Dementia

Question 1

What are the significance of the results of the 6CIT test

Answer 1

Below 7 is normal
8-9 signifies MCI
Above 9 is Dementia

Question 2

Is the 6CIT test enough to prove dementia

Answer 2

No, you need to contextualise the patient (ie if they fall)

Brain scans and protein content tell

Question 3

What is MCI?

Answer 3

A condition in which someone has minor problems with cognition and memory, but it doesn’t significantly affect their daily lives

Question 4

What is Dementia

Answer 4

A syndrome in which there’s deterioration in cognitive function beyond the normal ageing process. It affects Memory, learning, cognition etc. It results from a variety of diseases and injuries

Question 5

What is an MDT

Answer 5

A group of people relevant and pertinent in providing the best care in the best interest of the patient

Question 6

Who might be part of the MDT?

Answer 6

GP
Carer
Specialist nurses (give medication)
Occupational therapist (adjust home to be safe for illness)
Voluntary services - spend time with patient
Physiotherapist- if there’s falls

Question 7

What is assumption for capacity

Answer 7

Everyone is presumed to have capacity until proven otherwise AND they MUST have an underlying illness or condition

Question 8

What are the ways of accessing capacity ?

Answer 8

Understand information
Retain information
Weigh information
Communicate information back

Question 9

How many doctors must make assessment

Answer 9

2 doctors must sign the form and the team must discuss if patient lacks capacity

Question 10

If in an emergency (ie knocked out patient ) what happens in relation to capacity

Answer 10

Lone Doctor can now make decision in the best interest of the patient; capacity only lasts for 24 hours

Question 11

In what way is capacity fluid?

Answer 11

Patient have different capacity depending on the decision they have to make( ie changes with decision hence have to continually access capacity)

Capacity changes with time

Question 12

What’s the prevalence of Alzheimer’s and what is it’s unique symptoms that distinguish it from others

Answer 12

50% prevalence -most common

GRADUAL onset- may be mistaken for other disease or MCI

Retain long term memory and lose short term
Confused, memory loss,

Question 13

What’s the prevalence of vascular dementia and describe its uniques symptoms

Answer 13

25% prevalence

Multi infarcts (post stroke)
Medicine can make it better
It’s step wise- periods of stability then worsen very quickly
Issue in muscle movement and speech,
Numbness and paralysis in face
High BP and Cholesterol (atherosclerosis)

Question 14

What’s the prevalence of Lewy body and describe its uniques symptoms

Answer 14

20%

Build up of Lewy body in cortex
Trembling and stiffness (like Parkinson’s )
Visual Hallucinations
Highly sensitive to antipsychotic drugs (death )
Changes in alertness and attention
Lower sense of smell

Question 15

What is the prevalence of Frontotemporal dementia and it’s unique symptoms

Answer 15

20%

Low inhibition in behaviour 
Personality changes- affects family 
Lower communication (temporal lobe)
Decision making impairment 
Lack of interest

Question 16

What is the function of the Posterior Cingulate Gyrus and how does it link to the 6CIT

Answer 16

Orientation

What month is it? What time is it?

Question 17

What is the function of the thalamus and how does it relate to the 6CIT

Answer 17

Attention
Count backwards from 20-1
Count backwards the months of the year

Question 18

What’s the function of the hippocampus and relate it to the 6CIT

Answer 18

Memory

Remember the name and address etc

Question 19

What are the physiological signs of brain atrophy

Answer 19

Smaller gyri, larger sulci, larger ventricles - smaller brain- used to check significance of MCI also

Question 20

What is the function of the limbus system

Answer 20

Supports memory, emotion and behaviour

Question 21

What are the constituents of the limbic system?

Answer 21

Cingulate gyrus, hippocampus, anterior thalamus , entorhinal cortex etc

Question 22

What are the key findings in MCI

Answer 22

Decreased posterior cingulate gyrus volume
Reduced entorhinal cortex volume (part of the temporal lobe)

Decreased fractional anisotropy in the Parahippocampal cingulum

Question 23

How are Beta amyloid plaques formed?

Answer 23

When beta and gamma secretase cleaves amyloid precursor protein instead of alpha secretase and gamma

Question 24

What is the significance of having beta amyloid plaques

Answer 24

They Oligomerise to form Insoluble senile plaques (can’t be broken down)

Deposits in synapse and prevent communication (cell signalling )
Attract immune system to destroy neurones

Question 25

What are the familial genes responsible for early onset of Alzheimer’s

Answer 25

Presnellin 1 and 2 (changes where gamma secretase cleaves Amyloid precursor protein)
ApoE

Question 26

What is the sporadic risk allele for Alzheimer’s

Answer 26

E4 allele for making apolipoprotein

Question 27

How are Neurofibrillary tangles (NFTs) formed

Answer 27

Normal protein Tau (useful in microtubules) is hyper-phosphorylated by a kinase.
It oligomerises and form NFTs, this disrupt microtubules and impair cell growth.

Question 28

What does mutation in tau gene lead to?

Answer 28

Development of Frontotemporal dementia instead of Alzheimer’s

Question 29

How is severity of disease correlated to NFT and amyloid plaques

Answer 29

Severity isn’t correlated to amount of plaques but correlated with density of NFTs

Question 30

What else can promote hyper phosphorylation of Tau

Answer 30

A beta oligomers

Question 31

Where particularly is there loss of neurones in the brain in Alzheimer’s

Answer 31

Nucleus basalis of Meynert

Question 32

What’s the significance of loss of neurones in Nucleus basalis of Meynert?

Answer 32

Low Ach

Ach given as drug is a type of treatment to slow it down

Question 33

What does brain loss in brain stem particularly median raphe and locus cerulus signify

Answer 33

Median raphe- reduction in serotonin

Locus cerulus - noradrenaline levels

This contributes to sleep and mood effects of the disease

Question 34

How many people have dementia
What’s the prevalence of dementia in people aged over 85

How much does it cost the NHS

Answer 34

700k
20%
7billion pounds

Question 35

What are the ethical problems that people dealing with dementia face?

Answer 35

Balancing freedom with safety

Question 36

What does the legal framework for dealing with dementia provide

Answer 36

It provides a basis for recommendation for how to act

It provides no single best answer, must be judged on a case basis

Question 37

What are the 6 component of ethical framework

Answer 37

Case base approach

A belief about the nature of dementia
A belief about quality of life with dementia
The importance of promoting the interests both of the person with dementia
The requirement to act in accordance with solidarity
Recognising personhood, identity and calue

Question 38

What are the important points needed to provide accurate support for people with dementia

Answer 38

How things are done is better than the thing to be done

Carers should work in solidarity with families.

People should have access to good quality care and support from the time they were diagnosed

Professionals responsible should encourage patient to discuss it with family

Flexible care given - to adapt to patient

Good End of life care- may choose to die at home and with dignity