Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Stage 2: Ageing > Dementia > Flashcards

Dementia Flashcards

1
Q

Describe the neurological changes in normal ageing

A

1) Occasional memory lapse
2) Word finding difficulty
3) Planning intact
4) Orientation intact
5) Degree of brain atrophy - ventricles bigger, cortical ribbon (grey matter) thinner, sulci are deeper and more prominent
6) Degree of brain pathology e.g. Alzheimer’s changes as part of normal ageing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the definition of dementia?

A

Cognitive failure accompanied by deterioration in day-to-day function and evidence of long term progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the anatomy of cognitive failure

A
  • Pattern fo cognitive failure is linked to distribution of brain and NT dysfunction in early stages
  • Regional and global brain atrophy and neuronal loss occurs in later stages so at early stages the brain can look normal or only very subtle changes
  • How dementia presents depends on which bit of the brain is affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the cognitive domains (includes aspects of personality)?

A

1) Memory
2) Thinking
3) Orientation
4) Calculation
5) Learning
6) Language
7) Judgement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is perception?

A

Recognition, representation and understanding of sensory information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are cognitive deficits that occur in dementia?

A

1) Amnesia (memory deficit)
2) Aphasia (language deficit)
3) Apraxia (motor deficit)
4) Agnosia (perceptual/higher level sensory deficit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of amnesia?

A
  • Usually restricted to recent events, short term memory, new information
  • Recall impaired
  • Long term memory is better
  • Motor memory may remain intact until advanced disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the anatomy of memory failure

A
  • Hippocampus is local in the medial temporal lobe (medial temporal lobe = hippocampus)
  • Hippocampus is involved in the transition between short and longer term memory - going from moment to moment memory to a slightly longer short term memory e.g. remembering phone number for 5 minutes
  • Hippocampal atrophy is associated with memory impairment in dementia
  • The temporal horn of the lateral ventricle (ventricle next to hippocampus) and the collateral sulcus become bigger when you have hippocampal atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the features of aphasia?

A
  • Simplified use of language
  • Loss of second language if know two fluently (hybrid phase where may be mixing the two languages)
  • Less use of abstract and descriptive terms
  • Word finding problems
  • Naming difficulties
  • Repetitive problems
  • Problem understanding what people have said/complete loss of communication (advanced/late stages)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of apraxia?

A
  • Inability to perform volitional acts despite intact primary motor and sensory cortices (problem with higher level motor representations) e.g. dressing, eating
  • Constructional apraxia (can’t draw particular shapes)
  • Ideomotor apraxia - forgetting gestures e.g. wave goodbye
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is constructional apraxia?

A
  • Forgetting how to draw particular shapes
  • Can be due to loss of spatial vision but can also be bc don’t know anymore how to do the motor movements to make the shape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is ideomotor apraxia?

A
  • Forgetting gestures e.g. how to wave goodbye, comb hair, brush teeth
  • Can happen in early stages
  • Complicated higher motor patterns can be lost quite early on
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the features of agnosia?

A
  • Inability to understand the significance of sensory stimuli
  • Misidentification of object by feel
  • Proposoagnosia
  • R-L disorientation
  • Unable to recognise own body parts e.g. think their own arm is someone else’s
  • Loss of spatial vision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How might perception deficits affect artists?

A
  • Lose perception that the scale looks different and inclusion of distances
  • Less distinction between the foreground and background
  • Loss of spatial vision
  • Subtle changes in cognitive domains
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is proposoagnosia?

A
  • Misidentification of faces

- Can’t recognise family, carers even thoughtmxght still know these people by name

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an example of visual agnosia?

A

Could maybe copy and draw a teapot but don’t have a sense of what teapots do or how you use them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe tests of global cognition used in dementia

A
  • MMSE, ACE-R, MOCA
  • Screening summary tests that cover important different aspects of cognition
  • Can tell you which cognitive sub-domains are more likely to be affected
18
Q

Describe neuropsychiatric symptoms in dementia

A
  • Behavioural and psychological symptoms of dementia (BPSD)
  • Not thought of as cognitive changes, probably have cognitive basis but not measure by tests
  • These changes beyond cognition are usually more problematic than the cognitive changes and usually more important for people looking after the patients than the cognitive changes which are relatively easy to manage
19
Q

What are the neuropsychiatric symptoms that occur in dementia?

A

1) Hallucinations
2) Delusions
3) Depression/anxiety
4) Apathy
5) Behavioural disturbance e.g. shouting, pacing
6) Eating preference e.g. sudden craving/only eating chocolate
7) Sexual disinhibition, change in sexual preference
8) Sleep behaviours

20
Q

Why does depression/anxiety occur in dementia?

A

Part of the neurodegenerative process, not bc they have dementia, can occur before the dementia has been diagnosed

21
Q

What is a hallucination?

A

Seeing, hearing or smelling something that is not there

22
Q

What type of hallucinations tend to occur in dementia (and all diseases of older adults)?

A

Visual e.g. people and animals (unlike schizophrenia which is mainly hearing things)

23
Q

What is a delusion?

A

A false belief

24
Q

Describe features of delusions in dementia

A
  • Linked to memory problems
  • Typically of theft (things misplaced are thought stolen) e.g. forgot they put glasses on windowsill and will jump to the conclusion that they have been stolen
  • Paranoid feeling, can build up into a plot of people stealing things or moving things away
  • Occasionally misidentification delusions - reflection of emotional connection with visual perception phenomena
25
Q

What two specific forms of misidentification delusions are quite common in dementia and cause problems?

A

1) Capgras syndrome

2) Reduplicative paramnesia

26
Q

What is capgras syndrome?

A
  • The false belief that a family member/partner has been replaced by an imposter
  • e.g. person looks the same, speaks the same, seems to know you but you have a sense that it’s not them
  • Suspicion that the person is not the actual person
27
Q

What is reduplicative paramnesia?

A
  • The false belief that their house is not their home
  • e.g. sitting at home/clinic and think that this is a counterfeit location, a special place that has been set up to pretend to be their real home
28
Q

Describe the deterioration in day-to-day function in dementia

A
  • Interference with personal ADLs
  • Some change in the kind of activities that expect most older people without dementia to be able to do
  • This aspect of dementia is much more vague, no tests to test if function has been lost, more of a clinical impression that someone has lost specific function
  • Some OT designed scales but not universally designed to define dementia
29
Q

What functional domains are affected in dementia that lead to deterioration in day-to-day function?

A

1) Washing
2) Dressing
3) Eating e.g. not recognising food, not remembering how to use cutlery
4) Continence
5) Managing finances e.g. forgetting PINS or how to use internet banking
6) Navigation - getting lost in home/local environment

30
Q

Describe the progression of dementia in the early stages

A
  • Most of us will have changes in brain in middle age that may or may not lead to dementia later on e.g. deposition of amyloid and cell loss
  • A proportion of these people will then progress into getting mild cognitive changes/impairment (prodromal phase)
31
Q

What is key about the prodromal phase of dementia?

A
  • If do subtle testing can detect cognitive changes
  • Might hear mild cognitive impairment in the history
  • But haven’t yet reached the threshold for dementia bc haven’t got the functional impact
  • Therefore quite arbitrary when say someone now has dementia clinically
  • There are also changes before diagnosis that make you know that someone is on the trajectory to dementia
32
Q

Describe a typical patient who is near/at diagnosis of dementia

A
  • In the prodromal phase may see progression that one year their cognitive test is a certain amount and two years later do same test and can see a decline
  • Below the line for diagnosis maybe getting ⅔ of dementia criteria and then when reach diagnosis link is when you get the additional function and day-to-day deterioration and diagnosis of dementia
  • However have have the neuropathology and cognitive changes for many years before and may have have preliminary brain changes in 20s or 30s
33
Q

Why would you want to treat the prodromal phase?

A

To slow it down or reverse changes before you reach threshold - aim for cure

34
Q

What is the difference between dementia and delirium?

A

1) Dementia = chronic brain failure
2) Delirium = acute brain failure
- Happens suddenly in the context of something else
- Reversible
- Can be difficult to tell if delirium or early stage dementia, might only be able to say in retrospect

35
Q

What is the speed of onset, duration of onset, attention, alertness and sleep-wake cycle in dementia?

A

1) Slow onset
2) Months to years onset
3) Preserved attention
4) Usually normal alertness
5) Fragmented sleep

36
Q

What is the speed of onset, duration of onset, attention, alertness and sleep-wake cycle in delirium?

A

1) Rapid onset
2) Hours to weeks onset
3) Attention fluctuates
4) Alertness is hypervigilant or reduced vigilance
5) Frequent disruption of sleep e.g. day and night reversal

37
Q

Why can you not really tell if someone has early stage dementia just by looking at them?

A
  • In early stages of dementia, attention is totally preserved
  • So if had 5 people same age one with dementia couldn’t tell by looking for asking simple task e.g. to remember phone number
  • Only when question more carefully e.g. what day is it or what happened in the news recently then might get a clue which person has dementia
38
Q

Why is it easy to spot person who has hypervigilant delirium?

A

Hypervigilant delirium would not be sitting still or be engaged and would have cloudy consciousness, may be running around ward

39
Q

What type of delirium is easily missed and why?

A

Hypovigilent

  • V quiet and introverted
  • Not saying anything
  • Picking at bed sheets
40
Q

How would you try and differentiate between someone with dementia and someone with delirium?

A

Get access to their thinking, concentration and consciousness

Stage 2: Ageing (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions