Dementia Flashcards
What is chronological age?
- How many years old you are
What is biological age?
- How young you feel and how young you act
Give common things older people can struggle with? (3)
- Mobility
- Dexterity
- Communication
Give examples of mobility issues older people may struggle with? (2)
- Stairs
- Getting to the shops
Give examples of dexterity issues older people may struggle with? (2)
- Making a cup of tea
- Brushing teeth
Give example of communication issues that older people may struggle with? (2)
- Sight and hearing -> isolation
Give examples of medical conditions that older people may be more likely to suffer from? (8)
- Musculoskeletal
- Diabetes, hormonal dysfunction
- Cognitive impairment
- Visual conditions
- Hearing conditions
- Cardiovascular conditions
- GI condition
- Malignancy
Give examples of musculoskeletal conditions that older people may suffer from? (4)
- Arthritis
- Osteoporosis
- Gout
- Fractures
Give examples of thing that older people value? (4)
- Company and relationships
- Time
- A desire to contribute to society
- Someone listening
What is dementia?
- It is a syndrome - usually of a chronic or progressive nature
- Deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal aging
What does dementiak affect? (8)
- Memory
- Thinking
- Orientation
- Comprehension
- Calculation
- Learning capacity
- Language
- Judgement
What is cognitive function?
- It is our ability to process thoughts and learn new information
- It is our speech and our memory
Give a definition for dementia?
- Dementia is an acquired progressive loss of cognitive functions, intellectual and social abilities
- It is severe enough to interfewre with daily functioning
What is dementia characterised by? (4)
- Amnesia (especially for recent events)
- Inability to concentrate
- Disorientation in time, place or person
- Intellectual impairment
How many people over 65 will die with some form of dementia?
- 1 in 3
People with dementia will often have problems with day-to-day memory. How might this cause difficulty?
- Difficulty recalling events that happened recently
People with dementia will often have problems with concentrating, planning or organising. How might this cause difficulty?
- Difficulties making decisions, solving problems or carrying out a sequence of tasks (e.g. cooking a meal)
People with dementia will often have problems with language. How might this cause difficulty?
- Difficulties following a concersation or finding the right word for something
People with dementia will often have problems with visuospacial skills. How might this cause difficulty?
- Problems judging distances (e.g. on stairs) and seeing objects in three dimensions
People with dementia will often have problems with orientation. How might this cause difficulty?
- Losing track of the day or date, or becoming confused about where they are
Is consciousness affected in people with dementia?
- No - they have an awareness
The impairment in cognitive function is commonly accompanied, and occasionally preceded by a deterioration in what? (3)
- Emotional control
- Social behaviour
- Motivation
What is the most common type of dementia?
- Alzheimer’s (60%)
Alzheimer’s causes a reduction in the size of the cortex and severe in the hippocampus. How does this affect the person?
- Cortex is related to your personality, your motor function, your ability to process sensory information and your language processing
- Damage of hippocampus can result in short term memory loss and disorientation
What else occurs in alzheimer’s to cause the diesease? (2)
- Plaques are deposits of a protein fragment called beta-amyloid that builds up in the spaces between nerve cells - this results in a loss of brain function
- Tangles are twisted fibres or tau protein build up inside cells
Name distinctive features of alzheimer’s? (7)
- Short term memory loss
- Aphasia
- Communication difficulties
- Muddled over everyday activities
- Mood swings
- Withdrawn
- Loss of confidence
What is aphasia?
- Difficulty comprehending or formulating language
Give examples of associated factors for Alzheimer’s disease? (5)
- Age
- Gender - women > men
- Head injury
- Lifestyle
- Genetic - abnormalities on chromosome 1, 14 or 21
Give examples of lifestyle factors that increase the risk of Alzheimer’s? (4)
- Smoking
- Hypertension
- Low folate
- High blood cholesterol
Give examples of lifestyle factors that decrease the risk of Alzheimer’s? (3)
- Physical, mental and social activities
What is vascular dementia?
- It is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells
Vascular dementia can develop as a result of what? (4)
- Narrowing and blockage of the small blood vessels deep inside the brain (known as small vessel disease)
- A single large stroke (where the blood supply to part of the brain is suddenly cut off)
- Lots of mini strokes that cause tiny, but widespread damage to the brain
- In many cases, these problems are linked to underlying health conditions - such as high blood pressure and diabetes - as well as lifestyle factors, such as smoking and being overweight
Give examples of distinctive features of vascular dementia? (5)
- Memory loss of sudden onset
- Visuospatial difficulties
- Anxiety
- Delusions
- Seizures
What is dementia with Lewy bodies? (2)
- Deposits of an abnormal protein called Lewy bodies inside brain cells
- These deposits, which are also found in people with Parkinson’s disease, build up in areas of the brain responsible for things such as memory and muscle movement
What are distinctive features of dementia with Lewy bodies? (8)
- STML
- Cognitive ability fluctuates
- Visuospacial difficulties
- Attentional difficulties
- Overlapping motor disorders
- Speech and swallowing problems
- Sleep disorders
- Delusions
What is Frontotemporal dementia?
- The frontal lobes of the brain, found behind the forehead, deal with behaviour, problem-solving, planning and the control of emotions
- Changes in personality and behaviour, and difficulties with language
- Younger age of onset
- Ubiqitin associarted clumps of protein
- TDP-43
Give examples of distinctive features of frontotemporal dementia? (6)
- STML not always present
- Uncontrollable repetition of words
- Mutism
- Repetition of words of other people
- PErsonality change
- Decline in personal and docial conduct
Give examples of rarer forms of dementia? (6)
- HIV - related genitive impairment
- Parkinson’s disease
- Corticobasal degeneration
- Multiple sclerosis
- Niemann-Pick disease
- Creutzfeldt-jacob disease
Give examples of risk factors of dementia? (5)
- Age
- Gender
- Genetic background
- Medical history
- Lifestyle
Look at the diagnose and treat spider diagram
:)
What are ealry stage symptoms of dementia often misattributed to?
- Stress, bereavement or normal aging
What do early stage symptoms of dementia include? (5)
- Loss of short-term memory
- Confusion, poor judgement, unwilling to make decisions
- Anxiety, agitation or distress over perceived changes
- Inability to manage everyday tasks
- Communication problems - a decline in ability or interest in talking, reading and writing
What do middle stage symptoms of dementia include? (6)
- More support required, including reminders to eat, wash, dress and use the toilet
- Increasingly forgetful and may fail to recognise people
- Distress, aggression, anger, mood changes - frustration
- Risk of wandering and getting lost, leaving taps running, gas unlit, cooking unattended or forgetting to light the gas
- May behave inappropriatly e.g. going out in night clothes
- May experience hallucinations, throw-back memories
What do late stage symptoms of dementia include? (5)
- Inability to recognise familiar objects, surroundings or people - but there may be some flashes of recognition
- Increasing physical frailty, may start to shuffle or walk unsteadily, eventually becomming bed/wheelchair confined
- Difficulty eating and sometimes swallowing, weight loss
- Incontinence and gradual loss of speech
- Symptoms are progressive and irriversible
How can we diagnose and measure the progression of dementia? (4)
- Dementia screen to eliminate treatable causes - FBC, U&E’s, kidney, liver and thyroid function tests
- Glucose, serum B12, folate and calcium, C-reactive protein and urinalysis
- If indicated - syphilis serology, autoantibody screen, serum cholesterol and CT
- Meurological examination and detailed cognitive testing (Mini mental state exam)
What can we use for cognitive testing? (5)
- Mini-mental state examination
- Blessed dementia scale
- The montreal cognitive assessment
- Single neuropsychological tests:
- Clowck draw, delayed word recall, category fluency
- Conbined single tests:
- 7 minute screen, IQCODE, AD8 dementia screening
What are pros of the mini-mental state examination? (4)
- Wekk known
- Easy to administer
- Samples range of cognitive functions
- Test-re-test and inter rater availability
What are cons of the mini-mental state exam? (4)
- Only three words to be remebered on recall - not sensitive to mild impairment
- Old-new knowledge?
- Not standardised time between registration and recall
- Not sensitivie in testing frontal lobe
Give examples of what we can use to try to treat dementia? (5)
- There is no pharmacologicalm, surgical or behavioural cure
- Counselling may delay residential care by up to 1 year
- Aspirin and reducing cardiac risks (control of BP, weight, exercise etc) may halt deterioration of vascular type dementias
- NSAID’s may slow progression
- Vitamin E and Ginko Biloba may slow progression
Give examples of drug treatments that can be used for dementia patients? (4)
- Anticholinestrases: Donepezil (Aricept), galantamine, rivastgmine (Elexon) for mild/moderate Alzheimer’s
- May delay admission to residential care, assist in behavioural difficulty, defer deterioiration in cognition
- Treatment should continue until the patient, carer and/or specialist decide it is the right time to stop, if it is not working, or if the person’s MMSE score falls below 10
Give features of a dementia friendly care home? (6)
- Walls, floor coverings, skirting boards and doors are all different colours - provides good visual contrast to aid way finding
- Fix labels and images to drawers to help let people fidn what they need without assistance
- A bedroom WC should be visible from the bed on sitting and when lying down
- Position persontal pictures and items with personal relevance
- Radiators should be low temperature heating
- Furniture traditional and domestic
Give features of a dementia friendly healthcare environment? (8)
- Reception desk visible from the entrance door
- Ceilings, floors and floor coverings should be acoustically absorbant to support audible communication
- Colour and tone of walls should be distinctive from the flooring
- Colour and tone of furnature should be distinctive from the flooring
- Avoid non-essential signs
- Any signage should be at eye level with simple clear use fo text and colour. Use pictorial elements
- Ensure good levels of natural light to minimise artificial light
- Any staff only or locked rooms should be coloured the same as the walls to avoid attention
