dementia and lasting power of attorney Flashcards
LPA
legally empowered to make decison for another person - mental capacity act 2005
two types
1. money and fiances
2/ health and care provision
can consent to person
separate section for provision or withdrawal of life
what is an IMCA- mental capacity advocate fucntion
idndependt advocacy for a person when a person lacks capcity to maek decison adn the person is over 16 and there are no signifcatn others to consult for them
and where
serious medical treatments
change of accommodation
DOLS
significant other term define
knows the person well
significant time
be willing advocate
not paid career
serious medical treatments define
providing withholding or withdrawing treatments
fine balance between risk and benefit
choice of tx
serious consequences
changes in accomodation
over 8 weeks in alternative accomodation
over 28 days in hospital
who appoints an IMCA
decision maker
doctor considering serious tx
supervisin body
safeguarding adn care reviews
if IMCA disaggrees with LPA what happens
IMCA can request second opinion or refer to court of protection
deiscuccsion with relevnat bodies
powers of court of protection
can over rule
B12 and HIv and hypothyrosidism can cuase dementia so important to test for them
apathy good sign of what dementia
alzeihemers - dementia early
all investigations for dementia
cognitive tests
blood presssure, ECG and cholesterol - vascular RF
bloods - thyroid function, B12, folate and calcium - sometimes HIV and syphilis - reversibel casues
CT head - stroke and subdural haemorrhage - exlcude other pathology
MRI brain - medial temproal lobe atrophy in alzeihemers disease
SPECT perfusion scan - diagnostic uncertaintiy frontla lobe dementia
CT scan. lewy body
lumbar puncture - biomarkers in AD - a beta don adn tau up
main features of alziehemers
amyloid plaques - beta
nurofibrillary tangles - hyper-phosphorylated tau is what makes these up
what enzyme cuts amyloid precursor protein
alpha secretase
pathologically cut at 2 sites also by a gamma secretase complex which cuts in the transmembrane bit - ending up with 3 sections of this protein - 1 section the beta part forms the plaques
what is TAU
in healthy neurones part of structure of neurones
amyloid metabolises wrong way - beta - cause plaque causing tau to be phsophroyltated and response from microglia cells around these plaques all causing neuronal cell loss and this - alzeihemers
what trisomy linked to alzeihemers
downs syndrome
more common or earlier onset - APP gene expressed on chromosme 21 so more likely to get this
inhertied alziehmers - genes responsible - mutuations of APP or the enzymes that cut it up - presenilin 1,2
late onset Alzeiherms disease - genetic risk facotrs include
APOE e4 - 15% of population
majority associated with cholesterol metabolsim or inflammation
