Dementia Flashcards
What does Emily suffer from?
Hypertension
What medication does she take for hypertension?
Amlodipine
What is dementia?
Syndrome where there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities
What are the early signs of dementia?
Forgetfulness
Losing track of time
Becoming lost in familiar places
What are the middle stages of dementia?
Forgetting recent events and names Becoming lost at home Difficulty with communication Needing help with personal care Behaviour changes e.g. wandering and repeated questioning
What are signs of late stage dementia?
Becoming unaware of time and place Difficulty recognising loved ones Need for assisted self care Difficulty walking Behaviour changes that escalate includes aggression
What test did the doctor use to assess Emily’s memory?
Six item cognitive repair test
6-CIT
Give some examples of question used in the 6-CIT
What year is it? What month is it? Give the patient an address to remember with 5 components About what time is Count backwards from 20 Say the months of the year in reverse
Why was the new scoring system introduced?
Gives questions that are appropriate to everyone
E.g. takes into account cultural differences
Allows for a range of marking, accounts for no. of errors made
Not simply right or wrong
What was the outcome of Emily’s test?
Mild cognitive impairment
What’s the deal with mild cognitive impairment?
A condition in which someone has minor problems with cognition- their mental abilities such as memory or thinking
What’s dementia?
A syndrome usually chronic or progressive in which there is deterioration in cognitive function beyond what is normally expected
Which members of the MDT can help Emily?
Dementia social worker Dietician Carer Voluntary service Specialist nurses Physiotherapist
Why are specialist nurses important?
Administrating medication
Taking care of issues e.g incontinence
What can an occupational therapist do?
Adapt her environment to her condition
E.g. mat in bath
Chair lift
Specialist kitchen utensils
Why are members of voluntary services important?
Depression
Loneliness
Less reliant on family members
At what point would Mrs Wilkins lack capacity to make her own decisions?
When she is no longer able to carry out one of the following:
- understand information
- retain information
- weigh up pros and cons
- communicate their decision
What is the basis on the Mental Capacity Act?
Everyone has capacity until proven otherwise
What must be true for someone to lack capacity?
They have an underlying condition that is causing the lack of capacitance
Why does making decisions about capacity involve multiple people?
It is subjective
Must be signed of by two different doctors independently
What if decisions have to made very quickly?
Lack of capacitance stands for 24 hours until someone else is able to make an assessment
Who makes final decisions regarding adults without capacitance?
The medical team
Family’s views should be taken as guidance
Why do we assess capacitance on multiple occasions over time?
Things change over time
May regain capacity
Or deteriorate and no longer have capacity
What are the 4 most common types of dementia?
Alzheimer’s
Vascular
Lewy Body
Fronto-temporal dementia
What are the classic features of Alzheimer’s?
Memory lapses Confusion Gradual onset Better long term memory 50% of dementia cases
What are the classic features of Vascular dementia?
Multiple tiny infarcts due to atherosclerosis Symptoms of stroke e.g. paralysis Traced to cardiovascular problems Step-wise onset 25% of dementia cases
What are the risk factors for vascular dementia?
Hypertension High cholesterol Diabetes Smoking Obesity
What are the main features of Lewy body dementia?
Caused by a build of proteins in the brainstem Parkinson-like symptoms Hallucinations Sleep disorders Confusion Tremor
What are the main features of Frontal Temporal dementia?
Affects communication and speech
Behavioural and personality changes
Become disinhibited
Very difficult for families
How would you explain extracellular amyloid plaques to a patient?
Build up of proteins in your brain
Avoid terms such as growths of lumps that may be associated with cancer
How would you explain intracellular neurofibrillary tangles?
Mis-folding of proteins that have malformed that reduces the function of that cell
How would you explain synaptic deterioration and neuronal death?
The connections between your nerve cells aren’t functioning properly
And some of the cells are dying
How would you describe gross cerebro-cortical atrophy?
Due to these processes the volume of certain areas of your brian has been reduced
Where are the posterior cingulate cortex?
See diagram
Above corpus callosum
Posterior side
Where is the thalamus?
Centre of brain
Where is the hippocampus?
Below the thalamus
What are the areas most affected by Alzheimer’s?
Posterior cingulate cortex
Hippocampus
Anterior Thalamus
What is the function implicated by posterior cingulate cortex?
Orientation
6-CIT: Year/ Month/ Time
What is the function implicated by hippocampus?
Short term memory
6-CIT: Repeat address
What is the function implicated by the anterior thalamus?
Attention
6-CIT: Count back from 20
Say months in reverse
From the paper what are the key findings?
Reduced posterior cingulate volume
Reduced entorhinal cortex volume
Decreased fractional anisotrophy in the parahippocampal cingulum
What is the limbic system?
Supports memory, emotion and behaviour
Includes the cingulate gurus, hippocampus, anterior thalamus, entorhinal cortex and other structures
