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Psychiatry > Memory Problems > Flashcards

Memory Problems Flashcards

1
Q

is clouding of consciousness a symptom of dementia

A

no

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2
Q

what are the types of memory

A

sensory (<1 second)
working (repeating things in your head before storing them in short term)
short term (< 1 min)
long term (life time):
-implicit (unconscious, procedural- skills and tasks)
-explicit (conscious); declarative (facts and events)= episodic (events and experiences) or semantic (facts and ceoncepts about the world)

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3
Q

what are the stages of memory processing

A

attention
encoding
storage
retrieval

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4
Q

what is anterograde amnesia

A

difficulty in acquiring new material and remembering events since the onset of the illness/ injury

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5
Q

what is retrograde amnesia

A

difficulty in remembering information prior to the onset of the illness/injury

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6
Q

give examples of long term retrograde amnesia causes

A

korsakoffs

late stages of Alzheimers

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7
Q

what is globus pharyngeus/ hystericus

A

feeling of a lump in throat

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8
Q

define dementia

A

a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.

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9
Q

what conditions can you get dementia in

A 
alzheimers 
FTD
huntingtons
creutzfeldt-jacobs
hydrocephalus
lewy body dementia
parkinsons
vascular 
wernickes-korsakoss
depression 
diabetes
acohol misuse
head injury
medications
thyroid
tumour 
vit deficiency 
....
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10
Q

what symptoms do you need 2 or more of to have dementia

A 
forgetfullness
memory loss
confusion
poor reasoning and logic 
personality changes
poor judgement 
ability to focus 
visual perception
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11
Q

what is onset and course like in dementia

A

insidious
lasts months to years
stable, progressive or step wise

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12
Q

which out of dementia, delirium and depression will have altered alertness

A

delirium

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13
Q

which out of dementia, delirium and depression will have normal orientation

A

depression

can be normal in early dementia

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14
Q

is memory affect in depression

A

no but concentration is poor

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15
Q

how does thinking differ in dementia delirium and depression

A

dementia- slowed, reduced interest

delirium- can be paranoid, bizarre

depression- slow and preoccupied

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16
Q

how does perception differ in dementia delirium and depression

A

dementia- hallucinations

delirium- visual and auditory hallucinations common

depression- mood congruent auditory hallucinations

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17
Q

how do emotions differ in dementia delirium and depression

A

dementia- shallow, labile, irritable

delirium- irritable, aggressive and fearful

depression- flat, unresponsive and sad

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18
Q

how does sleep differ in dementia delirium and depression

A

dementia- nocturnal wandering and confusion

delirium- nocturnal confusion

depression- early morning wakening

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19
Q

what is it useful to ask in a corroborative history

A

Functional abilities at home
Help required to support them whilst at home
Any significant cognitive, physical or emotional changes in recent weeks
Rate and pattern of cognitive decline

also get corroborative history from staff

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20
Q

what does 4AT screen for

A

rapid assessment test for delirium

aimed at detecting moderate- severe cognitive impairment

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21
Q

what is included in the 4AT

A

months backwards test
abbreviated mental test- 4
Alertness- normal/ mild sleepiness/ clearly abnormal
AMT-4 (age, DOB, place, place, current year)
Attention (months backwards)
Acute or fluctuating course

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22
Q

what test for the diagnosis of dementia

A

MMSE

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23
Q

what test for initial cognitive testing

A

addenbrookes

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24
Q

what test for delirium

A

4AT

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25
Q

what is included in the MMSE

A 
orientation 
memory 
visuospatial 
language 
scored out of 30 
<24 support dementia
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26
Q

what are the pros and cons of MMSE

A

pros- quick, different languages, only need blank paper and pen, memorisable

cons- not adjusted for age, poor in severe impairment, poor assessment of executive function, poor in high premorbid functioning, hard if poor verbal skills, poor in detecting early stages

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27
Q

what are the bed side non specialist tests for dementia

A

GPCOG - Community setting
-Orientation to time, short-term recall, clock-drawing
- Informant history if score low
6CIT - Attention, orientation to time, short-term recall, corroborative Hx
clock drawing test

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28
Q

what does clock drawing test

A

executive function (planning- enough room for numbers)
visuospatial ability
abstraction (ability to use symbols)
correlates will with overall cognitive functioning
(frontal-parietal

29
Q

what is the MoCA

A

rapid screening instrument for mild cognitive dysfunction

assesses multiple cognitive domains

30
Q

what does addenbrookes test

A 
orientation and attention 
memory 
fluency 
language 
visuospatial functioning
31
Q

what are the functions of a neuropsychological assessment

A

To identify areas of deficits and preserved functioning in the cognitive profile
Aid with diagnosis process
Provide information regarding prognosis
To obtain a baseline assessment of functioning
To inform and facilitate interventions and strategies
To monitor change in cognitive functioning
To evaluate effectiveness of interventions
To provide indicators regarding the rate of recovery

32
Q

does a good cognitive assessment rule out dementia

A

no

33
Q

what are the features of lewey body dementia

A

fluctuates
visual hallucinations
parkinsonism
frequent falls

34
Q

what does SPECT show in FTD

A

reduced blood flow to FT lobes due to atrophy

35
Q

what is dementia

A

progressive global cognitive decline, irreversible, associated decline in functioning

36
Q

what are the cognitive tests for dementia

A

ACE-II (most common for dementia- used for monitoring mild cognitive impairment and diagnosing dementia, no dementia if score over 82)
MoCA (shorter, in lots of languages)
frontal assessment battery (tests executive function)
detailed neuropsychological testing (standardised to pre morbid ability)

37
Q

what questionnaire can be used to obtain a collateral history

A

short information cognitive decline in the elderly

38
Q

what are the reversible causes of cognitive impairment

A 
depression
brain lesion 
infection/ inflammation 
medication (steroids, anticholinergics)
delirium 
alcohol 
medication 
thyroid/ metabolic disorders
39
Q

what defines mild cognitive impairement

A

noticeable cognitive impairment with little deterioration of function
ACE-II 75-90, MoCA 24-26

repeat testing yearly

40
Q

what is subjective cognitive impairment

A

patient feel that they are cognitively impaired but cognitive testing and day to day function are normal
often associates with anxiety, stress, depression
often have relative/ friend with dementia
vicious cycle of increasing anxiety about memory causing memory lapses

41
Q

what are the features of Alzheimers

A 
memory loss, esp short term 
dysphasia 
dyspraxia 
agnosia 
insidious onset
42
Q

what is seen on imaging in alzheimers

A

CT/MRI normal

medial temporal lobe atrophy or temporoparietal atrophy

43
Q

what are the variants of alzheimers

A

frontal

posterior cortical atrophy

44
Q

what are the features of vascular dementia

A

dysphasia
dyscalculia
frontal lobe symptoms and affective symptoms more common than in alzheimers

may have: focal neuro signs, vascular risk factors, step wise decline

45
Q

what is seen on imaging in vascular dementia

A

CT/MRI shows moderate- severe small vessel disease or multiple lacunar infarcts
SPECT- patchy reduction in tracer uptake throughout brain

46
Q

what are the features of FTD

A

3 syndromes:
behavioural variant- behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills, apathy, obsessions, change in diet

primary progressive aphasia- effortful non fluent speech, speech sound/ articulatory errors, lack of grammar, lack of words

semantic dementia- impaired understanding of meaning of words, fluent but empty speech, difficulty retrieving names

47
Q

what is seen in imaging of frontotemporal dementia

A

CT/MRI- frontotemporal atrophy

SPECT- FT reduction in tracer uptake

48
Q

what are the features of lewey body dementia

A

early involvement of reduced attention, executive function and visuospatial skills
two of:
-visual hallucinations
-fluctuating condition (delirium like)
-REM sleep behaviour disorder
-parkinsonism (not more than 1 year prior to onset of dementia)
-positive DAT scan

49
Q

what is the difference with dementia in parkinsons to lewey body dementia

A

in parkinsons with dementia must have parkinsons 1 year prior to onset of dementia

50
Q

when should you suspect that something uncommon is causing the dementia

A 
fast progression
young patient 
neurological signs
family history of rare/ young dementia 
medical Hx- e.g. HIV
51
Q

what should you ask when diagnosing someone with dementia

A 
What do they already know?
What do they want to know?- some people dont want to know if they have it, ask if its okay to discuss with their family 
Clear explanation of dementia +/- type
What do they think?
How do they feel?
Address specific concerns
Management plan including support
Give information over time
52
Q

what imaging is used in dementia diagnosis and when

A

CT- standard (good for excluding tumout/ bleed/ large stroke, for quanitfying vasuclar changes/ identifying structural features)

MRI- if young, fast progression or atypical features

single photo emission CT (SPECT)- FTD (or clarifying alzheimers)

DaT (dopamine active transporter) scan - for suspected DLB/ DPD when patient doesnt have enough supporting clinical features for a diagnosis

53
Q

what drugs are uses in the treatment of dementia

A

cholinesterase inhibitor:

  • alzheimers disease - donepezil, rivastigmine, galatamine
  • DLB and DPD- rivastigmine, donepezil

memantine- licensed for alzheimers

54
Q

what do cholinesterase inhibitors do

A

block the enzyme cholinesterase which is responsible for breaking down acetylcholine

slow cognitive decline
have more effect in DLB/DPD than alzheimers

55
Q

what are the side effects of cholinesterase inhibitors

A

nausea and diarrhoea most common

headache, muscle cramps, bradycardias, can worsen COPD/ asthma

56
Q

what are the precaution when prescribing cholinesterase inhibitors

A

check pulse before prescribing/ increasing dose (bradycardia)
nor with active peptic ulcer or severe asthma/ COPD

57
Q

what does memantine do

A

NMDA glutamate antagnoist
slows cognitive decline, prevents behavioural and psychological symptoms of dementia
start in moderate dementia
when cholinesterase inhibitors CI

58
Q

what are the SEs of memantine

A 
well tolerated (but less effective)
hypertension (check BP before starting) 
sedation 
dizziness
headache 
constipation
59
Q

what can reduce informal carer distress and delay nursing home admission

A

psychosocial interventions

60
Q

can people with dementia drive

A

yes but must be reported to DVLA on diagnosis
fill out CG1 form, get report from doctor who decides if patient can drive will Ix ongoing
have to do on road driving test and rookwood driving battery

61
Q

what happens as dementia progresses

A

behavioural and psychiatric aspects of dementia become more prominent
physical co morbidity increases
reduced ability to carry out activities of daily living independently and hence greater need for support services - institutional care

62
Q

what are the behavioural and psychological symptoms of dementia

A 
hallucinations 
depression 
aggression 
agitation 
disinhibition 
anxiety 
insomnia 
delusions
63
Q

what pharmacological management for agitation in dementia

A

in alzheimers- antipsychotics, citralopram, mematine, analgesia, sextromethorphan

trazodone for FTD

64
Q

what type of dementia should you be very careful when prescribing antipsychotics

A

lewy body dementia

65
Q

what is used for anxiety in dementia

A

antidepressants, benzodiazepines, pregabalin

66
Q

what is used for visual hallucinations in dementia

A

cholinesterase inhibitors, antipsychotics

67
Q

what is used for insomnia in dementia

A

melatonin, Z drugs, benzodiazepines, sedating antidepressants

68
Q

what is used for agitation and aggression in dementia

A

benzodiazepines, antipsychotics, sedating antidepressants, cholinesterase inhibitors, memantine, pregabalin

Psychiatry (27 decks)

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