ILA 4 - dementia

Question 1

Dementia screening tool examples

Answer 1

Mini-mental state examination. GP-COG.

Question 2

Dementia definition

Answer 2

Syndrome of progressive impairment of higher cortical functions.

Question 3

Alzheimer’s Disease Hallmarks

Answer 3

beta-amyloid plaques and neurofibrillary tangles of protein tau. Atrophy of cerebral cortex.

Question 4

Risk factors for Alzheimer’s

Answer 4

1st degree relative. Down Syndrome. ApoE4 homozygosity. Loneliness. Depression. Lack of physical or cognitive exercise.

Question 5

Symptoms of Alzheimer’s

Answer 5

APHASIA, APRAXIA, AGNOSIA, AMNESIA, APATHY
Irritability, wandering, hallucinations, delusions. Viso-spatial impairment (gets lost), decrease in verbal abilities, loss of memory esp episodic memory. Agnosia (not recognise self)

Question 6

Investigations for memory loss

Answer 6

FBC for anaemia, U + E for sodium, glucose for ketosis, LFT for gamma GT, Thyroid for hypothyroidism, B12 and folate, ESR and CRP

Question 7

Management of Alzheimer’s

Answer 7

refer to specialist memory clinic. Acetylcholinesterase inhibitors (Donepezil, rivastigime), Antiglutamatergic (Memantine). Folic acid and vitamin B supplementation.

Question 8

Side effects of acetylcholinestase inhibitors

Answer 8

d+v, headache, cramps, dizziness, incontinence, arrhythmia, peptic ulcer, insomnia, raised LFT

Question 9

Side effects of memantine

Answer 9

hallucinations, confusion, hypertonia, hypersexuality, more sedative than anticholinesterase inhibitors.

Question 10

Vascular dementia hallmarks

Answer 10

Infactions in cerebral vasculature. More sudden onset and stepwise progression.

Question 11

Symptoms of vascular dementia

Answer 11

More focal signs present with memory loss.

Question 12

Treatment of vascular dementia

Answer 12

Prevent further vascular events e.g. anticoagulate (esp if AF) and antiplatelet. Control BP. Anticholinesterase inhibitors and Memantine may be beneficial.

Question 13

Lewy body dementia hallmarks

Answer 13

cortical and subcortical abnormal protein deposits called lewy bodies.

Question 14

Symptoms of Lewy Body dementia

Answer 14

Fluctuating. Visual hallucinations. Memory loss may not be apparent until later on in disease. Bradykinesia, tremor, rigidity (parkinsonism). Repeated falls, unsteady gait, dysphasia, incontinence.

Question 15

Treatment of Lewy Body dementia

Answer 15

Anticholinesterase inhibitors and Memantine may be beneficial.

Question 16

Fronto-temporal dementia hallmarks

Answer 16

degeneration of fronto and/or temportal lobes. No Alzheimer’s evidence. Knife-blade atrophy on CT.

Question 17

Symptoms of fronto-temportal dementia

Answer 17

Personality change. Behavioural disturbance (sex disinhibition, apathy). Dysphasia. Can have memory preserved. Younger onset than other types of dementia

Question 18

Cause of fronto-temportal dementia

Answer 18

Pick’s Disease. silver staining protein tau accumulations in frontotemporal region.

Question 19

Treatment of frontotemporal dementia

Answer 19

Antipsychotics, antidepressants. Alzheimer’s meds are not effective.

Question 20

Community support for dementia

Answer 20

Care coordinator, occupational therapist, physiotherapy, community psych nurse, Admiral nursing, Alzheimer’s Society. Carer respite/support groups.

Question 21

Basis for having capacity

Answer 21

Understand information, retain it, weigh it up and communicate decision. Context and decision dependent and needs to be re-assessed. Have right to make decision which may appear unwise. Have all support possible

Question 22

Basis for best interests

Answer 22

Choice with as little restriction on their freedoms and rights. Consider:

• relatives and carers views.
• Any views made by patient communicated.
• religious or cultural views which may be held.
• other healthcare professionals opinions

Question 23

DOLS

Answer 23

deprivation of liberty safeguarding. For those who lack capacity with mental disorder over 18yrs. Act in patient’s best interest.

Question 24

IMCA

Answer 24

Independent mental capacity advocate. Ensure mental capacity act is abided to. Support and represent patients who lack capacity with no one else to represent them.