Deteriorating memory Flashcards
Which investigations should be done for a patient with memory loss?
- Urinanalysis
Checking for UTI which could cause delirium or confusion - Bloods
As part of confusion screen - CT or MRI brain scan
Could help detecting harmorrhages/clots, space-occupying lesions, and atrophy
What should you ask in a memory loss history?
HPC:
- What has the patient been forgetting?
- How are their daily activities?
- Do they remember and recognise people?
- Do they remember names?
- Do they remember significant dates?
- How have they been eating?
- Do they get lost?
- Do they put their belongings in strange places?
- Do they forget that people have passed away?
- How is their vocabulary?
- How is their concentration?
- How are they sleeping?
- Do they feel any paranoia?
- Do they intermittently seem ‘normal’?
- Have they had any falls?
- Have they had any changes in personality?
Check PMH, FHx, and SHx.
How does normal pressure hydrocephalus present?
- Memory loss
- Magnetic gait
- Incontinence
How does Huntington’s disease present?
- Memory loss
- Progressive cognitive deficits
- Choreic movements
- Family history
- Relatively young onset
How does a traumatic brain injury present?
- History of fall or trauma
- Possibly reduced or fluctuating GCS
- Acute onset of deficits
- Focal signs
- Well defined, less progressive signs
How does the ACE III test work?
The ACE III is used in testing cognitive function Comprehensive assessment of - Memory - Attention - Fluency - Visuospatial skills - Language
A score less than 82 is suggestive of possible dementia. Not diagnostic (dementia is a clinical diagnosis)
What is an alternative cognitive test to the ACE III?
The MOCA (Montral Cognitive Assessment)
What are the different types of dementia?
- Alzheimer’s dementia
- Lewy-body dementia (memory before motor)
- Fronto-temporal dementia
- Parkinson’s dementia (motor before memory
- Vascular dementia
- Wilson’s dementia
What are some differentials for dementia?
- Huntington’s disease
- Spino-cerebellar degenerations
- HIV/AIDS dementia
- MND/MS dementia
- Alcohol-related dementias
What signs are seen in temporal lobe impairment?
- Prospagnosia (difficulty recognising faces
- Difficulty understanding words
- Short term memory loss
- Semantic memory loss
- Inability to categorise objects
- Difficulty identifying and verbalising
- Visuo-spatial neglect
What signs are seen in parietal lobe impairment?
- Anomia (cannot identify objects
- Dysgraphia
- Agnosia (body parts)
- L-R disorientation
- Dyscalculia
- Apraxia
- Visuo-spatial neglect
- Loss of tactile perception
What is Gerstamnn’s syndrome?
- Dominant parietal lobe lesion
- Agnosia (finger
- Agraphia
- Acalculia
- L-R disorientation
What signs are seen in frontal lobe impairment?
- Difficulty sequencing
- Loss of spontaneity
- Loss of cognitive flexibility
- Difficulty conceptialising
- Poor concentration
- Poor impulse control
- Difficulty problem solving
- Difficulty expressing language (Broca’s aphasia)
What is the scoring for MOCA?
- Score out of 30
- Takes 10-15 minutes
- Score less than 26 gives high sensitivity but low specificity
- Less than 26 - MCI
- Less than 17 - Dementia
How would you assess function?
- Functional activities questionnaire
- Activities of daily living assessment
- Bristol functional assessment
