Dementia Flashcards
What is dementia?
Irreversible progressive decline in global cognition with associated functional impairment
What is the standard assessment for dementia?
ACE III
Addenbrooks Cognitive Assessment
What other method of assessing dementia is there?
Montreal Cognitive assessment MoCA
Shorter different languages available
What happens in an occupation therapy assessment?
Cognitive performance task
Observation of daily activities but not in their own environment
Estimates cognitive function and level of supervision required
What are some reversible causes of cognitive decline?
Delirium Alcohol Medication Endocrine disorders Depression Brain tumour Neuro infection / inflammation
Someone with miild cognitive impairment will present with?
Noticeable but no functional changes in cognition
Mild cognitive impairment will score what in the ACE III and MoCA test?
ACE III 75-90
MoCA 24-26§
How many people who present with mild cognitive decline will go on to develop dementia?
10-15%
What is subjective cognitive impairment?
Patient feels they have declined but testing and functional ability is fine.
What is subjective cognitive decline linked to?
Anxiety
Depression
Stress
Often have a relative or friend with dementia
Why do patients with subjective cognitive decline generally complain of worsening memory loss?
A viscous cycle where increasing anxiety about memory causes more memory lapses
Primary Progressive aphasia
Effortful non fluent speech lack of grammar
Semantic Dementia
Impaired understanding of meaning of words, fluent but empty speech
Difficulty retrieving names
What Cholinesterase inhibitors are sued in Alzhiemers?
Donepezil
Rivastigmine
Galantamine
What Cholinesterase inhibitors are used in Lewy body dementia?
Rivastigmine
How do cholinesterase help in patients with cognitive decline?
Help slow progression of cognitive decline, but doesn’t tackle the underlying disease.
What are some side effects of Cholinesterase inhibitors?
Nausea Diarrhoea Headache Muscle cramps Bradychardia Worsen COPD or Asthma
What should be checked before giving Cholinesterase inhibitors?
Heart rate should be measured, NEVER administer if bellow 60bpm
When should Cholinesterase inhibitors never be used?
If your patient has an Active Peptic ulcer or severe Asthma or COPD
What does Memantine do?
Slows cognitive decline and helps prevent behavioural and Psychological disorders associated with Alzhiemers.
When should Memantine be used?
It should be started in moderate dementia
How would you go about starting a course of Memantine?
First check BP then titrate up slowly.
Who is offered post diagnostic support?
Patient and family is offered support for 1 year.
What is offered in post diagnosis support?
Help with applying for benefits, blue badge, housing etc
Psychosocial interventions with carers- reduces care home admissions.
What must be done in relation to driving in regards to you patent post diagnosis?
Report to the DVLA - ability to drive is determined by health not age
If a patient with Alzhiemers becomes agitated what medication can be given?
Antipsychotic Citalopram
Memantine
Pregablin
Insomnia can be treated by?
Melatonin
BDZ
Sedating antidepressant
Visual hallucinations can be treated by
Cholinesterase inhibotrs
Antipsychotics
