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)
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
3
Q
What are the clinical features/ domains of dementia?
A
- Cognitive Impairment
- Behavioural and Psychological Symptoms of Dementia
- Disease specific features
- ADLs
4
Q
What are the features of Cognitive impairment?
A
- Memory
- Organising + planning
- Attention + concentration
- Behavioural changes
- Language + communication
- Orientation
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
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
7
Q
What are specific features of Vascular disease?
A
- stepwise decline in function
- predominant gait, attention and personality changes
- focal neurological signs
8
Q
What are specific features of Dementia with lewy body?
A
- Parkinsonism, Falls, Syncope and hallucinations
9
Q
What are the specific features of Frontotemporal dementia?
A
- marked personality change and behavioural disturbances
- memory and perception is relatively preserved
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)
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
12
Q
What are the different cognitive assessment tools?
A
- Mini-cog
- AMTS
- MMSE
-MoCA
-ACE-III
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
14
Q
What is AMTS?
A
- a ten item scoring tool
- Hospital and GP
- 6-8/10 for dementia
15
Q
What is the MMSE?
A
- 11 item tool, measures cognitive function
- memory clinic, hospital
- 24/30 cut off for dementia
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
What is the Managment for Dementia?
- 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
What are some of the Pharmacological Treatments available?
- Acetylcholinesterase inhibitors
- N-methyl-D-aspartic acid receptor antagonists
- Antipsychotics - difficult to control behaviours
- CVS drugs ( Aspirin and Clopidogrel)
27
What is Mixed Dementia?
- 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
What is a Reversible Dementia?
- Conditions that may be associated with cognitive or behavioural symptoms that can be resolved once the primary eitology is treated
29
What is Creutzfeldt- Jakob disease?
- CJD is a rare and fatal condition that affects the brain
- It causes brain damage that worsens rapidly over time
30
What are some of the symptoms of CJD?
- 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
What causes CJD?
- 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
What causes CJD?
- 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
What is the managment for CJD?
- No known cure
- Treat with antidepressants for depression and anxiety
34
How can Syphilis cause dementia?
- Neurosyphilis is associated with cognitive decline and a progressive dementia
35
What are 5 preventable causes of dementia?
- Stroke- Stop Smoking
- Stroke - Reduce Alcohol - keep within limits
- high blood pressure Keep BP at healthy level
- Diabetes - obesity
- Depression - CBT
36
What is the best Cognitive tests for Dementia face to face?
- MOCA - Montreal Cognitive Assessment
37
What memory tests can you do over the phone?
- TICS-m - Modified Telephone Interview for Cognitive Status
38
Why should you not give a patient with Dementia Olanzapine?
- Antipsychotic medication
- Increased mortality in dementia patients
39
What is a contraindication for Donepezil?
- Bradycardia
