Dementia Flashcards
What are tasks that older people can struggle with
mobility
dexterity
communication
What are the medical diseases that are common in elderly
musculoskeletal diabetes, hormonal dysfunction cognitive impairment visual conditions hearing conditions CV conditions GI conditions malignancy
What do older people value
company and relationships
time
a desire to contribute to society
someone listening
What is dementia
a syndrome
usually of a chronic or progressive nature
results in deterioration in cognitive function beyond what might be expected from normal age
What does dementia effect
memory thinking orietnation comprehension calculation learning capacity language judgement
What is dementia defined as
an acquired progressive loss of cognitive functions, intellectual and social abilities
severe enough to interfere with daily functioning
What is dementia characterized by
amnesia
inability to concentrate
disorientation in time, place or person
intellectual impairment
What are issues that those with dementia may have
day to day memory concentrating, planning or organizing language visuospatial skills orientation
How is day to day memory effected
there is difficulty recalling events that happened recently
How is concentrating, planning or organizing effected
difficulties making decisions, solving problems or carrying out a sequence of tasks
What is language effected
difficulties following a conversation or finding the right word for something
How is visuospatial skills effected
problems judging distances e.g on stairs and seeing objects in 3D
How is orientation effected
losing track of the day or date, or becoming confused about where they are
What is the impairment in cognitive function commonly accompanied or preceded by
deterioration in
emotional control, social behavior, motivation
What is alzheimer’s
most common type of dementia
What is alzheimer caused by
reduction size of the cortex, severe in the hippocampus
caused by plaque and tangle
Describe the plaques seen in Alzeihmers
protein called beta amyloid build up in the spaces between nerve cells
Describe the tangles seen in Alzeihmers
twisted fibers of tau protein build up inside cells
What are distinctive features of alzeihmers
STML aphasia communication difficulties muddled over everyday activities mood swings withdrawn loss of confidence
What are associated factors with Alzeihmers
age gender (women>men) head injury lifestyle genetic
What lifestyle factors increase risk of Alzeihmers
smoking, hypertension, low folate, and high blood cholesterol
What lifestyle factors reduce risk of alzeihmers
physical, mental and social activities
What is the genetic factor that contributes to risk of alhzeihmers
abnormalities on chromosome 1, 14, 21
What is vascular dementia
caused by reduced flow to the brain which damages and eventually kills the brain cells
What can vascular dementia develop as a result of
small vessel disease
a single large stroke
lots of mini strokes
linked to underlying health conditions such as high blood pressure and diabetes as well as other lifestyle factors
What are distinctive features of vascular dementia
memory problem of sudden onset, visuospatial difficulties, anxiety, delusions, seizures
What is dementia with lewy bodies due to
deposits of an abnormal protein called Lewy bodies inside the brian 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 Lewy body dementia
STML cognitive abilityfluctuates visuospatial difficulties attentional difficulties overlapping motor disorders speech and swallowing problems sleep disorders delusions
What is frontotemporal dementia
effects frontal lobes of the brain
ubiqitin associated clumps of protein
TDP-43
What is the age of onset of frontotemporal
younger
What are distinctive features of frontotemporal dementia
STML not always present uncontrollable repetition of wards mutism repetition of words of other people personality change decline in personal and social conduct
What are the rarer forms
HIV - related genitive impairment Parkinson's disease corticobasal degeneration MS niemann-pick disease creutzfeldt-jakob disease
What are dementia risk factors
age gender genetic background medical histroy lifestyle
What are early stage symptoms often misattributed to
stress, bereavement or normal aging
What are the early onset symptom
loss of short term memory
confusion, poor judgement, unwilling to make decisions
anxiety, agitation or distress over perceived changes
inability to manage every tasks
communication problems - a decline in ability or interest in talking, reading and writing
What are the middle stage symptoms
more support required, including reminders to eat, wash, dress and use the toilet
increasing forgetful and may not recognize people
mood changes (aggression)
risk of wandering
may behave inappropriately
may experience hallucinations or throw back memories
What are late stage symptoms
inability to recognize familiar objects, surroundings or people - but there may be some flashes of recognition
increasing physical frailty, may start to shuffle or walk unsteadily, eventually becoming bed/wheelchair confined
difficulty eating and sometimes swallowing, weight loss
incontinence and gradual loss of speech
symptoms are progressive and reversible
What is the diagnosis and measurement of dementia tests
dementia screen to eliminate treatable causes
glucose, serum B12, folate and calcium, C-reactive protein and urinalysis
if indicates - syphillis serology, autoantibody screen, serum cholesterol and CT
neurological examination and detailed cognitive testing
What does the cognitive testing consist of
mini-mental state examination
blessed dementia scale
the montreal cognitive assessment (MoCA)
single neuropsychological tests
clock draws, delayed word recall, category fluency
combined single tests
What are the pros of the mini mental state exam (folstein)
well known
easy to administer
samples range of cognitive function
test - retest and inter rater availability
What are the cons of the mini mental state exam (Folstein)
only 3 words to be remembered on recall
not sensitive to mild impairment
old
non standardized time between registration and recall
not sensitive in testing frontal lobe
What is the treatment of dementia
no pharmocological, surgical or behavioral cure
consoling may delay residential care by up to a year
aspirin and reducing cardiac risks may halt deterioration of vascular types
NSAIDs may slow progression
vitamin E and ginkgo biloba may slow progression
What is the drug treatments
anticholinesterases
What is a dementia friendly care home
walls, floor coverings, skirting boards and doors are all in different colors providing good visual contrast to aid way finding
fix labels and images to drawers to help let people find what they need without assistance
bedroom WC should be visible from bed and when lying down
position personal pictures
radiators should be low temp
futrnite and traditional domestic
What are dementia friendly healthcare environments
reception desk visible from the entrance door
ceilings, floors and floor coverings should be acoustically absorbent to support audible communication
colors and tone of walls should be distinctive from the flooring
color and tone of furniture should be distinctive from the flooring
avoid non essential signs
any signage should be at eye level with simple clear use of text and color. use of pictorial elements
ensure good levels of natural light to minimize artificial light
any staff or locked rooms should be colored the same as the walls to avoid attention
