Dementia

Question 1

What is dementia?

Answer 1

Irreversible progressive decline in global cognition with associated functional impairment

Question 2

What is the standard assessment for dementia?

Answer 2

ACE III

Addenbrooks Cognitive Assessment

Question 3

What other method of assessing dementia is there?

Answer 3

Montreal Cognitive assessment MoCA

Shorter different languages available

Question 4

What happens in an occupation therapy assessment?

Answer 4

Cognitive performance task
Observation of daily activities but not in their own environment
Estimates cognitive function and level of supervision required

Question 5

What are some reversible causes of cognitive decline?

Answer 5

Delirium
Alcohol
Medication
Endocrine disorders
Depression
Brain tumour 
Neuro infection / inflammation

Question 6

Someone with miild cognitive impairment will present with?

Answer 6

Noticeable but no functional changes in cognition

Question 7

Mild cognitive impairment will score what in the ACE III and MoCA test?

Answer 7

ACE III 75-90

MoCA 24-26§

Question 8

How many people who present with mild cognitive decline will go on to develop dementia?

Answer 8

10-15%

Question 9

What is subjective cognitive impairment?

Answer 9

Patient feels they have declined but testing and functional ability is fine.

Question 10

What is subjective cognitive decline linked to?

Answer 10

Anxiety
Depression
Stress
Often have a relative or friend with dementia

Question 11

Why do patients with subjective cognitive decline generally complain of worsening memory loss?

Answer 11

A viscous cycle where increasing anxiety about memory causes more memory lapses

Question 12

Primary Progressive aphasia

Answer 12

Effortful non fluent speech lack of grammar

Question 13

Semantic Dementia

Answer 13

Impaired understanding of meaning of words, fluent but empty speech
Difficulty retrieving names

Question 14

What Cholinesterase inhibitors are sued in Alzhiemers?

Answer 14

Donepezil
Rivastigmine
Galantamine

Question 15

What Cholinesterase inhibitors are used in Lewy body dementia?

Answer 15

Rivastigmine

Question 16

How do cholinesterase help in patients with cognitive decline?

Answer 16

Help slow progression of cognitive decline, but doesn’t tackle the underlying disease.

Question 17

What are some side effects of Cholinesterase inhibitors?

Answer 17

Nausea
Diarrhoea 
Headache 
Muscle cramps 
Bradychardia
Worsen COPD or Asthma

Question 18

What should be checked before giving Cholinesterase inhibitors?

Answer 18

Heart rate should be measured, NEVER administer if bellow 60bpm

Question 19

When should Cholinesterase inhibitors never be used?

Answer 19

If your patient has an Active Peptic ulcer or severe Asthma or COPD

Question 20

What does Memantine do?

Answer 20

Slows cognitive decline and helps prevent behavioural and Psychological disorders associated with Alzhiemers.

Question 21

When should Memantine be used?

Answer 21

It should be started in moderate dementia

Question 22

How would you go about starting a course of Memantine?

Answer 22

First check BP then titrate up slowly.

Question 23

Who is offered post diagnostic support?

Answer 23

Patient and family is offered support for 1 year.

Question 24

What is offered in post diagnosis support?

Answer 24

Help with applying for benefits, blue badge, housing etc

Psychosocial interventions with carers- reduces care home admissions.

Question 25

What must be done in relation to driving in regards to you patent post diagnosis?

Answer 25

Report to the DVLA - ability to drive is determined by health not age

Question 26

If a patient with Alzhiemers becomes agitated what medication can be given?

Answer 26

Antipsychotic Citalopram
Memantine
Pregablin

Question 27

Insomnia can be treated by?

Answer 27

Melatonin
BDZ
Sedating antidepressant

Question 28

Visual hallucinations can be treated by

Answer 28

Cholinesterase inhibotrs

Antipsychotics