism >1yrs to dementia onset similar to lewy body but different pathology +ve DAT scan
42
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 ```
43
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
44
cholinesterase inhibitors used in AD
donezepil rivastigmine galanramine
45
cholinesterase inhibitors used in DLB and DPD
rivastigmine | donezepil
46
how do cholinesterase inhibitors act to treat dementia and what types are they more effective in
slow cognitive decline | DLB/DPD over AD
47
side effects of anticholinesterase inhibitors
``` nausea diarrhoea muscle cramp bradycardia worsening COPD/asthma ```
48
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
49
what is memantine, what dementia is it used for and what does it do
AD | slow cognitive declin and prevent BPSD
50
what can memantine cause and what are possible side effects
HTN | sedation, dizziness, headache, constipation
51
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
52
in middle and later stage dementia what aspects become more prevalent
behavioural and psychiatric | greater need for support and possible institutionalised care
53
behavioural/psychological symptoms associated with dementia
``` hallucination delusion insomnia anxiety disinhibition agitation agression depression ```
54
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 ```
55
pharmacological management of FTD for agitation
trazodone
56
pharmacological mx of agitation for AD
antipsychotics | citalopram, memantine, analgesia, dextromorphan
57
drugs for depression in dementia
antidepressant and adjunct
58
drugs for anxiety in dementia
antidepressant, BZD, pregabalin
59
drugs for visual hallucination in dementia
cholinesterase inhibitors/antipsychotics
60
drugs for insomnia in dementia
melatonin z drugs BZD sedating antidepressants
61
drugs for agitation/aggression in dementia
``` BZD antipsychotic sedating antidepressants cholinesterase inhibitors memantine pregabalin ```

MB3 Psychiatry (16 decks)

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