Dementia Flashcards
What is dementia?
An aquired syndrome due to disease of the brain.
Disturbance in multiple higher cortical functions.
What are the higher cortical functions?
Memory
Thinking
Orientation
Comprehension
Calculation
Learning
Language
Judgement
(More than one of these must be affected for dementia diagnosis)
What are the features of dementia?
Cognitive function changes are accompanied by:
- Deterioration in social behaviour
- Motivation.
- Emotional control.
Also: Interference with personal activities of daily living:- - Washing - Dressing - Eating - Continence - Finances
What are the features of dementia that are ‘sometimes’ present?
- Delusions
- Hallucinations
- Depression
- Anxiety
- Behavioural Disturbance
What are the 5 ‘A’s’ of dementia?
Amnesia (New learning at first)
Apraxia
Agnosia
Aphasia
Additional Symptoms
What is amnesia like in dementia?
- Recent events.
- New information.
- Recall impaired.
- Long Term better
- Motor memory may remain intact for long periods periods.
What is apraxia?
- Inability to perform volitional acts despite intact motor and sensory systems. Eg. - Dressing. - Eating. - Constructional (drawing). - Ideomotor (wave goodbye)
What is agnosia?
Inability to understand the significance of sensory stimuli.
- Misidentification of object by feel.
- Misidentification of faces (proposoagnosia).
- R-L disorientation.
- Unable to recognise own body parts
What is aphasia?
Simplified use of language.
- Less use of abstract and descriptive terms.
- Word finding problems.
- Naming difficulties
- Receptive problems.
- Complete loss of communication
What are the ‘associated features’ of dementia?
Aggression. - Can often be avoided by talking things. Through and explaining situations
Wandering.- Have a routine walk that they often/always follow
Sexual disinhibition
Eating - Tastes and diets can change - get a sweet tooth maybe
Sleeping - Doze in the day then alert at night - stress for tired carers
Delusions. - 16-37%, Theft or personal harm, Infidelity, House is not their home (eg.Want to go back to a past home - maybe with a relative who has died)
Hallucinations
- 50% in the course of the illness, Auditory and visual are common, Linked with rapid decline
Probably even more common in other types of dementia.
Mood Disorders
- Anxiety and depression are common.
- Rarely mania.
Misidentifications.
- Intruders in the home, Mirror image, Television for real, Individual people.
What other conditions are likely to be confused with dementia?
- Reversible dementia.
- Delirium.
- Depression.
- Mild learning difficulty.
- Puesdo-dementia: depression thyroid disorders brain tumours Etc.
Which blood tests should be performed in suspected dementia?
FBC
ESR
U&Es
LFTs
Ca++
BS
Lipids
Syphillis serology
What is asked in the AMT cognitive test?
- Short, Sensitive not specific.
- Age
- Time
- Address recall
- Year
- Address
- Recognition of two people
- Date of Birth
- Year of first WW
- Name of Monarch
- Count from 20-1
What is the gold standard of cognitive testing for dementia?
Mini-Mental State Examination.
- Wide range of domains.
- Easily completed.
- Acceptable.
- Much used.
- Too language based
- Many languages.
- Relatively culture free
What is the assessment offered by the community mental health team for a new/suspected dementia patient?
Comprehensive mental health assessment.
Current levels of cognitive functions.
Impact on daily living
Interactions with medical problems.
The way personality and life experiences are colouring the illness.
Carer stress and burden.
Care Plan to meet needs.
Diagnostic specificity.
What is the most commonly diagnosed cause of dementia?
Alzheimer’s
See page 39 of intro to dementia lecture for diagram of progression of disease
-
What is the point prevalence of dementia at ages 65,75 and 85
65 - 2.5%
- 10%
85 - 40%
What are the stages of the 3-stage model of memory?
Sensory register (memory)
Short-term memory
(Rehearsal)
Long term memory
What is sensory memory?
- Lingering impression after the sensory stimulus has ceased
- Large capacity storage buffer
• Holding sensory data in relatively unprocessed form for
very brief period of time
- Iconic, Echoic, Haptic
- Probe memory task with varying delayed probes.
See page 9 of memory and cognitive function lecture for working memory
-
What are aspects of working memory
Phonological loop (acoustic code)phonological similarity
- word length
- articulatory suppression
- decay/interference
Visuospatial sketch pad (VSSP)
- visual and spatial information
- integration
Episodic buffer
- holds integrated episodes
- multidimensional representations
- capacity, rehearsal maintainance
- access to consciousness
What is long term memory?
• Declarative memory
- Episodic - particular episodes
- Semantic - memory of facts
(• Close to everyday use of the term “memory”
• Representational
• True/false
• Flexible & accessible)
• Non-declarative memory
- Dispositional (performance)
- Skills and habits
- Conditioning
- Emotional learning
- Priming
- Perceptual learning
- Habituation/sensitization
- Perceptual memory
- Implicit/explicit memory
What effect does damage to the hippocampus have upon memory?
Damage to hippocampus - not a loss of memory but a loss to the ability to form new memories
Once memory is in long term storage damage here does not affect it
