Dementia and derlirium Flashcards
What is a DOLS realted to?
Mental capacity act
What is the ACE tool?
Test for cognitive impariments in disorders like dementia
Sections in ACE tool
Memory - 18
Attention - 18
Fluency - 14
Language - 26
Visuospatial -16
Score out of 100
What lobes are affected in frontotemporal dementoa?
Frontal and temporal lobes
What is loss of function in the temporal lobe ass with?
Language problems
What is chnages in the frontal lobe ass with?
Behavioural changes eg disinhibiiton, personality change
What lobes are ass with alzeihmers dementia affected in functional scan?
temporal and parietal lobes esp
How does a fTG PET scan work?
Carbon 13 glucose metabolism - isotope picked up on scan to see levels of metabolism in different areas of teh brain
What dementias are ass with lewy bodies?
Alzeihmers
Lewy body dementia
Causes of memory or concentration difficulties in under 50s
-recreational, and some prescription, drugs
－ alcohol
－ affective disorders
－ stress.
- ADHD
- Anxiety
What to tell people when they’re diagnosed with dementia
what their dementia subtype is and the changes to expect as the condition progresses
which healthcare professionals and social care teams will be involved in their care and how to contact them
if appropriate, how dementia affects driving, and that they need to tell the Driver and Vehicle Licensing Agency (DVLA) and their car insurer about their dementia diagnosis
their legal rights and responsibilities
Advance carew planning
their right to reasonable adjustments (in line with the Equality Act 2010) if they are working or looking for work
how the following groups can help and how to contact them:
local support groups, online forums and national charities
financial and legal advice services
advocacy services.
What to do on initial assessment for dementia?
from the person with suspected dementia and
if possible, from someone who knows the person well (such as a family member).
Conduct physical exam
undertake appropriate blood and urine tests to exclude reversible casuses cognitive decline
What to do on initial assessment for dementia?
from the person with suspected dementia and
if possible, from someone who knows the person well (such as a family member).
Conduct physical exam
undertake appropriate blood and urine tests to exclude reversible casuses cognitive decline
Cognitive testing screens
the 10-point cognitive screener (10-CS)
the 6-item cognitive impairment test (6CIT)
the 6-item screener
the Memory Impairment Screen (MIS)
the Mini-Cog
Test Your Memory (TYM).
When refer person to specialist dementia service
Reversible causes cognitive decline eg delirium or from meds ruled out
Dementia is still suspected
What medications can mimic demnetia
Increased antih=cholinergic burden
What to rule out if rapidly deteriorating dementia
Creutzfeldt-Jakob disease and similar conditions
CSF investigations
When include verbal episodic memory test in the assessment?
Alzeihmers suspected
When to do neuropsychological testing
whether the person has cognitive impairment or
whether their cognitive impairment is caused by dementia or
what the correct subtype diagnosis is.
What are the diagnosis for primary progressive aphasia ?
Inclusion
Most prominent clinical feature is language difficulty
Deficits are principal cause of impaired ADLs
Aphasia should ne the most prominent deficit at symptoms onset and intial phase of disease
Exclusion
Pattern or deficits better accounted for by other diagnossis
Cognitive the same
Prominent intial episodic memory, visual memory, visuoperceptual impairments
Prominent, inital behavioural disturbance
Types o frontoemtporal dementia
Progressive non fluent aphasia
Semantic dementia
Behavioural variatn
Primary progressive aphasia inclusion criteria
Most prominent clinical feature must be difficulty in language
Must cause impairment of ADLs
Aphasia must be most prominent at symptom onset and early stage of disease
Semantic variatn of PPA criteria for diangosis
Both of following must be present:
Impaired confrontation namin
Impaired single word comprehehnsion
At least 3 of the following:
Impaired object knowledge, particuarky for low frquency or low familiarity items
Surface dyslexa or dysgrapgi
Spared repetition
Spared repetiion
Spared speech production (grammar and motor speech)
Imaging supported criteria semantic variant PPA diagnosis
Predominant anterior tmeporal lobe atrophy
Predominant anterior temproal hypoperfusion or hypometabolism on SPECT or PET
Pathology of semantic variant of PPA with definitie pathology criteria
hISTOPATHOLOGIC EVIDENCE OF NEURODEGEN PATHOLOGY EG tau, TDP, Alzeihmers
Presence of known pathogenic mutation
Possibel FTLD criteria
3 of the follwoing
A - early behavioural disinhibition
B - Early apathy or intertia
C - Early loss of sympahy or empathy
D - Early perseverative, stereotyped or compulsive/ritualistic behaviour - Simple repetitive movement, complex compulsive or ritualistic behaviours, Stereotypy of speech
E - Hyperorality and dietary changes
F - Neuropsychological profile - executive/generation deficits with relative sparing of memory and visuospatial functions - Deficits in executive tasks, Relative sparing of episodic memory, sparing of visuospatial skills
Behavioural disinhibition examples
Socially innapropriate behaviour
Loss of manners or decorum
Impulsice, rash, careless
Signs of decreased empathy or sympathy
Diminished response to other peoples needs and feelings
Diminished social interest, interrelatedness or personal warmth
Signs of decreased empathy or sympathy
Diminished response to other peoples needs and feelings
Diminished social interest, interrelatedness or personal warmth
Hyperorality and dietary changes in FTLD
Altered food preferences
binge eating, increased consumption of alcohol or cogs
Oral exploration or consumption of inedible objects
Probable FLTD
Meets criteria for possible FLTD
Significant functional decline
Imaging results consistent with FLTD
Exclusionary criteria for FLTD
Patern if deficits better accounted for by another disorder
Beahviour - ^
Biomarkers strnigly indicate alzeihmers
Core clinical criteria for dementia
Interfere with the ability to function at work or at usual activities; and
Represent a decline from previous levels of functioning and performing; and
Are not explained by delirium or major psychiatric disorder;
Cognitive impairment is detected and diagnosed through a combination of (1) history-taking from the patient and a knowledgeable informant and (2) an objective cognitive assessment, either a “bedside” mental status examination or neuropsychological testing. Neuropsychological testing should be performed when the routine history and bedside mental status examination cannot provide a confident diagnosis.
The cognitive or behavioral impairment involves a minimum of two of the following domains:
Impaired ability to acquire and remember new information—symptoms include: repetitive questions or conversations, misplacing personal belongings, forgetting events or appointments, getting lost on a familiar route.
Impaired reasoning and handling of complex tasks, poor judgment—symptoms include: poor understanding of safety risks, inability to manage finances, poor decision-making ability, inability to plan complex or sequential activities.
Impaired visuospatial abilities—symptoms include: inability to recognize faces or common objects or to find objects in direct view despite good acuity, inability to operate simple implements, or orient clothing to the body.
Impaired language functions (speaking, reading, writing)—symptoms include: difficulty thinking of common words while speaking, hesitations; speech, spelling, and writing errors.
Changes in personality, behavior, or comportment—symptoms include: uncharacteristic mood fluctuations such as agitation, impaired motivation, initiative, apathy, loss of drive, social withdrawal, decreased interest in previous activities, loss of empathy, compulsive or obsessive behaviors, socially unacceptable behaviors.
Alzeihmers probable criteria
Normal dementia criteria and
Insidious onset
Clear cut history of worsening cognition by report or observation
IINitial and most prominnet cognitive deficiets are evident on histories and exma in one of
-amnestic presentation
-Nonamnestic presentation
Amnestic presentation of AD
It is the most common syndromic presentation of AD dementia. The deficits should include impairment in learning and recall of recently learned information. There should also be evidence of cognitive dysfunction in at least one other cognitive domain, as defined earlier in the text.
Nonamnestic presnetations of AD
Language
Visuospatial
Executive dysfucntion - judgement, reasoning etc
INdiciative biomarkers of aleihmers
Tau, amyloid beta
Core clinical features of DLB
Fluctuating cognition - pronounced variation in attention and alertness
Recurrent visual hallucinations detailed
REM sleep behaviour disorder
One or more spontaneous cardinal features of parkinsons
Investigations for indicative biomarkers of DLB
Reduced dopamine tranporter uptake in absal ganglia on SPECT or PET
Abnormal iodine - MIBG myocardial scintigraphy
Polysomnograohic confrimation of REM sleep without atonai
When can DLB be probable?
Twp or more clinical features of DLB present with or wothout presence of indicative biomarkers
ONly one core clincial feature with one or more clinical biomarkers
What is possible DLB>
Once clinical feature, no + biomarkers
1 indicative biomarkers but no clinical features
WHen should DLB be diagnosied>
When dementia occurs before or concurrently with parkinsonism
What is PDD?
Parkinsons disease dementia - when demnetia occurs in context of well established Parkinsons disease
How long before DLB becomes PDD?
1 year after onset of parkinsons symptoms
What is used to diagnose global impairment DLB?
Mini - mental state examination - MMSE
Montreal cognitive Assessment
Pattern of vascular dementia course
Static
Remitting
Progressive
Subtypes of vascular dementia
ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions;
What do you need to establish for diagnosis of vascular dementia?
Relationship between stroke and dementia
Further tests for alzeihmers after CT
FDG-PET scan
Perfusion SPECT
OR
examine CSF for:
Total tau and phosphorylated tau
Amyloid beta 1-40 or 1-42
What can make you get a false posotive on CSSF with AD?
bEING OLDER
Further tests for dementia with lewy bodies after CT
I-FP-CIT SPECT
if unavailanle use I-MIBG cardiac scintigrapgy
Further tests for FLTD
FDG PET OR perfusion SPECT
Don’t rule out based on any imaging tests
Further tests for vascular dementia
MRI/CT
Hwo to differentiate delirum and dementia with cognitive impairement in hisptial?
Long confusionassessment method (CAM)
Observational Scale of arousal - OSLA
What need to be aware of when managing dementia
arrange an initial assessment of the person’s needs, which should be face to face if possible
provide information about available services and how to access them
involve the person’s family members or carers (as appropriate) in support and decision-making
give special consideration to the views of people who do not have capacity to make decisions about their care, in line with the principles of the Mental Capacity Act 2005
ensure that people are aware of their rights to and the availability of local advocacy services, and if appropriate to the immediate situation an independent mental capacity advocate
develop a care and support plan, and:
agree and review it with the involvement of the person, their family members or carers (as appropriate) and relevant professionals
specify in the plan when and how often it will be reviewed
evaluate and record progress towards the objectives at each review
ensure it covers the management of any comorbidities
provide a copy of the plan to the person and their family members or carers (as appropriate).
