dementia Flashcards
things people can struggle with in their old age
- Mobility -> Stairs, Getting to the shops
- Dexterity -> making a cup of tea , Brushing teeth
- Communication -> sight and hearing -> isolation
common medical diseases in the elderly
- Musculoskeletal – Arthritis, Osteoporosis, gout, fractures
- Diabetes, Hormonal dysfunction
- Cognitive Impairment
- Visual conditions
- Hearing conditions
- Cardiovascular conditions
- GI condition
- Malignancy
dementia
syndrome
- usually of a chronic or progressive nature
Deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing.
what does dementia affect
- Memory
- Thinking
- Orientation
- Comprehension
- Calculation
- Learning capacity
- Language
- Judgement
thoughts and abilities
dementia
definition
acquired progressive loss of cognitive functions, intellectual and social abilities
Severe enough to interfere with daily functioning,
- Characterized by:
- Amnesia (especially for recent events),
- Inability to concentrate,
- Disorientation in time, place or person,
- Intellectual impairment
dementia prevelance
2014 850,500
2025 1.14 million
2051 2 million
- Only 46% of people with dementia in the UK currently have a diagnosis
- 1 in 3 people over 65 will die with a form of dementia
Communication with patients
- Capacity / Consent
5 areas of struggle for dementia pts
- day-to-day memory
- concentrating, planning, organising
- language
- visuospatial skills
- orientation
day to day issues for dementia pts
- difficulty recalling events that happened recently
concentration, planning or organising issues for dementia pts
- difficulty recalling events that happened recently
language issues for dementia pts
- difficulties following a conversation or finding the right word for something
visuospatial skills for dementia pts
- problems judging distances (eg on stairs) and seeing objects in three dimensions
orientation issues for dementia pts
- losing track of the day or date, or becoming confused about where they are.
what is not affected in dementia
Consciousness is not affected have awareness
The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in:
- Emotional control
- Social behavior
- Motivation
4 main types of dementia
- alzheimers
- vascular
- dementia with Lewy Bodies
- frontotemporal
rarer forms of dementia
- HIV – related genitive impairment
- Parkinson’s disease
- Corticobasal degeneration
- Multiple Sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease (CJD)
Alzeheimer’s dementia
Most common (60%)
Reduction size of the Cortex, severe in hippocampus
-
Related to personality, motor ->short term memory loss
- Plaques are deposits of a protein fragment called beta-amyloid that build up in the spaces between nerve cells.
- Tangles are twisted fibers of tau protein build up inside cells.
distinctive factors of alzeheimers
STML, Aphasia (difficulty forming language), Communication Difficulties, Muddled over everyday activities, mood swings, withdrawn, loss of confidence
associated factors of alzeheimers
- Age
- Gender – Women > Men
- Head injury
- Lifestyle
- Increased risk = smoking, hypertension, low folate, high blood cholesterol
- Reducing risk = physical, mental and social activities
- Genetic – abnormalities on chromosome 1, 14 or 21
most common type of dementia
alzeheimers
vascular dementia
caused by reduced blood flow to the brain, which damages and eventually kills the brain cells.
can develop as a result of:
- narrowing and blockage of the small blood vessels deep inside the brain (known as small vessel disease)
- a single large stroke (where the blood supply to part of the brain is suddenly cut off)
- lots of mini-strokes that cause tiny, but widespread, damage to the brain
In many cases, these problems are linked to underlying health conditions – such as high blood pressure and diabetes – as well as lifestyle factors, such as smoking and being overweight.
distinctive features of vascular dementia
- Memory problem of sudden onset, visuospatial difficulties, anxiety, delusions, seizures
dementia with Lewy bodies
Deposits of an abnormal protein called Lewy bodies inside brain cells.
- Deposits build up in areas of the brain responsible for things such as memory and muscle movement
Also found in people with Parkinson’s disease
distincitve features of dementia with lewy bodies
- STML, Cognitive ability fluctuates, visuospatial difficulties, attentional difficulties, overlapping motor disorders, speech and swallowing problems, sleep disorders, delusions
frontotemporal dementia
The frontal lobes of the brain (behind the forehead) deal with behaviour, problem-solving, planning and the control of emotions.
- Changes in personality and behaviour, and difficulties with language.
- Ubiqitin associated clumps of protein
- TDP-43
- Younger age of onset
distinctive features of frontotemporal dementia
- STML not always present, uncontrollable repetition of words, mutism, repetition of words of other people, personality change, decline in personal and social conduct
cost of dementia
- Every dementia patient costs the economy ￡27,647 per year: more than the UK median salary (￡24,700).
- patients with cancer cost ￡5,999, heart disease ￡3,455, stroke ￡4,770 per year.
dementia risk factors
- Age
- Gender
- Genetic background
- Medical history
- Lifestyle
“A dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons.” Roberts et al. (2012) JAlzheimersDis. 2012;32:329-39.
alzeheimers affects
women more commonly than men
vascular dementia prevalence
2nd most common
affects men more
- Likely due to men have high blood pressure, which increases the risk of having a stroke (a cause of vascular dementia).
lifestyle risk factors for stroke include
- High blood pressure
- High cholesterol
- Diabetes
- Smoking
- Being obese
- Lack of exercise
- Irregular heart beat (such as atrial fibrillation)
why diagnose and treat dementia early?
- Financial
- early diagnosis, better controlled, longer time before needing 24/7 care,
- may have domino effect of getting family to be care givers,
- better QoL
early stage dementia symptoms
often misattributed to stress, bereavement or normal ageing.
- Loss of short-term memory
- Confusion, poor judgement, unwilling to make decisions
- Anxiety, agitation or distress over perceived changes
- Inability to manage everyday tasks.
- Communication problems – a decline in ability or interest in talking, reading
- and writing.
It currently takes around three years for a person with dementia to get a formal diagnosis and only around a third of sufferers end up properly diagnosed.
middle stage symptoms of dementia
- More support required, including reminders to eat, wash, dress and use the lavatory;
- Increasingly forgetful and may fail to recognise people;
- Distress, aggression, anger, mood changes – frustration;
- Risk of wandering and getting lost, leaving taps running, gas unlit, cooking unattended or forgetting to light the gas;
- May behave inappropriately e.g. Going out in nightclothes;
- May experience hallucinations, throw-back memories
Symptoms are progressive and irreversible
late stage symptoms of dementia
- Inability to recognise familiar objects, surroundings or people – but there may be some flashes of recognition.
- Increasing physical frailty, may start to shuffle or walk unsteadily, eventually becoming bed/wheelchair confined.
- Difficulty eating and sometimes swallowing, weight loss soft, high calorie - dental
- Incontinence and gradual loss of speech.
- Symptoms are progressive and irreversible.
diagnosis and measurement of progression of dementia
MMSE
Dementia screen to eliminate treatable causes
- FBC, U&E’s, kidney, liver and thyroid function tests
- Glucose, serum B12, Folate and Calcium, C-Reactive Protein and Urinalysis
If indicated
- Syphilis serology, autoantibody screen, serum cholesterol and CT
Neurological examination and detailed cognitive testing (MMSE).
cognitive testing for dementia
5 types
- Mini-mental State Examination MMSE (Folstein)
- Blessed Dementia Scale
- The Montreal Cognitive Assessment (MoCA)
- Single Neuropsychological Tests:
- Clock draw, Delayed word recall, Category Fluency
- Combined single tests
7 minute screen, IQCODE, AD8 Dementia Screening
Pros of MMSE (Folstein)
- well known
- easy to administer
- samples range of congnitive functions
- test-re-test and inter rate availability
MMSE
mini-mental state examination
Cons of MMSE (Folstein)
- only 3 words are to be remembered on recall - not sensitive to mild impairment
- old - new knowledge?
- non standardised time between registration and recall
- not sensitive in testing frontal lobe
ex of single test for dementia
Category Fluency
- You have 1 minute:
- Name as many animals as you can……….
- Name as many football teams as you can…
- Name as many countries as you can…..
Delayed Word Recall
- 10 words
- Make up a sentence
Castle Bottle Anchor Plane Cat Queen Book Hat Cloud Green
e.g. The QUEEN sat in her CASTLE wearing a GREEN HAT made of CAT whilst she read a BOOK about a PLANE which dropped from a CLOUD an ANCHOR smashing a BOTTLE.
treatment for dementia
There is no pharmacological, surgical or behavioural cure
- Counselling may delay residential care by up to 1 year
Aspirin and reducing cardiac risks (control of BP, weight, exercise etc..) may halt deterioration of vascular type dementias. Lower co-morbidities
- Non-Steroidal Anti Inflammatory Drugs (NSAIDs) may slow progression.
- Vitamin E and Ginko Biloba may slow progression
how long should treatment continue for dementia
Treatment should continue until the patient, carer, and/or specialist decide it is the right time to stop, if it is not working, or if the person’s MMSE score falls below 10.
possible drug treatments for dementia
- Anticholinesterases: Donepezil (Aricept®), galantamine, rivastigmine (Exelon®) for mild/moderate Alzheimer’s
- May delay admission to residential care, assist in behavioural difficulty, defer deterioration in cognition
- Adverse effects nausea, vomiting, diarrhoea, 29% left studies
- May delay admission to residential care, assist in behavioural difficulty, defer deterioration in cognition
- Specialist instigation and review. 1 in 3 on these drugs?
drug treatment for vascular dementia
possible?
In a review of six RCTs involving 597 people, Cerebrolysin significantly improved cognitive function compared to standard care alone or placebos. It had a small positive effect on patients’ overall clinical state.
- Some evidence that long-term treatment may give greater benefits, although only two trials looked at long-term effects.
This was assessed with scales testing recall, arithmetic or other cognitive abilities.
Chen N et al; Cerebrolysin for vascular dementia; Cochrane Database of Systematic Reviews 2013, Issue 1
dementia friendly care home
- Walls, floor coverings, skirting boards and doors are all different colours – provides good visual contrast to aid wayfinding
- Fix labels and images to drawers to help let people find what they need without assistance
- A bedroom WC should be visible from the bed on sitting and when lying down
- Position personal pictures and items with personal relevance
- Radiators should be low temperature heating
- Furniture traditional and domestic
dementia friendly healthcare environments
- Reception desk visible from the entrance door
- Ceilings, floors and floor coverings should be acoustically absorbent to support audible communication
- Colour and tone of walls should be distinctive from the flooring
- Colour and tone of furniture should be distinctive from the flooring
- Avoid non-essential signs
- Any signage should be at eye level with simple clear use of text and colour. Use pictorial elements
- Ensure good levels of natural light to minimise artificial light
- Any staff only or locked rooms should be coloured the same as the walls to avoid attention
