dementia Flashcards
Define mild-cognitive impairment
cognitive decline beyond expected for that age and education, without significantly interfering with normal daily function
What is amnestic MCI?
When impairment manifests as memory loss frequently seen as an early stage of Alzheimer’s disease
What percentage of patients with MCI progress to dementia annually?
10-15%
What percentage of patients over the age of 65 are affected by MCI?
5-20%
What score on the 6CIT qualifies for MCI?
8-9
List some cognitive deficits of MCI?
memory
language
thinking
attention
visual depth
perception
judgement
Define dementia
Dementia is the chronic and progressive insidious deterioration of behaviour and higher intellectual function due to organic brain disease.
Dementia is a condition associated with old age and is referred to as an umbrella term for memory loss impairment.
What score on the 6CIT is used as a screening as a basis of referral?
8+
What are some typical manifestations of dementia?
Memory disorders
Changes in personality
Deterioration in personal care
Impaired reasoning ability
Disorientation
Accompanied by deterioration in emotional control, social behaviour and motivation.
What are the differences between MCI and dementia?
MCI associated with normality of ageing whereas dementia isn’t directly a normality of the ageing process
MCI describes a set of symptoms and there may not always be a causative underlying pathophysiology whereas dementia is a chronic syndrome arising from a multitude of pathophysiologies
MCI doesn’t interfere with normal daily function whereas dementia does
MCI has no approved drug treatment whereas dementia has a number of available treatments (particularly for Alzheimer’s disease)
What are some similarities between MCI and dementia?
Both impact a person’s cognitive abilities
Neither impacts a person’s consciousness
What can be done to reduce the risk of developing dementia?
Physical activity (aerobic and resistance activities)
Mediterranean diets (traditionally high in fruits, vegetables and cereals + low in meat, sugar and saturated fat)
Not smoking
Not drinking to excess
Remaining socially active
Engaging in cognitive stimulation
Prompt treatment of depression
What are the score-breakdowns of the 6CIT test?
0-7 Normal
8-9 - MCI
10-28 - Severe cognitive impairment (refer)
What are the advantages and the disadvantages of the 6CIT test?
Adv: Test has high sensitivity without compromising specificity. It is an accessible and simple test to conduct.
Dis: Scoring and weighting of the test can initially be confusing
List members of an MDT
Dementia social worker
Dietician
Carers
Volunteer
Specialist nurse
Consultant
OT
Physiotherapists
What does a dementia social worker do?
Makes sure a patient is safe and well supported at home
What does a dietician do?
Assess a patient’s diet and suggest necessary modifications
What does a carer do?
Update staff on how a patient is on a day to day basis
What can a volunteer do?
Offered by charities to support and give company to patients
Specialist nurse
creates treatment plans for patients with dementia, and tracks cognitive tests - evaluating the results and providing practical advice - flagging activity groups to help support the carers and the family
What does a consultant do?
Responsible for diagnosing patients with dementia and monitors clinical progression
What does an OT do?
Optimises the working and living environment of the patient and suggesting modifications to improve patients ADLs.
What does a physiotherapist do?
Assess the patient’s mobility and suggesting modifications to support this.
Prescribes an exercise regime to minimise the risk of dementia
Define capacity
Ability to use and understand information to make a decision and communicate any decision made
According to MCA when is an individual unable to make a decision for themselves?
Can’t:
Understand info relevant to discussion
Retain that info
Use or weigh-up the info as part of the decision-making process
How can you assess capacity?
2 stage test:
Does the person have an impairment of their mind or brain, whether as a result of an illness or external factor?
Does the impairment mean the person is unable to make specific decision when they need to?
What happens if the patient lacks capacity?
Patient’s medical team decides what’s in their best interest, including input from family and friends
How many doctors must independently asses and agree capacity should be withdrawn?
2
What is the most common type of dementia?
Alzheimer’s disease
What is Alzheimer’s disease?
Chronic neurodegenerative disease with progressive and an insidious onset.
What is Alzheimer’s characterised by?
Memory impairment and as the disease progresses, changes include: language deficits, impaired visuospatial skills, loss of judgement and inability to conduct daily activities
What are symptoms of Alzheimer’s?
Amnesia
Anomia
Apraxia
Agnosia
Aphasia
Amnesia
Loss of short-term memory
Anomia
Inability to name objects
Apraxia
Loss of dexterity
Agnosia
Inability to recognise things, unable to understand the function of objects
Aphasia
Inability to talk
What causes Alzheimer’s disease?
Extracellular amyloid plaques, Intracellular neurofibrillary tangles (NFTs), and synaptic deterioration and neuronal death
How do amyloid plaques form?
Amyloid precursor protein (APP) > transmembrane protein assisting in neuronal repair and growth> typically cleaved by alpha secretase.
Aberrant cleavage > cleavage by beta and gamma secretases leading to surplus production of amyloid beta
Amyloid beta peptides aggregate into oligomers and fibrils with beta-sheet pairing > Diffusing out of extracellular fluid and depositing as insoluble senile plaques
Accumulation of extracellular amyloid-beta forms amyloid plaques which interferes with neuronal communication and contributes towards inflammation
How do NFTs form?
Tau proteins > involved in the assembly of microtubules, an essential component for neuronal growth and development.
Tau hyper-phosphorylation undergoes oligomerisation and aggregates into filamentous neuro-fibrillary tangles (NFTs)
How do NFTs work?
Disrupt the microtubular system resulting in impaired neuronal growth, transport and communication
Appear to deposit in the hippocampus, medial temporal lobe, frontal cortices and the lateral parietotemporal regions
Explain how synaptic deterioration and neuronal death are detrimental
Neuronal atrophy is attributed to a loss of synapses and neurones, macroscopically this is defined as cerebro-spinal atrophy
Neurones are predominantly rich in acetylcholine > supplying the hippocampus, amygdala and neocortex
What are the symptoms of vascular dementia?
Slower thinking
Personality changes
Movement problems
Bladder problems
Describe slower thinking
Increased time to process information and to formulate thoughts and structured sentences
Describe personality changes
Individuals have a low mood, are more emotional or lose interest to external environment
Describe movement problems
Difficulty walking or changes in the way a person walks, in addition to reduced stability
Describe bladder problems
Frequent urge to urinate, other bladder problems
What is vascular dementia linked with?
Cardiovascular diseases
Describe the onset of vascular dementia
Stepwise progression; progressively worsen as time proceeds; progresses over several years, with the speed of change fluctuating and varying between individuals
What percentage of people does vascular dementia affect?
5-10%
What is Lewy Body dementia associated with?
Aberrant deposits of alpha-synuclein protein within the brain, predominantly within the primary motor cortex > deposits referred to as Lewy bodies
Describe the onset of LBD
Progressive and insidious over time
What are the symptoms of LBD?
Hallucinations, sleep problems (REM sleep is affected) and memory loss; includes Parkinson like features
Parkinson like features
Movement impairments (cogwheel like rigidity) and tremor
What does treatment of LBD involve?
acetylcholinesterase inhibitors
What causes fronto-temporal dementia?
Neuronal atrophy of the frontal and temporal lobes due to the presence of abnormal proteins within them, predominantly phosphorylated tau or TDP-43
Describe the onset of FTD
Chronic and progressive disease; however the onset of symptoms can occur more rapidly than other forms
What are the symptoms of FTD?
Frontal lobe, temporal lobe, obsessions, diet, lack of interest
Frontal lobe in FTD
FTD associated with speech problems, behavioural changes, emotional problems and disinhibition
Temporal lobe in FTD
Semantic dementia > understanding of language and factual knowledge are affected-leading to progressive non-fluent aphasia
Explain obsessions
Develop unusual beliefs or interests
Diet in FTD
Changes in food preference, increasing sweet, over-eating or over-drinking
Lack of interest
Withdrawn or lose interest in looking after themselves, failure of normal level of personal hygiene
What does the limbic system comprise of?
Cingulate gyrus, amygdala, hippocampus and mamillary body
What is the function of posterior cingulate gyrus?
concerned with orientation (Time, place and identity)
What is the function of hippocampus?
Concerned with short-term memory
What is the function of anterior thalamus?
Concerned with attention
