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OPIC > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the definition Dementia?

A
  • Dementia is a clinical syndrome characterised by a significant deterioration in mental function that leads to impairment of normal function (ADLs)
  • ADLs (Personal - Washing, dressing, toileting, continence, transferring)/ (Domestic - cooking, cleaning, shopping, managing finances, taking medication)
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2
Q

What are the 7 different types of Dementia?

A
  • Alzheimer’s disease
  • Vascular dementia
  • Dementia with Lewy-body
  • Frontotemporal dementia
  • Parkinson’s disease dementia
  • Huntington’s disease
  • Prion disease
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3
Q

What are the clinical features/ domains of dementia?

A
  • Cognitive Impairment
  • Behavioural and Psychological Symptoms of Dementia
  • Disease specific features
  • ADLs
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4
Q

What are the features of Cognitive impairment?

A
  • Memory
  • Organising + planning
  • Attention + concentration
  • Behavioural changes
  • Language + communication
  • Orientation
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5
Q

What are the features of BPSD?

A
  • Agitation and emotional lability
  • Depression and anxiety
  • Sleep cycle disturbance
  • Disinhibition
  • Withdrawal/ apathy
  • Motor disturbance
  • Psychosis
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6
Q

What are specific features of Alzheimer’s disease?

A
  • early impairment of memory
  • Manifests as short-term memory loss and difficulty learning new information
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7
Q

What are specific features of Vascular disease?

A
  • stepwise decline in function
  • predominant gait, attention and personality changes
  • focal neurological signs
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8
Q

What are specific features of Dementia with lewy body?

A
  • Parkinsonism, Falls, Syncope and hallucinations
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9
Q

What are the specific features of Frontotemporal dementia?

A
  • marked personality change and behavioural disturbances
  • memory and perception is relatively preserved
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10
Q

What are the specific features of activities of daily living?

A
  • Loss of independence
  • Early stages: problems with higher level function ( managing finances, difficulties at work)
  • Later stages: problems with basic personal care (washing, eating and toileting) and motor function (walking, transferring)
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11
Q

What are the different cognitive domains?

A
  • Attention and concentration
  • Recent and remote memory
  • Language
  • Praxis (planned motor movement)
  • Executive function
  • Visuospatial function
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12
Q

What are the different cognitive assessment tools?

A
  • Mini-cog
  • AMTS
  • MMSE
    -MoCA
    -ACE-III
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13
Q

What is Mini-cog ?

A
  • GP screening tool
  • 2/4 mins
  • A three item word memory and clock drawing
  • Cut off 5/8
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14
Q

What is AMTS?

A
  • a ten item scoring tool
  • Hospital and GP
  • 6-8/10 for dementia
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15
Q

What is the MMSE?

A
  • 11 item tool, measures cognitive function
  • memory clinic, hospital
  • 24/30 cut off for dementia
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16
Q

What is MoCA?

A
  • tests several domains including executive function, attention, language, memory and visuospatial skills
  • memory clinic, hospital setting
  • 26/30 dementia cut off
17
Q

What is ACE-III?

A
  • longer cognitive assessment tool assess 5 domains: attention, memory, renal fluency, language and visuospatial abilities
  • 15-20 minutes
  • Memory clinic
  • 82-88/100 cut off for dementia
18
Q

What is the Diagnostic Criteria for Dementia?

A

DSM-V:
1. Functional Ability - inability to carry out normal functions. Represents a decline from previous functional level
2. Cognitive Domains - impairment involving > or equal to 2 cognitive domains
3. Differentials excluded - clinical features can not be explained by another cause e.g. psychiatric disorders and delirium

19
Q

What is Mild Cognitive Impairment?

A
  • This describes cognitive deficits in one or more of the major cognitive domains
  • However, the deficit is insufficient to interfere with independence in daily activities
  • Mild cognitive impairment is increasingly important as it helps to identify patients at risk of progression to dementia.
  • Patients should have regular follow-up and be advised to undertake healthy brain activities (exercise and socialising)
20
Q

What are the Differential Diagnosis for Dementia?

A
  • Depression (and other Psychiatric Disorders)
  • Drugs ( anti-cholinergic effects - anti-histamines, anti-psychotics and anti-epileptics)
  • Delirium
21
Q

How is the Severity of Dementia determined?

A
  • Determined based on the level of functional inability
  • Using cognitive assessment tools (mild, moderate and severe)
22
Q

What bloods would you do for Dementia?

A
  • FBC
  • ESR
  • U+E
  • Bone Profile
  • HBA1c
  • LFTs
  • TFTs
  • Serum B12 and Folate
23
Q

What other investigations would you consider for Dementia?

A
  • ECG
  • Virology (HIV)
  • Syphilis testing
  • CXR
24
Q

What Imaging would you consider?

A
  • MRI scan of brain
25
Q

What is the Managment for Dementia?

A
  • Assess capacity and advanced care planning
  • Physical and Mental Health
  • Driving (DVLA)
  • Care Plans - details of diagnosis, treatment, environmental modifications and review plans
  • End of Life Care - focus on physical, psychological, social and spiritual needs. Oral nutrition is encouraged as long as possible. No evidence for long-term feeding methods
26
Q

What are some of the Pharmacological Treatments available?

A
  • Acetylcholinesterase inhibitors
  • N-methyl-D-aspartic acid receptor antagonists
  • Antipsychotics - difficult to control behaviours
  • CVS drugs ( Aspirin and Clopidogrel)
27
Q

What is Mixed Dementia?

A
  • A condition in which a person has more than one type of dementia
  • The most common combination is Alzheimer’s disease and vascular dementia
  • You can also have Alzheimer’s disease and Lewy Body Disease
28
Q

What is a Reversible Dementia?

A
  • Conditions that may be associated with cognitive or behavioural symptoms that can be resolved once the primary eitology is treated
29
Q

What is Creutzfeldt- Jakob disease?

A
  • CJD is a rare and fatal condition that affects the brain
  • It causes brain damage that worsens rapidly over time
30
Q

What are some of the symptoms of CJD?

A
  • loss of intellect and memory
  • changes in personality
  • loss of balance and co-ordination
  • slurred speech
  • vision problems and blindness
  • abnormal jerking movements
  • progressive loss of brain function and mobility
31
Q

What causes CJD?

A
  • CJD is caused by an abnormal infectious protein called a prion
  • These prions accumulate at high levels in the brain and cause irreversible damage to nerve cells
32
Q

What causes CJD?

A
  • CJD is caused by an abnormal infectious protein called a prion
  • These prions accumulate at high levels in the brain and cause irreversible damage to nerve cells
33
Q

What is the managment for CJD?

A
  • No known cure
  • Treat with antidepressants for depression and anxiety
34
Q

How can Syphilis cause dementia?

A
  • Neurosyphilis is associated with cognitive decline and a progressive dementia
35
Q

What are 5 preventable causes of dementia?

A
  • Stroke- Stop Smoking
  • Stroke - Reduce Alcohol - keep within limits
  • high blood pressure Keep BP at healthy level
  • Diabetes - obesity
  • Depression - CBT
36
Q

What is the best Cognitive tests for Dementia face to face?

A
  • MOCA - Montreal Cognitive Assessment
37
Q

What memory tests can you do over the phone?

A
  • TICS-m - Modified Telephone Interview for Cognitive Status
38
Q

Why should you not give a patient with Dementia Olanzapine?

A
  • Antipsychotic medication
  • Increased mortality in dementia patients
39
Q

What is a contraindication for Donepezil?

A
  • Bradycardia

OPIC (18 decks)

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