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clinical mental health > Dementia > Flashcards

Dementia Flashcards

0
Q

Aphasia

A

失語症

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1
Q

Frontotemporal lobar degeneration spectrum (frontotemporal dementia)

A

Built up abnormal protein in the brain

Often starts younger than Alzheimer’s.
Usually have personality change/speech
Naming and emotion and behavioural problems, fluent speech with loss of word

Apathy, disinhibition, lack empathy

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2
Q

Dementia

A

A syndrome due to disease of the brain. Chronic and progressive in nature. Disturbance of multiple higher cortical functions. Consciousness is not impaired. Impairments of cognitive function are accompanied by deterioration in memory loss, emotional control, social behaviour (clothing), communication, or motivation and reasoning

Progressive, global cognitive impairment

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3
Q

Epidemiology in dementia in uk

A

Two third are women

One in three over 65 years old will develop dementia

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4
Q

Dementia sighs and symptoms

A

Struggling to remember recent events but easily recalling past events (Alzheimer’s)
Finding hard to follow conversation or program on tv
Forgetting the names of friends or everyday objects
Repeating yourself
Problem with thinking and reasoning
Feeling depressed, anxious or angry about forgetfulness
Confused even in a family environment
A decline in the ability to read and write

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5
Q

Diagnosing /assessing dementia

A

Screening (primary care)
-MMSE/mini mental state exam(below 24/30) or ACE-R (below 88)

Then pre-assessment planning(explaining the purpose of referral/assessment)

Then assessment

  • blood test (vitamin/thyroid/UTI)
  • brain scan: CT scan for brain area/degeneration
  • clinical interview with client, carer, staff
  • neuropsychological testing

Interpret the best explanation
Dementia type vs MCI vs normal aging

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6
Q

Drug treatment for Alzheimer’s disease

A

For mild to moderate AD, or mixed dementia, cholinesterase inhibitors are recommended (it prevents breakdown of acetylcholine that improves neuron communication)

For severe AD/when cholinesterase not effective, memantine (NMDA antagonist) is licensed for treatment
It improves alertness, motivation, and daily living , ease distressing behaviour and delusion

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7
Q

Types of dementia

A 
Alzheimer's 62%
Vascular 17%
Mixed 10%
DLB (dementia Lewy bodies) 4%
Frontotemporal 2%
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8
Q

Alzheimer’s disease

A

Caused by accumulation of Amyloid plaques and Neurofibrillary tangles
–> senses remain intact, higher cognitive function are affected

Only one of dementia which Symptoms modification with drug treatment (cholinesterase inhibitor) is possible

Global cerebral atrophy (esp medial temporal lobes) with increase in ventricles and sulci size

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9
Q

Symptoms of Alzheimer’s disease

A 
Short term memory loss 
Difficulty with finding the right word 
Solving problems 
Making decision 
Perceiving things in 3D
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10
Q

Vascular dementia

A

Due to gradual reduced blood supply AND mini strokes

O2 supply to brain reduce –>killing brain cell

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11
Q

Risk factor for vascular dementia

A

Hypertension, smoking, overweight, genetics

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12
Q

Difference between Alzheimer’s and vascular dementia

A

Onset and course are different

Vascular ; sudden onset and stepwise decline
Symptoms may be more focal
Usually less impairment in episodic memory than AD and more in visual skills, semantic memory, executive functioning (problem solving, planning, thinking and concentrating )

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13
Q

Lewy bodies dementia

A

Share pathology and symptoms with Parkinson’s disease (motor symptom) and Alzheimer’s

Protein deposit in brain lead to brain cell death

DAT scan is used to differentiate LBD from Alzheimer’s. DAT scan can detect changes in dopamine transporter.

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14
Q

Lewy bodies dementia symptoms

A

Fluctuation of alertness and cognition
Episodic memory is less affected
Visuospatial problems are more common
Visual hallucination without auditory hallucination is common (60-70%)
Motor symptoms of Parkinson’s disease are followed

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15
Q

Differential diagnosis between dementia and normal aging

A

Short term memory impairment
- delayed episodic memory
AND poor category fluency together

Normal aging- they forget old memory

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16
Q

Difference between dementia and mild cognitive impairment

A

Objective cognitive impairment but no day to day social functional impairment

10%of them develop dementia later

17
Q

Difference between dementia and depression

A

Similar clinical presentation
Similarities : deficits in episodic memory, and learning, working memory, processing speed, and categorical fluency, motor speed and attention shift

Difference: depressive symptoms tend to be detente by patients rather than family members.
Negative thought processing and Physical symptoms (insomnia, lack of appetite)

Cognitive task; dementia people tend to guess the answer, but depressives people are not attempt to answer

18
Q

Difference between dementia and delirium

A

Usually due to infection (UTI)
Usually drowsy and fluctuating cognitive ability

Dementia shouldn’t diagnosed in acute hospital setting

19
Q

Behaviour and psychiatric symptoms of dementia

A 
Agitation 75% 
Wandering 60%
Depression 50%
Psychosis 30%
Vocalist ion 25% 
Aggression 20%
20
Q

Risk factor for dementia

A 
Aging
Gender (female 60% more risk)
Genetics (stronger link for early onset)
Medical history (cardiovascular disease, head injury) 
Diet , lifestyle 
Level of education
21
Q

Prevention

A 
Healthy lifestyle 
No smoking 
Physical exercise 
Healthy weight 
Less drinking 
Intelligence to increase cognitive reserve
Socially and mentally active
Treat depression early
22
Q

Mini mental state examination

A

Orientation to time, orientation to place, Registration(repeating named prompts), attention and calculation, recall language, repetition, ability to follow simple commands

What year are we in? 
What season ?
What month ? 
What's the date today ? 
What day of the week ? 
What country ? 
What city? 
What's the name of this place ? 
Which floor ? 
Name 3 objects and repeat them and remember 
Spell backward 
7 away from 100 
Show object and name them ( name recalling)
23
Q

Behavioural symptoms of dementia

A 
Restlessness 
Boredom 
Resistant to do anything new or different from routine 
Agitation 
Repeating 
Walking and pacing up and down 
Aggression 
Suspicious of others
24
Q

Steps for diagnosis and treatment of dementia

A
  1. GP assess physical health, blood tests, MMSE
  2. GP recommend further memory investigation and refer consultant psychiatry or memory clinic
  3. psychiatrist collect detailed history, brain scan, blood test so that physical health problem can be ruled out
  4. If a diagnosis is made, they are referred to cognitive stimulation therapy, OT, dementia navigator, social service. Medication will start if necessary
  5. if medication is started, memory service nurse will visit after a few weeks.
  6. Advanced care planning could be offered
25
Q

Cognitive stimulation therapy

A

A brief treatment for people with mild to moderate dementia

26
Q

Dementia navigator

A

A new service in islington.

Offer one off contact to all people who have had diagnosis of dementia

27
Q

Therapy that doesn’t work

A

Light therapy
Aromatherapy
Home like care

28
Q

Effective intervention for agitation

A

Activity
Music therapy following a specific protocol
Sensory intervention
Dementia care mapping
Training staff in person centred or communication skills was effective in reducing severe agitation but only if this was supervised on an ongoing fashion

29
Q

Treatment for Lewy bodies

A

Although they show psychotic symptoms, antipsychotic medication should be avoided or used very carefully because 50% of them might experience severe neuroleptic sensitivity

Cholinesterase inhibitor (for mild to moderate AD) is also effective in reducing psychotic symptoms of Lewy bodies

30
Q

Treatment for frontotemporal dementia

A

The use of antipsychotic and antidepressant drugs are still not well supported to be effective

SSRI may help control the loss of inhibitions, compulsive behaviour

31
Q

Treatment for vascular dementia

A

Antipsychotic can increase the risk of stroke so not really recommended

Cholinesterase inhibitor might be used but not really effective since its for AD

32
Q

Ministerial announcement

A

10/8 2014

75% of patients refereed for talking therapies should be seen within 6weeks , 100% in 18 weeks

33
Q

Ethic and clinical care

A

Non maleficence -no harm
Autonomy -respecting the patients’ right to make decision
Beneficence-act in patients best interest
Justice- being fair in decision about which patients receive which treatment

34
Q

Mental state examination

A 
A&B: appearance and behaviour 
S: speech 
M: mood 
T: thoughts
P: perception 
C: cognition 
I: insights
35
Q

Investigation for dementia

A

Primary care
-Blood test (for vitamin deficiency, hypothyroidism)

Secondary care

  • CT scan
  • MRI
  • SPECT to assess regional blood flaw and dopamine scan to detect Lewy body
36
Q

Behavioural and psychiatric symptom of dementia (BPSD)

A

BPSD are very frequent, affecting, around 90% of people at some stage in their illness

37
Q

Management/treatment of dementia -cognition.

A 
Vitamins & supplements 
Cholinesterase inhibitor 
Memantine (hardly ever used) 
Cognitive stimulation
Cognitive rehabilitation 
Reminiscence (story telling)
38
Q

Cholinesterase inhibitor

A

Prevent break down of acetylcholine to top up the level

Improve symptoms or temporary stop progression

40-70% patient benefit

Side effect: nausea, diarrhea, vomiting, fatigue, muscle pain

39
Q

Psychological therapy

A

Counselling: to come to terms with diagnosis
Intervention: coping with depression/anxiety
Cognitive rehabilitation: retain mental skills & raise confidence
Consultation: for change to be made at home to support independence
Cognitive stimulation: to keep mind active
Reminiscence therapy: telling story

clinical mental health (12 decks)

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