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dementia Flashcards

1
Q

Define mild-cognitive impairment

A

cognitive decline beyond expected for that age and education, without significantly interfering with normal daily function

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2
Q

What is amnestic MCI?

A

When impairment manifests as memory loss frequently seen as an early stage of Alzheimer’s disease

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3
Q

What percentage of patients with MCI progress to dementia annually?

A

10-15%

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4
Q

What percentage of patients over the age of 65 are affected by MCI?

A

5-20%

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5
Q

What score on the 6CIT qualifies for MCI?

A

8-9

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6
Q

List some cognitive deficits of MCI?

A

memory
language
thinking
attention
visual depth
perception
judgement

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7
Q

Define dementia

A

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.

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8
Q

What score on the 6CIT is used as a screening as a basis of referral?

A

8+

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9
Q

What are some typical manifestations of dementia?

A

Memory disorders
Changes in personality
Deterioration in personal care
Impaired reasoning ability
Disorientation
Accompanied by deterioration in emotional control, social behaviour and motivation.

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10
Q

What are the differences between MCI and dementia?

A

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)

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11
Q

What are some similarities between MCI and dementia?

A

Both impact a person’s cognitive abilities

Neither impacts a person’s consciousness

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12
Q

What can be done to reduce the risk of developing dementia?

A

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

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13
Q

What are the score-breakdowns of the 6CIT test?

A

0-7 Normal

8-9 - MCI

10-28 - Severe cognitive impairment (refer)

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14
Q

What are the advantages and the disadvantages of the 6CIT test?

A

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

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15
Q

List members of an MDT

A

Dementia social worker
Dietician
Carers
Volunteer
Specialist nurse
Consultant
OT
Physiotherapists

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16
Q

What does a dementia social worker do?

A

Makes sure a patient is safe and well supported at home

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17
Q

What does a dietician do?

A

Assess a patient’s diet and suggest necessary modifications

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18
Q

What does a carer do?

A

Update staff on how a patient is on a day to day basis

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19
Q

What can a volunteer do?

A

Offered by charities to support and give company to patients

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20
Q

Specialist nurse

A

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

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21
Q

What does a consultant do?

A

Responsible for diagnosing patients with dementia and monitors clinical progression

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22
Q

What does an OT do?

A

Optimises the working and living environment of the patient and suggesting modifications to improve patients ADLs.

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23
Q

What does a physiotherapist do?

A

Assess the patient’s mobility and suggesting modifications to support this.

Prescribes an exercise regime to minimise the risk of dementia

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24
Q

Define capacity

A

Ability to use and understand information to make a decision and communicate any decision made

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25
Q

According to MCA when is an individual unable to make a decision for themselves?

A

Can’t:

Understand info relevant to discussion

Retain that info

Use or weigh-up the info as part of the decision-making process

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26
Q

How can you assess capacity?

A

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?

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27
Q

What happens if the patient lacks capacity?

A

Patient’s medical team decides what’s in their best interest, including input from family and friends

28
Q

How many doctors must independently asses and agree capacity should be withdrawn?

A

2

29
Q

What is the most common type of dementia?

A

Alzheimer’s disease

30
Q

What is Alzheimer’s disease?

A

Chronic neurodegenerative disease with progressive and an insidious onset.

31
Q

What is Alzheimer’s characterised by?

A

Memory impairment and as the disease progresses, changes include: language deficits, impaired visuospatial skills, loss of judgement and inability to conduct daily activities

32
Q

What are symptoms of Alzheimer’s?

A

Amnesia
Anomia
Apraxia
Agnosia
Aphasia

33
Q

Amnesia

A

Loss of short-term memory

34
Q

Anomia

A

Inability to name objects

35
Q

Apraxia

A

Loss of dexterity

36
Q

Agnosia

A

Inability to recognise things, unable to understand the function of objects

37
Q

Aphasia

A

Inability to talk

38
Q

What causes Alzheimer’s disease?

A

Extracellular amyloid plaques, Intracellular neurofibrillary tangles (NFTs), and synaptic deterioration and neuronal death

39
Q

How do amyloid plaques form?

A

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

40
Q

How do NFTs form?

A

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)

41
Q

How do NFTs work?

A

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

42
Q

Explain how synaptic deterioration and neuronal death are detrimental

A

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

43
Q

What are the symptoms of vascular dementia?

A

Slower thinking
Personality changes
Movement problems
Bladder problems

44
Q

Describe slower thinking

A

Increased time to process information and to formulate thoughts and structured sentences

45
Q

Describe personality changes

A

Individuals have a low mood, are more emotional or lose interest to external environment

46
Q

Describe movement problems

A

Difficulty walking or changes in the way a person walks, in addition to reduced stability

47
Q

Describe bladder problems

A

Frequent urge to urinate, other bladder problems

48
Q

What is vascular dementia linked with?

A

Cardiovascular diseases

49
Q

Describe the onset of vascular dementia

A

Stepwise progression; progressively worsen as time proceeds; progresses over several years, with the speed of change fluctuating and varying between individuals

50
Q

What percentage of people does vascular dementia affect?

A

5-10%

51
Q

What is Lewy Body dementia associated with?

A

Aberrant deposits of alpha-synuclein protein within the brain, predominantly within the primary motor cortex > deposits referred to as Lewy bodies

52
Q

Describe the onset of LBD

A

Progressive and insidious over time

53
Q

What are the symptoms of LBD?

A

Hallucinations, sleep problems (REM sleep is affected) and memory loss; includes Parkinson like features

54
Q

Parkinson like features

A

Movement impairments (cogwheel like rigidity) and tremor

55
Q

What does treatment of LBD involve?

A

acetylcholinesterase inhibitors

56
Q

What causes fronto-temporal dementia?

A

Neuronal atrophy of the frontal and temporal lobes due to the presence of abnormal proteins within them, predominantly phosphorylated tau or TDP-43

57
Q

Describe the onset of FTD

A

Chronic and progressive disease; however the onset of symptoms can occur more rapidly than other forms

58
Q

What are the symptoms of FTD?

A

Frontal lobe, temporal lobe, obsessions, diet, lack of interest

59
Q

Frontal lobe in FTD

A

FTD associated with speech problems, behavioural changes, emotional problems and disinhibition

60
Q

Temporal lobe in FTD

A

Semantic dementia > understanding of language and factual knowledge are affected-leading to progressive non-fluent aphasia

61
Q

Explain obsessions

A

Develop unusual beliefs or interests

62
Q

Diet in FTD

A

Changes in food preference, increasing sweet, over-eating or over-drinking

63
Q

Lack of interest

A

Withdrawn or lose interest in looking after themselves, failure of normal level of personal hygiene

64
Q

What does the limbic system comprise of?

A

Cingulate gyrus, amygdala, hippocampus and mamillary body

65
Q

What is the function of posterior cingulate gyrus?

A

concerned with orientation (Time, place and identity)

66
Q

What is the function of hippocampus?

A

Concerned with short-term memory

67
Q

What is the function of anterior thalamus?

A

Concerned with attention

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