Dementia Flashcards
What age does WHO define as old age?
- 65years old
What are some tasks that old people struggle with?
Mobility - Stairs and getting to shops
Dexterity - Making cup of tea, brushing teeth
Communication - Sight and hearing - Socialising
What are some medical disease associated with old age?
- Arthritis
- Osteoporosis
- Gout
- Fractures
- Diabetes and hormonal dysfunction
- Cognitive impairment
- Visual and hearing conditions
- GI condition
- Cardiovascular conditions
- Malignancy
What do older people value?
- Company and relationships
- Time
- Desire to contribute to society
- Someone listening
What is Dementia?
- Is a chronic syndrome that is progressive in nature
- Deterioration in cognitive function beyond what might be expected from normal ageing
It affects
- Memory
- Thinking
- Orientation (of the day or where they are)
- Comprehension
- Calculation
-Learning capacity
- Language (hard to follow conversation)
- Judgement (spacial judgment of stairs)
Characterised by
- Amnesia (esp recent events)
- Inability to concentrate
- Disorientation in time, place or person
- Intellectual impairment
What is Alzheimer’s?
- Most common dementia (60%)
- Reduction in size of Cortex, sever in hippocampus
What are some distinctive features of Alzheimers?
- Aphasia
- STML
- Communication difficulties
- Muddled over everyday activities
- Mood swings
- Withdrawn
- Loss of confidence
What are some predisposing factors of Alzheimers?
- Age
- Women> Men
- Head injury in past
- Smoking, hypertension, low folate and high blood cholesterol
- Genetic abnormalities on chromosome 1, 14 or 21
What is Vascular dementia?
- Caused by reduced blood flow to brain
- Damages and eventually kills the brain cells
- Can result from small vessel disease/ Stroke/ lots of mini strokes
What are some distinctive factors for Vascular dementia?
- Memory problem of sudden onset’
- Visuospatial difficulties
- Anxiety
- Delusions
- Seizures
What is dementia with Lewy Bodies?
- Abnormal protein called Lewy bodies deposits in brain cells
- Found in people with Parkinson’s and build up in brain repsonsible for memory or muscle movement
What are some distinctive features of Dementia with Lewy bodies?
- STML
- Cognitive ability fluctuates
- Visuospatial difficulties
- Speech and swallowing problems
- Sleep disorders
- Delusions
What is Frontotemporal dementia?
- Frontal lobes deal with behaviour, problem solving, planning and control of emotions
- Changes in personality and behaviour and difficulties to lamguage
- Younger age of onset
What are some distinctive features of Frontotemporal dementia?
- Uncontrollable repetition of words
- Mutism
- Personality change
- Decline in personal and social conduct
What are some rarer forms of dementia?
- HIV - related genitive impairment
- Parkinsons disease
- Corticobasal degeneration
- Multiple Sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease
What are some rarer forms of dementia?
- HIV - related genitive impairment
- Parkinson’s disease
- Corticobasal degeneration
- Multiple Sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease
Why is early diagnosis and treatment beneficial for Dementia?
- Helping family or other caregivers
- Cost saves money long term as less home health aid etc
- Patient benefit to delay progression and give them life goals
- Planning for future to appoint POA and living arrangements etc..
- Improve quality of life not prolong it
What are some early stage symptoms of Dementia?
- Loss of short-term memory
- Confusion, poor judgement, unwilling to make decision
- Anxiety, distress over change
- Inability to manage everyday tasks
- Communication problems (decline in ability or interest in talking, reading and writing)
What are some middle stage symptoms of dementia?
- More support required like reminder to eat and dress
- Fail to recognise people
- Wandering and getting lost
- Behave inappropriately like going out in nightclubs
What are some late stage symptoms of dementia?
- Can’t recognise familiar object or people
- Increasing physical frailty eventually bedbound
- Difficulty eating and swallowing - weight loss
- Incontinence and loss of speech
- Symptoms are progressive and irreversible
What cognitive tests can be done to diagnose dementia?
- Mini-mental state examination (MMSE)
- Blessed demnentia scale
- Single neuropsychological tests
What are some pros of MMSE?
- Well known
- Easy to administer
- Samples range of cognitive functions
- Test-re-test and inter rater availability
What are some cons of MMSE?
- Only three words are to be remembered on recall so not insensitive to mild impairment
- Quite old
- Non standardises time between registration and recall
- Not sensitive to testing frontal lobe
What is the treatment for Dementia?
- No pharmalogical, surgical or behavipoural cure
What is the treatment for Dementia?
- No pharmalogical, surgical or behavioural cure
- Counselling may delay care by up to 1 year
- Aspirin and reducing cardiac risk may halt deterioration of vascular type dementia
- NSAIDS may slow progression
What can be included in dementia friendly care home?
- Different colours for wall and skirting boards etc
- Labels and images on drawers
- Bedroom WC should be visible on bed sitting and lying down
- Personal pictures in sight
- Easy furniture
- Radiators not too hot
What can be included in Dementia friendly healthcare environments?
- Reception desk visible from entrance door
- Floors, ceilings and furniture different colours
- Avoid non essential signs
- Any signage at eye level
- Ensure good natural light instead of artificial
- If any staff rooms or rooms you don’t want patients to enter then paint them as same colour as walls
What elements of psychosis can be present in a patient with dementia?
Visual, auditory, and tactile.
They are diagnostic criteria in patients with Lewy body dementia.
What are some steps you can take to manage a patient with dementia?
Avoid misconceptions
Avoid long explanations
Stay general but assertive
Try not to correct patient
Be non-confrontational
Distraction
What aspects of treatment planning are impacted by a dementia diagnosis?
Progressive nature of dementia
Maintaining OH
Retaining key teeth
Establish preventative regime
Why are older people more at risk from GA?
Weaker organs and tissues
Limited physiological reserve upon stressor application.
