Dementia Flashcards
What are the significance of the results of the 6CIT test
Below 7 is normal
8-9 signifies MCI
Above 9 is Dementia
Is the 6CIT test enough to prove dementia
No, you need to contextualise the patient (ie if they fall)
Brain scans and protein content tell
What is MCI?
A condition in which someone has minor problems with cognition and memory, but it doesn’t significantly affect their daily lives
What is Dementia
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
What is an MDT
A group of people relevant and pertinent in providing the best care in the best interest of the patient
Who might be part of the MDT?
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
What is assumption for capacity
Everyone is presumed to have capacity until proven otherwise AND they MUST have an underlying illness or condition
What are the ways of accessing capacity ?
Understand information
Retain information
Weigh information
Communicate information back
How many doctors must make assessment
2 doctors must sign the form and the team must discuss if patient lacks capacity
If in an emergency (ie knocked out patient ) what happens in relation to capacity
Lone Doctor can now make decision in the best interest of the patient; capacity only lasts for 24 hours
In what way is capacity fluid?
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
What’s the prevalence of Alzheimer’s and what is it’s unique symptoms that distinguish it from others
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,
What’s the prevalence of vascular dementia and describe its uniques symptoms
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)
What’s the prevalence of Lewy body and describe its uniques symptoms
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
What is the prevalence of Frontotemporal dementia and it’s unique symptoms
20%
Low inhibition in behaviour Personality changes- affects family Lower communication (temporal lobe) Decision making impairment Lack of interest
What is the function of the Posterior Cingulate Gyrus and how does it link to the 6CIT
Orientation
What month is it? What time is it?
What is the function of the thalamus and how does it relate to the 6CIT
Attention
Count backwards from 20-1
Count backwards the months of the year
What’s the function of the hippocampus and relate it to the 6CIT
Memory
Remember the name and address etc
What are the physiological signs of brain atrophy
Smaller gyri, larger sulci, larger ventricles - smaller brain- used to check significance of MCI also
What is the function of the limbus system
Supports memory, emotion and behaviour
What are the constituents of the limbic system?
Cingulate gyrus, hippocampus, anterior thalamus , entorhinal cortex etc
What are the key findings in MCI
Decreased posterior cingulate gyrus volume
Reduced entorhinal cortex volume (part of the temporal lobe)
Decreased fractional anisotropy in the Parahippocampal cingulum
How are Beta amyloid plaques formed?
When beta and gamma secretase cleaves amyloid precursor protein instead of alpha secretase and gamma
What is the significance of having beta amyloid plaques
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
What are the familial genes responsible for early onset of Alzheimer’s
Presnellin 1 and 2 (changes where gamma secretase cleaves Amyloid precursor protein)
ApoE
What is the sporadic risk allele for Alzheimer’s
E4 allele for making apolipoprotein
How are Neurofibrillary tangles (NFTs) formed
Normal protein Tau (useful in microtubules) is hyper-phosphorylated by a kinase.
It oligomerises and form NFTs, this disrupt microtubules and impair cell growth.
What does mutation in tau gene lead to?
Development of Frontotemporal dementia instead of Alzheimer’s
How is severity of disease correlated to NFT and amyloid plaques
Severity isn’t correlated to amount of plaques but correlated with density of NFTs
What else can promote hyper phosphorylation of Tau
A beta oligomers
Where particularly is there loss of neurones in the brain in Alzheimer’s
Nucleus basalis of Meynert
What’s the significance of loss of neurones in Nucleus basalis of Meynert?
Low Ach
Ach given as drug is a type of treatment to slow it down
What does brain loss in brain stem particularly median raphe and locus cerulus signify
Median raphe- reduction in serotonin
Locus cerulus - noradrenaline levels
This contributes to sleep and mood effects of the disease
How many people have dementia
What’s the prevalence of dementia in people aged over 85
How much does it cost the NHS
700k
20%
7billion pounds
What are the ethical problems that people dealing with dementia face?
Balancing freedom with safety
What does the legal framework for dealing with dementia provide
It provides a basis for recommendation for how to act
It provides no single best answer, must be judged on a case basis
What are the 6 component of ethical framework
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
What are the important points needed to provide accurate support for people with dementia
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
