Dementia 2- Vicki Lean's Lecture Flashcards
What is the sign and symptoms of dementia
- Memory Loss
Forgetting recent conversations or events
Struggle with daily tasks
Getting lost in similar surroundings or
familiar journeys
2.Language and Communication
Struggling to find the right words in a conversation or for an object.
Struggling to recognise faces - Visuoperceptual perception
Misperception
Misidentification
4.Hallucinations
Seeing something that’s not there (Lewy Body Dementia)
Dementia includes problems with…..
Thinking speed
Mentalsharpness and quickness
Understanding
Judgement
Mood
Movement
Difficulties carrying out daily activities
How common is Dementia?
Around 850,000 people in the UK have dementia
1 in 14 people over 65years old will develop dementia
Affects 1 in 6 people over 80 years old
Can occur in under 65years old
Number increasing due to people living longer
List the main types of Dementia
- Alzhemiers disease
- Vascular Dementia
- Dementia with lewy body
- Frontotemporal Dementia
List other types of Dementia
Mixed Dementia
Young onset Dementia
Creutzfeldt-Jakob Disease (CJD)
Parkinson’s Disease Dementia
Alcohol Related Brain Damage
Learning Disabilities
Facts about Alzhemiers Disease
Most common cause of dementia.
In Alzheimer’s disease, connections between these cells are lost.
Due to protein build up forming abnormal structures called ‘plaques’ and ‘tangles’
Eventually nerve cells die and brain tissue is lost.
Progressive disease
What is vascular Dementia
Second most common form of dementia
Caused by reduced blood supply to the brain.
Different Types
Stroke-related dementia
Post stroke dementia
Single and multi-infarct dementia
Subcortical dementia
Explain Dementia with Lewy body
Canbe diagnosed wrongly and is oftenmistaken for Alzheimer’s disease.
Lewy bodies are tiny depositsof a protein (alpha-synuclein) that appear in nervecells in the brain.
Not fully understood why cause dementia but believed
low levels of important chemicals (mainlyacetylcholine and dopamine) that carry messagesbetween nerve cells
a loss of connections between nerve cells, whichthen die.
What is Frontotemporal Dementia?
It is sometimes called Pick’s disease or frontal lobe dementia.
Refers to the lobes of the brain that are damaged in this type of dementia.
Changes in personality and behaviour, and difficulties with language.
Significant cause of dementia in younger people
Linked to clumps of abnormal proteins inside the cells, including proteins called tau and TDP-43
List the risk factors for Dementia
Age
Mild Cognitive Impairment
Learning Difficulties
Genetics (YOD: mutations in the amyloid precursor protein gene (APP) or the presenilin genes (PSEN1 or PSEN2))
Cardiovascular Risks
Parkinson’s Disease
Stroke
Depression
Heavy Alcohol Consumption
Low Educational Attainment
Low Social Engagement and Support
State when to suspect dementia
Suspect dementia if:
Cognitive impairment
Behavioural and psychological symptoms of dementia (BPSD)
Difficulties with activities of daily living (ADLs)
List symptoms related to the four main types of dementia
Alzheimer’s Disease - Early impairment of episodic memory
Vascular Dementia - Stepwise increases in the severity of symptoms
Dementia with Lewy bodies - Repeated falls, syncope, transient loss of consciousness and early and persistent visual hallucinations.
Frontotemporal Dementia - Personality change and behavioural disturbance
State how to diagnose dementia in a non specialist seting
Take a history from the person (and, if possible, a carer or close family member)
Timescale of changes
Co-morbidities
Drugs
Risk Factors
Assess Cognition
Assess Daily Function
Assess for BPSD,asking about factors which may trigger or exacerbate
Examine Person
Blood Tests
Suspected dementia or mild cognitive impairment should be referred to
‘Memory Assessment Service’
Facts about consent when diagnosing Dementia
Person must have the proposed action explained to them and have the mental capacity to make an informed decision.
Establish that a person lacks mental capacity:
Have ‘an impairment of, or a disturbance in the functioning of, the mind or brain’ which may affect their ability to make a specific decision and
Because of this be unable to:
Understand the relevant information and the consequences of deciding against a treatment or intervention and,
Retain the information long enough to consider it and come to a decision and,
Make the decision without pressure from anyone else and,
Communicate the decision
Facts about diagnosis of Dementia
Access to a memory service or equivalent hospital- or primary-care-based multidisciplinary dementia service.
Should offer a choice of flexible access or prescheduled monitoring appointments.
When people living with dementia or their carers have a primary care appointment, assess for any emerging dementia-related needs and ask them if they need any more support.
Provide people living with dementia with a single named health or social care professional who is responsible for coordinating their care
State the support a named healthcare professional to offer those living with Dementia
Named professionals should:
Arrange an initial assessment of the person’s needs, which should be face to face if possible
Provide information about available services and how to access them
Involve the person’s family members or carers in support and decision-making
Give special consideration to the views of people who do not have capacity to make decisions about their care, in line with the principles of the Mental Capacity Act 2005.
Ensure that people are aware of their rights to and the availability of local advocacy services, and if appropriate to the immediate situation an independent mental capacity advocate
State Interventions to Promote Cognition in Dementia Patients
Offer group cognitive stimulation therapy to people living with mild to moderate dementia.
Consider group reminiscence therapy for people living with mild to moderate dementia.
Consider cognitive rehabilitation or occupational therapy to support functional ability in people living with mild to moderate dementia.
Do not offer acupuncture to treat dementia
Do not offer ginseng, vitamin E supplements, or herbal formulations to treat dementia
State when memantine can be used as monotherapy in dementia management
moderate dementia and are intolerant/contra-indication to others
Severe AD
State the treatment for vascular dementia
Only consider AChE inhibitors or memantine for people with vascular dementia if they have suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
Need to manage cardiovascular conditions such as hypertension and high cholesterol
state the treatment for Dementia with Lewy body
Offer donepezil or rivastigmine to people with mild/moderate/severe dementia.
Only consider galantamine if donepezil or rivastigmine not tolerated.
Consider memantine if other AChE inhibitors not tolerated/contra-indicated
State how to treat frontotemporal Dementia
There is no pharmacological treatment for now
Do not offer AChE inhibitors or memantine to people with frontotemporal dementia.
State the mode of action of AChE Inhibitors
Acetylcholinesterase removes Acetylcholine which is released from neurones into 2 inactive fragments.
If acetylcholinesterase activity is inhibited, acetylcholine availability at its receptors is increased.
Small improvement in cognitive function
List the cholinergic side effects of ACHEI
nausea, abdominal cramps, fatigue, sleep disturbances and agitation
State the mode of action of NMDA Antagonists
Neurotransmitter – Glutamate
Attaches to NMDA receptors - activated- Ca2+ influx.
In Alzheimer’s Disease you have too much glutamate
Too much calcium speeds up nerve damage.
So,
Memantine acts as a competitive ‘NMDA antagonist’ thus reducing Ca2+entry into the cells
Some commonly prescribed medicines are associated with increased anticholinergic burden, and therefore cognitive impairment. True/false?
True
List two examples of medication that can increase cholinergic burden
olanzapine
Amitripyline
List the Behavioural and Psychological Symptoms of dementia (BPSD)
Agitation, aggression, hoarding, wandering, hallucinations, sexual disinhibition, delusions, apathy and shouting
List the possible clinical cause of BPSD in DEMENTIA
pain, constipation, infection (such as delirium) or dehydration
List the environmental causes of BPSD in Dementia
changes in surrounding environment, inappropriate care, disrupted routine, noise or discomfort
State the first line treatment for the non cognitive symptoms of Dementia
Music therapy, aromatherapy, physical exercise if able, dance, hand massage, social interaction and stimulation, reminiscence or therapeutic touch
Changes to environment: can they find the toilet-? Pictorial toilet signs, identity any trip hazards/ remove clutter, room temperature, is their light?
According to NICE guidelines, when should an antipsychotic be used in the treatment of BPSD in Dementia?
only offer an antipsychotic if the patient is at ‘risk of harming themselves or others’ or ‘experiencing agitation, hallucinations or delusions that are causing them severe distress’: LAST RESORT!
The only licensed antipsychotic in BPSD is…..
Risperidone
Facts about the administration of Risperidone
Lowest effective dose
Shortest period of time
Review clinical need at least every 6 weeks
Increased risk of stroke
Discontinue if the client is not getting any benefit
To be prescribed alongside non-pharmacological interventions
Do not offer ……… medication for BPSD
Valproate
Facts about Risperidone
Atypical antipsychotic
BNF: ‘Short-term treatment (up to 6 weeks) of persistent aggression in patients with moderate to severe Alzheimer’s dementia unresponsive to non-pharmacological interventions and when there is a risk of harm to self or others’.
Short-term intervention
Dosage: 250mcg BD-can be increased by 250mcg BD on alternate days
Usual dose: 500mcg BD (max. 1mg BD)
Formulations: tablet, orodispersible tablet and a oral solution
State the side effects of risperidone
postural hypotension, extra pyramidal side effect (akathisia and parkinsonism) and drowsiness
State the role of the pharmacy team in dementia
Prescribing: NMP memory clinic
Clinical interventions: treatment recommendations (such as: advising on the management of complex case or alterative formulations)
Counselling
Supporting carers
Signposting
Dementia Friends/ Champion: https://www.dementiafriends.org.uk/
Dementia Friendly Communities
List examples of hospital intervention in dementia
Twiddle Muffs
RITA (Reminiscence Interactive Therapy Activities)
Knowing Me Volunteers
Activity Boxes
