HCOLL 1. Quick Cards Flashcards
Mrs H is having problems with her day to day memory and she often finds she can’t find the exact word she wants to use. It has come on slowly over time.
What are 5 common causes of dementia and their main presenting features?
- Alzheimer’s disease - day to day memory, difficulty finding the right words, solving problems, making decisions or perceiving in 3 dimensions.
- Vascular dementia - These can occur suddenly, or over time. Symptoms overlap with Alzheimer’s - problem solving, planning, thinking quickly and concentrating, periods of confusion.
- Mixed dementia
- Dementia with lewy bodies - alertness that varies over the day, hallucinations, difficulty judging distance. Day to day memory is not often affected early. (cf. Alzheimer’s) it is similar to P.D.
- Frontotemporal dementia - personality, behaviour and language.
True or false?
It is a normal part of aging to lose your memory
How can dementia be defined?
False, this is a commonly accepted myth.
A loss of cognitive ability in a previously unimpaired person beyond what might be expected from normal ageing.
In relation to the following, decide a likely diagnosis based on the temporal relation of symptoms to cognitive impairment
- Mrs Smith with insidious onset change in cognition?
- Mr Johnson with a sudden change and step-wise decline especially after stroke.
- Mrs Kilburn who has an acute (days to weeks) or subacute (weeks to months) change in her cognitive ability
- Mr Mortimore who was fine yesterday now doesn’t know where he is or what is happening.
- Alzheimer’s - degenerative process.
- Vascular type cause
- Infection, metabolic disorder, an expanding brain lesion, medications, stroke, or hydrocephalus, CJD.
- Delirium, acute confusional state from infection.
How should you approach assessing a patient with cognitive impairment.
- History
- Cognitive Exam
- Physical Exam
- Medication r/v
Mrs Gin has presented to you in the GP surgery with her husband. He says how recently she has been struggling with her day to day memory and regularly forgets meeting new people, or appointments, she would usually be very good at remembering these. He also feels recently she has become more “snappy” with him.
What ICD-10 categories need to be fulfilled to diagnose dementia?
- A decline in memory - especially learning new information and verified from hx. the decline in cognition should impact daily living and functioning.
- Judgement
- Thinking
- Planning
- Organisng - Consciousness is not impacted
- Decline in emotional control, motivation or social behaviour such as:
- emotional lability
- irritability
- apathy
- coarsening of social behaviour - present for at-least six months
What is mild cognitive impairment? - what percentage go on to develop dementia?
- Evidence of early memory decline on formal memory tests without clinical evidence of other features of dementia. 10-15%
Ron who is 82 presents to A&E with his wife Dorothy, he is confused and has been since last night when he was especially bad, he is some what better this morning. He had has a history of BPH, HTN, & mild cognitive impairment. He is also slightly deaf.
What syndrome is Ron likely presenting with? What does he have to fulfil for a diagnosis?
- Disturbed attention (reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention. - Lethargy, dis-tractability
- A change in cognition (memory, language deficit, or disorientation) not accounted for by pre-existing diagnosis
- Disturbance develops acutely, over hours to days and tends to fluctuate over the course of the day.
- Evidence from the history, physical exam, or investigations that the disturbances are the result of a physiological consequence of
- A medical condition
- intoxication
- medication
- drug withdrawal
Ron who presented with ? Delirium needs a Abbreviated Mental Test
What questions do you need to ask?
What score is abnormal?
What test would you do next?
Age
Time
Address for recall
Year
Name of hospital
Recognize 2 people
DOB
Year of first world war
Name of current Monarch
Count backwards 20 -> 1
A score <8 is abnormal
Confusion Assessment Method
Ron presents with delirium, what would be good first line investigations?
ECG TFT Glu CXR LFT FBC U & Es Urinalysis CRP
Doris wants to know how her husband who has had delirium, will be back to his usual self?
Recovery is slow.
40% persist at 2 weeks
33% (1/3) at 4 weeks (1mo)
25% (1/4) at 3 months
How might disease in the frontal lobe present?
Problems with inhibition, initiating action, reasoning and abstract thought
How might pathology in the parietal lobe present?
Difficulty recognizing faces and objects and difficulty in carrying out a sequence of actions
If someone has damaged their temporal lobe what problems may they present with?
Diminished attention, difficulty with short term memory and producing speech.
David (66) presents to his GP with his wife who says he is having memory problems.
He denies this, but she say’s he is struggling to remember people’s names, appointments and has difficulty with making decisions about day to day tasks which he would normally have been fine with. The problems have been going on since he was last in hospital 16 months ago - though he has no on going health problems.
What does David need to fulfil to be diagnosed with Dementia?
There must be impairment of 2 cognitive domains (over 65 years)
- memory (as is affected here)
- language
- behaviour
- visuospatial
- executive function (as affected here)
The problems with the above have to negatively impact on normal ADLs
Symptoms have to be present for at least 6 months
How can you define dementia?
. A progressive clinical syndrome of deteriorating mental function, significant enough to interfere with ADLs.
It affects cognitive and social domains (memory, thinking, language, orientation, judgement; and emotion control and motivation respectively)
