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OPIC > Dementia/Delirium > Flashcards

Dementia/Delirium Flashcards

1
Q

What are the benefits of early screening for cognitive impairment?

A
  • If negative, concerns are alleviated
  • Can manage comorbidities more effectively
  • Avert or address any safety issues
  • Allows person to finalise an advanced directive
  • Encourages participation in clinical research
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2
Q

What are the points of AMT

A 
Age in Years
Time of Day
Name of Hospital
Remember Address
Recognise Person 
Current Year 
Current Monarch 
DOB
Date of WW2
Count backwards 20-1
Recall address
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3
Q

What score in AMT10 indicates cognitive impairment?

A

< or equal to 7

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4
Q

What is the MMSE

A

30 point test

Sections include: Orientation, Registration, Attention and Calculation, Recall, Language, Copying intersecting pentagons

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5
Q

What is the difference between Mild Cognitive Impairment and Dementia?

A

Mild cognitive impairment doesn’t affect ADLs

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6
Q

Describe the presenting features of Delirium using the mnemonic ‘DELIRIUM’

A 
Disordered Thinking
Euphoric
Language Impaired
Illusions
Reversal of Sleep Cycle
Inattention
Unaware
Memory Deficits
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7
Q

Describe the ICD10 features of Delirium

A 
Impairment of consciousness and cognition
Global Disturbance in Cognition 
Psychomotor disturbance
Disturbance of sleep wake cycle
Emotional Disturbance
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8
Q

Describe the CAM assessment method

A

1) Acute Onset and Fluctuating
2) Inattention (serial 7s)
3) Disorganised thinking
4) Altered Conscious

Requires 1 and 2 and 3/4

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9
Q

What might you need to consider applying for with Delirious Patients?

A

Temporary Mental Capacity Act or DOLS

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10
Q

Who might you refer Delirious patients to?

A

FOPAL - Frail Older Persons Advice and Liaison Service

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11
Q

Define Dementia

A

Acquired decline in memory and cognitive function to sufficiently impair ADLs, present for at least 6 months

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12
Q

Name four reversible causes of Dementia

A

Visual/Hearing impairment
Nutritional Deficiencies
Normal Pressure Hydrocephalus
Hypothyroid

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13
Q

Name a contraindication for Donepazil

A

Bradycardia

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14
Q

Name a contraindication for Memantine

A

Renal Failure

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15
Q

What is the Ninds Airen Criteria for Vascular Dementia?

A
  • Cognitive decline impairing ADLs

- Cerebrovascular disease on imaging

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16
Q

How is Vascular Dementia managed?

A

Stroke Prevention

If mixed (with Alzheimers) can use Alzheimers medication

17
Q

How can DLB be managed?

A

Memantine and Donepazil

18
Q

Name four things that would make you consider delirium in a patient

A
  • Patient is over 65
  • Abbreviated AMT < 4 (Age, DOB, Place, Year)
  • Patient more confused/withdrawn than normal
  • 4AT>4
19
Q

What is the 4AT?

A

1) Alertness (0 is normal, 4 is not)
2) AMT4 (0 no mistakes, 2 is one mistake, 4 is more than one mistake)
3) Attention (serial sevens backwards, 0,1 or 2)
4) Acute and Fluctuant from History (Yes =4, No = 0)

20
Q

Name five immediate actions for the delirious patient

A
  • Focussed history/examination and collateral
  • Identify and treat underlying cause (go down SIRS pathway if fitting criteria)
  • Complete a ‘Know Me a Better’ Profile
  • More in depth cognitive assessment (MMSE, AMT10)
  • Update and involve relatives
21
Q

How would you manage a wandering delirious patient?

A
  • Close observation within a safe and reasonably closed environment (refer to DOLS)
  • Allow wandering in safe environment
  • Ask relatives to offer meaningful distractions
22
Q

How would you manage Delirious Patients false ideas?

A
  • Avoid contraindicating and challenging patients
  • Change the subject or use distraction techniques
  • Concentrate on their feeling behind what they’re saying
23
Q

Who is part of the FOPAL team?

A 
Consultant Geriatrician
Physicians Assistant
Specialist Nurses
Physiotherapists
Occupational Therapists
24
Q

What is the aim of FOPAL

A

Comprehensive review of the patient, including sourcing collateral information, to ensure timely and appropriate discharge for patients with complex needs

25
Q

What is asked in history at mem clinic?

A
  • timeline from collateral
  • degree of insight
  • cognitive assessment: attention and orientation, memory, language, executive function, apraxia, visuospacial abilitym (8 As)
  • assesment of behavioural symtoms: aggression, agitation, restless, pychosis, sexual disinhibiton, wandering
  • ability to drive
  • mood
  • degree of support
  • risks: wandering, cooking, neglect
  • comorbidities
  • ADLs: self care, managing finances, driving, social network
26
Q

What investigations are carried out at mem clinic

A
  • physical exam: cause of infection or focal neurology
  • bloods: U+E, fbc, haematinics, TFT
  • ECG
  • CXR
  • ? EEG
  • MSU
  • ?LP
  • CT/ MRI almost always to exclude differentials
  • extended cognitive assessment eg ACE or MOCA
27
Q

What are the 8 As?

A
  • Anosognosia: dont realise something is wrong
  • Amnesia: memory loss
  • Agnosia: dont recognise sense eg sight/ smell
  • Aphasia: loss of language
  • Apraxia: loss of purposeful movement and direction following
  • Apathy
  • Altered perception: illusions and delusions
  • attention deficit
28
Q

What drugs are effective in alzheimers?

A
  • donepezil, rivastigmine and galantamine (ACHe inhibitors)- do not impact cognition but may help behavioural symptoms
  • memantine (NMDA receptor antagonist)- however can cause seizures
  • these are of little- no use in vascular or frontotemporal dementia
29
Q

What 10 questions are asked for abbreviated mental test?

A

age, time, year, location, identify 2 people, DoB, historic date, current world leader, count down from 10, recall an address

30
Q

What is Section 2 of MHA?

A

Admission to hospital for assessment, followed by medical treatment if necessary, for up to 28 days;
Requires two medical recommendations one of which should be made by a doctor who knows the service user;

31
Q

What is Section 3 MHA?

A

Admission to hospital for treatment for up to 6 months; appropriate medical treatment must be available.
Requires 2 medical recommendations one of which should be made by a doctor who knows the service user;

32
Q

What is a CTO MHA?

A

Allows certain in-patients to be discharged with some conditions, and allows them to be recalled to the original section if it is necessary for them to return to hospital

33
Q

What is Section 5 (4) of the MHA?

A

Compulsory detention in hospital by a registered nurse for up to 6 hours for the purpose of consideration of Section 5(2) – see below;
The service user must already be receiving treatment for mental disorder as an in-patient.

34
Q

What is Section 5 (2) of the MHA?

A

Compulsory detention in hospital, usually by the doctor in charge of the patient’s care (but Approved Clinicians from non-medical backgrounds may undertake this role)
Detention can last for up to 72 hours to allow a Mental Health Act assessment to take place.
The service user must already be an in-patient in hospital, but not necessarily for treatment for mental disorder.

So cannot be used in A&E, as not an in-patient

35
Q

What is Section 136 of MHA?

A

This is an arrest by a police officer from a public place;
Compulsory detention to a place of safety for up to 24 hours for a Mental Health Act assessment by medical practitioner and an AMHP

36
Q

What is Section 135 of MHA?

A

Allows the Police to gain entry into an individual’s home when an assessment under the Act is being considered and voluntary access is denied. Such entry requires a warrant authorised by a Magistrate

37
Q

What is Section 117 of MHA?

A

This section concerns the duty to provide after care for people who are subject to certain sections of the Act in order to support their mental health for as long as they require it
Service user does not have to pay for the services provided under Section 117
To stop it must be discharge by Local Authority and Clinical Commissioning Group.

OPIC (6 decks)

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