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BDS3 Special Care Dentistry > Dementia > Flashcards

Dementia Flashcards

1
Q

What is chronological age?

A
  • How many years old you are
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2
Q

What is biological age?

A
  • How young you feel and how young you act
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3
Q

Give common things older people can struggle with? (3)

A
  • Mobility
  • Dexterity
  • Communication
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4
Q

Give examples of mobility issues older people may struggle with? (2)

A
  • Stairs

- Getting to the shops

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5
Q

Give examples of dexterity issues older people may struggle with? (2)

A
  • Making a cup of tea

- Brushing teeth

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6
Q

Give example of communication issues that older people may struggle with? (2)

A
  • Sight and hearing -> isolation
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7
Q

Give examples of medical conditions that older people may be more likely to suffer from? (8)

A
  • Musculoskeletal
  • Diabetes, hormonal dysfunction
  • Cognitive impairment
  • Visual conditions
  • Hearing conditions
  • Cardiovascular conditions
  • GI condition
  • Malignancy
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8
Q

Give examples of musculoskeletal conditions that older people may suffer from? (4)

A
  • Arthritis
  • Osteoporosis
  • Gout
  • Fractures
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9
Q

Give examples of thing that older people value? (4)

A
  • Company and relationships
  • Time
  • A desire to contribute to society
  • Someone listening
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10
Q

What is dementia?

A
  • 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
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11
Q

What does dementiak affect? (8)

A
  • Memory
  • Thinking
  • Orientation
  • Comprehension
  • Calculation
  • Learning capacity
  • Language
  • Judgement
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12
Q

What is cognitive function?

A
  • It is our ability to process thoughts and learn new information
  • It is our speech and our memory
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13
Q

Give a definition for dementia?

A
  • Dementia is an acquired progressive loss of cognitive functions, intellectual and social abilities
  • It is severe enough to interfewre with daily functioning
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14
Q

What is dementia characterised by? (4)

A
  • Amnesia (especially for recent events)
  • Inability to concentrate
  • Disorientation in time, place or person
  • Intellectual impairment
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15
Q

How many people over 65 will die with some form of dementia?

A
  • 1 in 3
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16
Q

People with dementia will often have problems with day-to-day memory. How might this cause difficulty?

A
  • Difficulty recalling events that happened recently
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17
Q

People with dementia will often have problems with concentrating, planning or organising. How might this cause difficulty?

A
  • Difficulties making decisions, solving problems or carrying out a sequence of tasks (e.g. cooking a meal)
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18
Q

People with dementia will often have problems with language. How might this cause difficulty?

A
  • Difficulties following a concersation or finding the right word for something
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19
Q

People with dementia will often have problems with visuospacial skills. How might this cause difficulty?

A
  • Problems judging distances (e.g. on stairs) and seeing objects in three dimensions
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20
Q

People with dementia will often have problems with orientation. How might this cause difficulty?

A
  • Losing track of the day or date, or becoming confused about where they are
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21
Q

Is consciousness affected in people with dementia?

A
  • No - they have an awareness
22
Q

The impairment in cognitive function is commonly accompanied, and occasionally preceded by a deterioration in what? (3)

A
  • Emotional control
  • Social behaviour
  • Motivation
23
Q

What is the most common type of dementia?

A
  • Alzheimer’s (60%)
24
Q

Alzheimer’s causes a reduction in the size of the cortex and severe in the hippocampus. How does this affect the person?

A
  • 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
25
Q

What else occurs in alzheimer’s to cause the diesease? (2)

A
  • 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
26
Q

Name distinctive features of alzheimer’s? (7)

A
  • Short term memory loss
  • Aphasia
  • Communication difficulties
  • Muddled over everyday activities
  • Mood swings
  • Withdrawn
  • Loss of confidence
27
Q

What is aphasia?

A
  • Difficulty comprehending or formulating language
28
Q

Give examples of associated factors for Alzheimer’s disease? (5)

A
  • Age
  • Gender - women > men
  • Head injury
  • Lifestyle
  • Genetic - abnormalities on chromosome 1, 14 or 21
29
Q

Give examples of lifestyle factors that increase the risk of Alzheimer’s? (4)

A
  • Smoking
  • Hypertension
  • Low folate
  • High blood cholesterol
30
Q

Give examples of lifestyle factors that decrease the risk of Alzheimer’s? (3)

A
  • Physical, mental and social activities
31
Q

What is vascular dementia?

A
  • It is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells
32
Q

Vascular dementia can develop as a result of what? (4)

A
  • 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
33
Q

Give examples of distinctive features of vascular dementia? (5)

A
  • Memory loss of sudden onset
  • Visuospatial difficulties
  • Anxiety
  • Delusions
  • Seizures
34
Q

What is dementia with Lewy bodies? (2)

A
  • 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
35
Q

What are distinctive features of dementia with Lewy bodies? (8)

A
  • STML
  • Cognitive ability fluctuates
  • Visuospacial difficulties
  • Attentional difficulties
  • Overlapping motor disorders
  • Speech and swallowing problems
  • Sleep disorders
  • Delusions
36
Q

What is Frontotemporal dementia?

A
  • 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
37
Q

Give examples of distinctive features of frontotemporal dementia? (6)

A
  • STML not always present
  • Uncontrollable repetition of words
  • Mutism
  • Repetition of words of other people
  • PErsonality change
  • Decline in personal and docial conduct
38
Q

Give examples of rarer forms of dementia? (6)

A
  • HIV - related genitive impairment
  • Parkinson’s disease
  • Corticobasal degeneration
  • Multiple sclerosis
  • Niemann-Pick disease
  • Creutzfeldt-jacob disease
39
Q

Give examples of risk factors of dementia? (5)

A
  • Age
  • Gender
  • Genetic background
  • Medical history
  • Lifestyle
40
Q

Look at the diagnose and treat spider diagram

A

:)

41
Q

What are ealry stage symptoms of dementia often misattributed to?

A
  • Stress, bereavement or normal aging
42
Q

What do early stage symptoms of dementia include? (5)

A
  • 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
43
Q

What do middle stage symptoms of dementia include? (6)

A
  • 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
44
Q

What do late stage symptoms of dementia include? (5)

A
  • 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
45
Q

How can we diagnose and measure the progression of dementia? (4)

A
  • 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)
46
Q

What can we use for cognitive testing? (5)

A
  • 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
47
Q

What are pros of the mini-mental state examination? (4)

A
  • Wekk known
  • Easy to administer
  • Samples range of cognitive functions
  • Test-re-test and inter rater availability
48
Q

What are cons of the mini-mental state exam? (4)

A
  • 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
49
Q

Give examples of what we can use to try to treat dementia? (5)

A
  • 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
50
Q

Give examples of drug treatments that can be used for dementia patients? (4)

A
  • 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
51
Q

Give features of a dementia friendly care home? (6)

A
  • 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
52
Q

Give features of a dementia friendly healthcare environment? (8)

A
  • 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

BDS3 Special Care Dentistry (9 decks)

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