Dementia and Memory Clinic Flashcards
What are the four different parts of memory clinic?
- History and Collateral History
- Physical and Mental State Examination inc Risk Assessment
- Cognitive Assessment e.g ACE-III, MOCA
- Investigations
What are some questions to ask in the history in the memory clinic?
- What is the course of symptoms over time?
- Any impact on day to day life?
- Why have they come now?
- Any changes in general health?
What physical exams may you consider at memory clinic?
- Neurological
- CVS
What investigations may you do at memory clinic?
- Bloods
- ECG (look for contraindications)
- CT head/MRI brain to assist dementia subtype
What cognitive assesments can you do for a patient in hopsital with suspected dementia?
ACE-III gold standard
AMT-10
6-CIT
MOCA
MMSE
Generally patients in hospital are difficult to assess so ask GP to see in 6-8 weeks when illness has settled and refer to memory clinic
Why is a blood screen done in new suspected dementia?
To look for reversible causes
What things do we need to risk assess in memory clinic?
- Self neglect
- Vulnerability e.g locking doors, finances
- Driving
- Medications
- Self harm and Suicide
- Falls
- Risk to others e.g irritable, aggressive
How would you describe dementia to a patient in clinic OR OSCE?
Umbrella term for damage to the brain. What causes the damage determines what type of dementia it is
Cannot get diagnosis from CT, can only get post-mortem by taking a brain sample, however CT can show patterns that point towards one disease process over the other
It is irreversible but we can do XYZ to support
We can also refer you to the.. (e.g OT, physio, social services) who can help you with these things
Assess carer strain
What MMSE score is suggestive of dementia?
24 or less out of 30
Alzheimer’s disease is the most common cause of dementia. How does it present?
Insidious onset with slow progression. Behavioural problems are common. Diagnosed on clinical history but brain imaging may show disproportionate hippocampal atrophy.
What are the risk factors of Alzheimer’s disease?
family history,
lack of aerobic physical activity,
smoking and alcohol,
obesity, htn, diabetes
Down’s syndrome,
depression,
hearing loss
What is the strongest genetic risk factor for Alzheimer’s disease?
apolipoprotein E (APOE) gene
What is the diagnostic criteria of Alzheimer’s disease?
causative AD genetic mutation or all of the following:
memory and learning decline plus one other cognitive domain,
steady gradual cognitive decline,
no evidence of mixed aetiology
Alzheimer’s disease causes widespread cerebral atrophy mainly involving…
the cortex and hippocampus
What are the microscopic pathological changes in Alzheimer’s disease?
cortical plaques due to the deposition of type A-beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein