Dementia General Flashcards ☺️
What is dementia
How does this differ from normal ageing
What are the general types
Normal ageing Occasional memory lapse Word finding difficulty Planning, orientation intact Degree of brain atrophy and pathology
Dementia
-cognitive failure accompanied by deterioration in day to day function over time
Early onset - dementia in U65s
Mild cognitive impairment - cognitive impairment that does not fulfil the diagnostic criteria
What is Alzheimer’s disease
How does it present
60% of all dementia
Gradual onset with continuous decline
Early impairment of episodic memory due to medial temporal hippocampal atrophy
- include memory loss for recent events, repeated questioning, and difficulty learning new information.
- multiple cognitive deficits
Normal gait and posture
What is vascular dementia
2rd most common
Often coexists with Alzheimers - mixed dementia
Vascular risk factors
Stepwise increase in the severity of symptoms —
- early onset gait issues, falls, urinary incontinence
- exaggerated mood changes, involuntary facial muscle control
- speech and swallowing problems
- focal neurological signs (such as hemiparesis or visual field defects) may be present.
What is dementia with Lewy bodies
-how does it differ from PD
3rd most common
Daily fluctuation of symptoms
Early symptoms
-poor memory, concentration, visual hallucinations, aphasia
Late symptoms
- resting tremor, bradykinesia, reduced facial expression, sleep disorders, falls
- autonomic dysfunction (such as postural hypotension, difficulty in swallowing, and incontinence or constipation)
PD starts with motor symptoms
Treatment
- cognitive symptoms (donepezil)
- motor symptoms (ropinirole)
What is frontotemporal dementia
-what are the types
Mainly affects U65s
- personality and behaviour changes
- progressive and semantic aphasia (difficulty maintaining conversation, finding the right words)
- mental rigidity but memory preserved
- depression and anxiety
Pick’s disease/Behavioural variant
- formation of PIck bodies => brain atrophy
- lewd, rude, nude, crude
Semantic Variant Primary Progressive Aphasia => difficulty finding right words
Non fluent Variant Primary Progressive Aphasia => can understand what is being said but can’t find the right words
What are the other causes of dementia
Creutzfeldt Jakob
HD
How can patients with dementia communicate unmet psychological or physical needs
Non verbally through their behaviour Psychological needs are experienced more intensely but are unable to meet these themselves -comfort -identity -attachment -occupation -inclusion -love
Physical reason for behavioural change
- pain, fatigue
- fear, loneliness
- infection
How can you support someone with dementia socially?
Initiatives such as
- Dementia Friends
- Dementia Cafes (for people living with dementia and carers)
- Dementia Detetives (for secondary school students)
- Dementia friendly communities
Stigma has led people to feel socially excluded
How can you support a patient with dementia in their own homes
Use of assistive technology
Talking clocks => prevent disorientation about time
Removing doors => easier movement around the house
GPS => prevent people from going missing
Grab rails, ramps, level floors => aid mobility
Maximise natural light => reminders of the time of day
iPads and dial phones => connect with family
Avoid glossy floors, patterned carpets => mistaken for changes in floor level
Movement triggered lights => guide people to the bathroom
What are the 4 key cognitive symptoms
Pattern of cognitive failure linked to brain distribution and NT dysfunction in early stages
Regional and global brain atrophy in later stages
Agnosia (perceptual deficit) -misidentification of sensory stimuli Amnesia (due to hippocampus atrophy) -short term memory affected first -long term and motor memories affected in advanced disease -may lose 2nd language, revert to 1st Aphasia -simplified language -word finding problems => loss of verbal communication Apraxia (higher motor function) -inability to perform voluntary actions -difficulties dressing, eating, drawing BUT CAN STILL MOVE
How would you assess cognition?
MMSE
Pros
-measures orientation, working memory, recall language, praxis
-can track progress over time
Cons
-less sensitive for mild cognitive impairment and early dementia
-false positives for people with less education
ACE-3
Pros
-incorporates MMSE and expands on domains
-sensitive to early AD and FTD
-differentiates between depression and progressive degenerative disorders
Cons -requires knowledge of past governments MOCA Pros -more sensitive for MCI and early dementia -greater assessment of higher cognitive function Cons -more time consuming than MMSE
What are the neuropsychiatric symptoms that may arise
Hallucinations (seeing, hearing, smelling things that aren’t there)
-most commonly visual of animals and people
Delusions (false belief)
-misplaced items misinterpreted as stolen
-misidentification of people or places
Depression, anxiety, apathy
Sexual disinhibition
Sleep behaviours
What are the functional domains
How are these impacted by dementia
Continence Dressing Eating Finances Navigation Washing Dementia interferes with these
Describe how dementia progresses over time
How can you differentiate between dementia and delirium?
Mild cognitive impairment progresses rapidly into dementia
Severity of dementia progresses relatively slowly
Dementia = chronic brain failure Delusions = acute brain failure
Dementia
- slow onset
- lasts months - years
- attention preserved
- alertness normal
- fragmented sleep
Delirium
- rapid onset
- lasts hours - weeks
- fluctuating attention
- hypervigilant or reduced vigilance
- frequent sleep disruption
What are the types of aphasia
Expressive => they can understand but cannot communicate their thoughts due to difficulties in finding words
Receptive => difficulties understanding but are unaware that they have problems understanding
-make frequent speech errors
