ILA 4 - dementia Flashcards
Dementia screening tool examples
Mini-mental state examination. GP-COG.
Dementia definition
Syndrome of progressive impairment of higher cortical functions.
Alzheimer’s Disease Hallmarks
beta-amyloid plaques and neurofibrillary tangles of protein tau. Atrophy of cerebral cortex.
Risk factors for Alzheimer’s
1st degree relative. Down Syndrome. ApoE4 homozygosity. Loneliness. Depression. Lack of physical or cognitive exercise.
Symptoms of Alzheimer’s
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)
Investigations for memory loss
FBC for anaemia, U + E for sodium, glucose for ketosis, LFT for gamma GT, Thyroid for hypothyroidism, B12 and folate, ESR and CRP
Management of Alzheimer’s
refer to specialist memory clinic. Acetylcholinesterase inhibitors (Donepezil, rivastigime), Antiglutamatergic (Memantine). Folic acid and vitamin B supplementation.
Side effects of acetylcholinestase inhibitors
d+v, headache, cramps, dizziness, incontinence, arrhythmia, peptic ulcer, insomnia, raised LFT
Side effects of memantine
hallucinations, confusion, hypertonia, hypersexuality, more sedative than anticholinesterase inhibitors.
Vascular dementia hallmarks
Infactions in cerebral vasculature. More sudden onset and stepwise progression.
Symptoms of vascular dementia
More focal signs present with memory loss.
Treatment of vascular dementia
Prevent further vascular events e.g. anticoagulate (esp if AF) and antiplatelet. Control BP. Anticholinesterase inhibitors and Memantine may be beneficial.
Lewy body dementia hallmarks
cortical and subcortical abnormal protein deposits called lewy bodies.
Symptoms of Lewy Body dementia
Fluctuating. Visual hallucinations. Memory loss may not be apparent until later on in disease. Bradykinesia, tremor, rigidity (parkinsonism). Repeated falls, unsteady gait, dysphasia, incontinence.
Treatment of Lewy Body dementia
Anticholinesterase inhibitors and Memantine may be beneficial.
Fronto-temporal dementia hallmarks
degeneration of fronto and/or temportal lobes. No Alzheimer’s evidence. Knife-blade atrophy on CT.
Symptoms of fronto-temportal dementia
Personality change. Behavioural disturbance (sex disinhibition, apathy). Dysphasia. Can have memory preserved. Younger onset than other types of dementia
Cause of fronto-temportal dementia
Pick’s Disease. silver staining protein tau accumulations in frontotemporal region.
Treatment of frontotemporal dementia
Antipsychotics, antidepressants. Alzheimer’s meds are not effective.
Community support for dementia
Care coordinator, occupational therapist, physiotherapy, community psych nurse, Admiral nursing, Alzheimer’s Society. Carer respite/support groups.
Basis for having capacity
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
Basis for best interests
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
DOLS
deprivation of liberty safeguarding. For those who lack capacity with mental disorder over 18yrs. Act in patient’s best interest.
IMCA
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.
