Memory Problems Flashcards
is clouding of consciousness seen in dementia?
no
only in delirium
3 main groups of human memory?
sensory memory (<1 sec) short term/working memory long term memory
types of long term memory?
explicit memory (conscious) and implicit memory (unconscious)
types of explicit memory?
declerative memory (facts, events)
- episodic (events/experiences)
- semantic (facts, concepts)
example of implicit memory?
procedural (skills/tasks)
- e.g driving, becomes an unconscious action
stages of memory processing?
attention
encoding
storage
retrieval
what is anterograde amnesia?
difficulty in acquiring new memories
cant remember events since onset of illness/injury
what us retrograde amnesia?
cant remember information prior to the inset of illness/injury
what things are classified as normal memory loss?
sometimes misplaces keys, glasses etc momentarily forgets acquaintance's name occasionally has to search for words occasionally forgets to run an errand may forget event from distant past may momentarily forget where to turn while driving but quickly orientates self jokes about memory loss
what things are classed as mild cognitive impairment?
frequently misplaces items
frequently forgets people’s names and is slow to recall them
has more difficulty using the right words
begins to forget important events and appointments
may forget more recent events or newly learned information
may temporarily become lost more often, may have trouble understanding/following map
worries about memory loss, family and friends notice the lapses
what things are classed as dementia?
forgets what an item is used for or puts it in an inappropriate place
may not remember knowing a person
begins to lose language skills and may withdraw from social interaction
loses sense of time, doesnt know what day it is
has serious impairment of short term memory and difficulty learning/remembering new information
becomes easily disorientated or lost in familiar places, sometimes for hours
may have little or no awareness of cognitive problems
how does delirium differ from dementia?
acute onset hours/days/weeks/months duration fluctuating course impaired alertness and orientation can have paranoid and bizarre thinking hallucinations more common more likely to be irritable, aggressive and fearful
useful questions to ask the patient when assessing cognition?
has memory problem affected day to day life?
any problems in the kitchen?
can you still use home appliances (remote, phone, microwave, washing machine etc)
do you follow the news? tell me something specific you’ve seen in the news
have you ever got lost or disorientated?
do you drive? any recent accidents?
can you still enjoy hobbies? (golf,bingo,bridge etc)
important aspects of corroborative history from family?
functional abilities at home
help required to support them while at home?
any significant cognitive, physical or emotional changes in recent weeks
rate and pattern of cognitive decline
what should be assessed in cognitive screening?
memory attention and concentration executive functioning visuo-spatial functioning language consider screen to rule out co-morbid psychological problems (e.g depression)
what is the 4AT?
rapid assessment screening test for delirium
quick, pragmatic, validated
aimed at detecting mod-severe cognitive impairment
uses the months backwards test and AMT-4 (abbreviated mental test-4)
what 4 things does 4AT measure?
alertness
AMT-4 (age, DOB, place, year)
attention (months backwards)
acute or fluctuating course
SIGN guidelines on testing for dementia?
MMSE should be used in diagnosis of dementia in individuals with suspected cognitive imapirment
initial cognitive testing can be improved by use of addenbrookes cognitive examination
cut offs for MMSE?
>27 = normal 25-26 = borderline cognitive impairment <24 = supports dementia diagnosis
drawbacks of MMSE?
not adjusted for age
wont pick up early stages
poor measure of executive functioning
what bedside tests can be used in suspected cognitive impairment?
GPCOG
6CIT
clock drawing test
what does clock drawing test measure?
executive functioning (planning) visuo-spatial ability abstraction (ability to use symbols) correlates well with overall cognitive functioning frontal-parietal functioning
what is MoCO?
montreal cognitive assessment
rapid screening tool for mild cognitive dysfunction
assesses multiple cognitive domains
what is addenbrooke’s cognitive examination?
upgraded from first issue (ACE-R)
bridges the gap between MMSE and neuropsychological assessment
scored out of 100 with 5 domains
what are the 5 domains of addenbrookes?
orientation and attention memory fluency language visuo-spatial functioning
cut offs in addenbrookes?
> 88 = normal
<82 = supports dementia diagnosis
84 generally ok, may be borderline
