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Year 4 - OPIC > Dementia > Flashcards

Dementia Flashcards

1
Q

Cognitive impairment
- Definition

A

Cognitive impairment
- Definition

  1. Disturbance of higher cortical functions
    - memory, judgement, language
    - perception, awareness
  2. Single or multiple
  3. Static or progressive
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2
Q

Dementia
- ICD 10

A

Dementia
- ICD 10

  1. Cognitive impairment
    - both memory and thinking
  2. Impairs ADLs
    - processing incoming information
  3. Clear consciousness
  4. Present for >6 mo
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3
Q

Delirium
- ICD10

A

Delirium
- ICD10

  1. Impairment of cognition
    - Attention and conscious disturbances
    - Abnormal psychomotor behaviour
    - Sleep-wake cycle disturbance
  2. Usually active onset
    - hours/days
  3. Symptoms fluctuate during daytime
    - worst at night
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4
Q

Delirium
- Three subtypes

A

Delirium
- Three subtypes

  1. Hyperactive
    - restlessness/irritability, wandering
    - carphologia, hallucinations/delusions
  2. Hypoactive
    - sleepy, inactive
    - apathetic, unmotivated
  3. Mixed
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5
Q

Dementia
- Epidemiology

  1. % in acute hospital
  2. Life expectancy from time of diagnosis
A

Dementia
- Epidemiology

  1. 10 years life expectancy from time of diagnosis
  2. 20% in acute hospital
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6
Q

Dementia
- Most common dementias

A

Dementia
- Most common dementias

  1. AD
  2. VaD
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7
Q

Features of dementia

  1. Early
  2. Mid
  3. Late
A

Features of dementia

  1. Early
    - Memory
    - Loss of interest
    - Limited intrusion
  2. Mid
    - Language and executive function
    - Behaviour
    - Instrumental ADLs affected
    - Awareness diverges from reality
  3. Later
    - Disorientation
    - Agnosia/apathy
    - Agitation/restlessness
    - ADLs lost
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8
Q

Dementia
- BPSD

A

Dementia - BPSD

  • Behavioural and psychological symptoms of dementia
  1. Non-cognitive symptoms
  2. Challenging to manage
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9
Q

BPSD
- Four main clusters

A

BPSD
- Four main clusters

  1. Affective
  2. Apathetic
  3. Psychotic
  4. Hyperactive
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10
Q

BPSD clusters
- Features

A
  1. Affective
    - agitation, depression
    - screaming, crying, hoarding
  2. Apathetic
    - Indifference, appetite
  3. Psychotic
    - Delusions and hallucination
  4. Hyperactive
    - Aggression, irritability
    - Lability, wondering
    - Disinhibition
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11
Q

BPSD
- ABC Charting

A

BPSD
- ABC Charting

  1. Antecedants
  2. Behaviour
  3. Consequences
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12
Q

BPSD
- Management

A

BPSD
- Management

  1. Treat precipitating illness
  2. Behavioural management
    - quiet, distraction, music therapy, interests
  3. Pharmacology
    - Antipsychotics
    - Caution with LB dementia
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13
Q

Dementia
- Brain imaging

  1. Alzheimers
  2. Vascular
  3. FT
  4. LB
  5. EToH
A

Dementia
- Brain imaging

  1. Alzheimers
    - Volume loss
    - Medial temporal lobe
  2. Vascular
    - infarcts, bleeds
  3. FT
    - FT atrophy
  4. LB
    - Nothing specific
  5. EToH
    - Age-disproportionate atrophy
    - Cortical and white matter
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14
Q

Dementia
- Mx

  1. Alzheimers
A

Dementia
- Alzheimer’s Mx

  1. Supportive
  2. Cholinesterase
    - Donepezil
    - Rivastigmine
    - Galantamine
  3. Depression
    - Sertraline/Citalopram
    - Mirtazapine
  4. Psychosis
    - Risperidone/olanzapine
    - Quetiapine/aripiprazole
  5. Insomnia
    - Trazodone
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15
Q

Dementia mx
- Vascular

A

Dementia mx
- Vascular

  1. Lifestyle
  2. Athersclerosis
    - Aspirin +- dipyridamole
    - Clopidogrel
  3. Cardioembolic
    - Warfarin
    - DOAC
  4. HTN/DM/Cholesterol
  5. Depression/agression
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16
Q

Dementia Mx
- FT dementia

A

Dementia Mx
- FT dementia

  1. Irritability/aggression
    - Benzo/Antipsych
    - Lorazapam, risperidone
  2. Compulsions
    - SSRI
  3. Sleep disturbance
    - Mirtazapine, zolpidem, clonazepam
    - Eszopiclone, zaleplon, trozodone
    - Melatonin
  4. Euphoria, mania, agression
    - Valproate
    - Topiramate
17
Q

Dementia mx
- LB dementia

A

Dementia mx
- LB dementia

  1. Supportive care
  2. Cholinesterase/mematine
    - Donepezil, ravastigmine
    - Galantamine, memantine
  3. Psychosis
    - Careful quetiapine, clozapine
    - Pimavanserin
  4. Depression/anxiety
  5. Sleep behavioural disorder (REM)
    - clonazepam/melatonin
  6. Severe motor
    - carbidopa, levodopa
18
Q

Delirium
- Drug-causes

A

Delirium
- Drug-causes

  1. Psychotropic drugs
    - anti-depressants/anti-psychotics/benzos
  2. Anti-parkinsonian
  3. Anticholinergic
  4. Opiates
  5. Steroids
  6. Diuretics
  7. Recreational and withdrawal
19
Q

CAM Scoring

A

CAM Scoring
- Confusion assessment method

  1. Acute onset and fluctuating course
  2. Inattention
  3. Disorganised thinking
  4. Altered conscious level
20
Q

THINK DELIRIUM

A

THINK DELIRIUM

T - Trauma
H - Hypoxia
I - Increasing age
N - Neck of femur
K - SmoKer or alcohol

D - Drugs
E - Environment
L - Lack of sleep
I - Imbalanced electrolytes
R - Retention
I - Infection
U - Uncontrolled pain
M - Medical conditions

21
Q

Dementia
- Investigation

A

Dementia
- Cognitive screening

  1. MMSE (<24/30)
  2. MoCA
    - Montreal cog. asses.)
  3. ACE III
  4. GP COG
  5. 6 CIT
    - 6item cog impairment test
  6. FAB
    - Frontal assessment battery
22
Q

Dementias
- Prion disease

A

Dementias
- Prion disease

  1. CJD
  2. FI
    - Fatal insomnia
  3. Kuru
    - Incredibly rare
23
Q

Genetic dementias

A

Genetic dementias

  1. AD
    - Presenilin 1&2/APP
  2. MND/FTD
    - C9: ORF22
  3. HD
    - CAG repeat expansion
  4. Downs Syndrome
    - Trisomy 21
    - Alzheimer’s
  5. CADASIL
    - Rare vascular dementia
24
Q

Brain MRI
- Atrophy scale

A

Brain MRI
- Global Cortical Atrophy (GCA)
- Pasquier Scale

GCA 0 - Normal

GCA 1 - Opening of sulci

GCA 2 - Volume loss of gyri

GCA 3 - ‘Knife blade’ atrophy

25
Posterior cortical atrophy - S&S
Posterior cortical atrophy - S&S 1. Visual recognition 2. Reading 3. Distance judgement and coordination 4. Light sensitivity/ halucinations
26
Dementia - PCA Management
Dementia - Posterior cortical atrophy mx 1. Medication - Cholinesterase i 2. MDT 3. Support
27
Dementia - MEMORY LANES timeline
Dementia - MEMORY LANES timeline M - emory E - mployment M -otor symptoms O - ver eating R - isk Y - usual self L - anguage A - ccidents N - ight E - exclusion of others S - ight
28
Fronto-temporal dementias - Sub-types
Fronto-temporal dementias - Sub-types 1. MND/ALS 2. bv FTD - behaviour variant 3. SD/svPPA (primary progressive aphasia) - Semantic variant PPA 4. PNFA/nfvPPA - Nonfluent variant PPA 5. LPA/lvPPA - Logopenic variant PPA 6. CBS - Corticobasal syndrome 7. PSP - Progressive supranuclear palsy
29
Dementia - Mimics
Dementia - Mimics 1. Delirium 2. Functional - Depression/anxiety - Catatonia/schizophrenia 3. Substance misuse 4. Menopause 5. Fibromyalgia 6. Normal pressure hydrocephalus 7. Sensory deprivation - loss of hearing/seeing - NB posterior cortical atrophy
30
Types of memory
Types of memory - Short term - Long term 1. Semantic - general knowledge 2. Episodic - events and experience 3. Procedural

Year 4 - OPIC (5 decks)

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