Memory Problems Flashcards
is clouding of consciousness a symptom of dementia
no
what are the types of memory
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)
what are the stages of memory processing
attention
encoding
storage
retrieval
what is anterograde amnesia
difficulty in acquiring new material and remembering events since the onset of the illness/ injury
what is retrograde amnesia
difficulty in remembering information prior to the onset of the illness/injury
give examples of long term retrograde amnesia causes
korsakoffs
late stages of Alzheimers
what is globus pharyngeus/ hystericus
feeling of a lump in throat
define dementia
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.
what conditions can you get dementia in
alzheimers FTD huntingtons creutzfeldt-jacobs hydrocephalus lewy body dementia parkinsons vascular wernickes-korsakoss depression diabetes acohol misuse head injury medications thyroid tumour vit deficiency ....
what symptoms do you need 2 or more of to have dementia
forgetfullness memory loss confusion poor reasoning and logic personality changes poor judgement ability to focus visual perception
what is onset and course like in dementia
insidious
lasts months to years
stable, progressive or step wise
which out of dementia, delirium and depression will have altered alertness
delirium
which out of dementia, delirium and depression will have normal orientation
depression
can be normal in early dementia
is memory affect in depression
no but concentration is poor
how does thinking differ in dementia delirium and depression
dementia- slowed, reduced interest
delirium- can be paranoid, bizarre
depression- slow and preoccupied
how does perception differ in dementia delirium and depression
dementia- hallucinations
delirium- visual and auditory hallucinations common
depression- mood congruent auditory hallucinations
how do emotions differ in dementia delirium and depression
dementia- shallow, labile, irritable
delirium- irritable, aggressive and fearful
depression- flat, unresponsive and sad
how does sleep differ in dementia delirium and depression
dementia- nocturnal wandering and confusion
delirium- nocturnal confusion
depression- early morning wakening
what is it useful to ask in a corroborative history
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
what does 4AT screen for
rapid assessment test for delirium
aimed at detecting moderate- severe cognitive impairment
what is included in the 4AT
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
what test for the diagnosis of dementia
MMSE
what test for initial cognitive testing
addenbrookes
what test for delirium
4AT
what is included in the MMSE
orientation memory visuospatial language scored out of 30 <24 support dementia
what are the pros and cons of MMSE
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
what are the bed side non specialist tests for dementia
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
what does clock drawing test
executive function (planning- enough room for numbers)
visuospatial ability
abstraction (ability to use symbols)
correlates will with overall cognitive functioning
(frontal-parietal
what is the MoCA
rapid screening instrument for mild cognitive dysfunction
assesses multiple cognitive domains
what does addenbrookes test
orientation and attention memory fluency language visuospatial functioning
what are the functions of a neuropsychological assessment
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
does a good cognitive assessment rule out dementia
no
what are the features of lewey body dementia
fluctuates
visual hallucinations
parkinsonism
frequent falls
what does SPECT show in FTD
reduced blood flow to FT lobes due to atrophy
what is dementia
progressive global cognitive decline, irreversible, associated decline in functioning
what are the cognitive tests for dementia
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)
what questionnaire can be used to obtain a collateral history
short information cognitive decline in the elderly
what are the reversible causes of cognitive impairment
depression brain lesion infection/ inflammation medication (steroids, anticholinergics) delirium alcohol medication thyroid/ metabolic disorders
what defines mild cognitive impairement
noticeable cognitive impairment with little deterioration of function
ACE-II 75-90, MoCA 24-26
repeat testing yearly
what is subjective cognitive impairment
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
what are the features of Alzheimers
memory loss, esp short term dysphasia dyspraxia agnosia insidious onset
what is seen on imaging in alzheimers
CT/MRI normal
medial temporal lobe atrophy or temporoparietal atrophy
what are the variants of alzheimers
frontal
posterior cortical atrophy
what are the features of vascular dementia
dysphasia
dyscalculia
frontal lobe symptoms and affective symptoms more common than in alzheimers
may have: focal neuro signs, vascular risk factors, step wise decline
what is seen on imaging in vascular dementia
CT/MRI shows moderate- severe small vessel disease or multiple lacunar infarcts
SPECT- patchy reduction in tracer uptake throughout brain
what are the features of FTD
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
what is seen in imaging of frontotemporal dementia
CT/MRI- frontotemporal atrophy
SPECT- FT reduction in tracer uptake
what are the features of lewey body dementia
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
what is the difference with dementia in parkinsons to lewey body dementia
in parkinsons with dementia must have parkinsons 1 year prior to onset of dementia
when should you suspect that something uncommon is causing the dementia
fast progression young patient neurological signs family history of rare/ young dementia medical Hx- e.g. HIV
what should you ask when diagnosing someone with dementia
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
what imaging is used in dementia diagnosis and when
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
what drugs are uses in the treatment of dementia
cholinesterase inhibitor:
- alzheimers disease - donepezil, rivastigmine, galatamine
- DLB and DPD- rivastigmine, donepezil
memantine- licensed for alzheimers
what do cholinesterase inhibitors do
block the enzyme cholinesterase which is responsible for breaking down acetylcholine
slow cognitive decline
have more effect in DLB/DPD than alzheimers
what are the side effects of cholinesterase inhibitors
nausea and diarrhoea most common
headache, muscle cramps, bradycardias, can worsen COPD/ asthma
what are the precaution when prescribing cholinesterase inhibitors
check pulse before prescribing/ increasing dose (bradycardia)
nor with active peptic ulcer or severe asthma/ COPD
what does memantine do
NMDA glutamate antagnoist
slows cognitive decline, prevents behavioural and psychological symptoms of dementia
start in moderate dementia
when cholinesterase inhibitors CI
what are the SEs of memantine
well tolerated (but less effective) hypertension (check BP before starting) sedation dizziness headache constipation
what can reduce informal carer distress and delay nursing home admission
psychosocial interventions
can people with dementia drive
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
what happens as dementia progresses
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
what are the behavioural and psychological symptoms of dementia
hallucinations depression aggression agitation disinhibition anxiety insomnia delusions
what pharmacological management for agitation in dementia
in alzheimers- antipsychotics, citralopram, mematine, analgesia, sextromethorphan
trazodone for FTD
what type of dementia should you be very careful when prescribing antipsychotics
lewy body dementia
what is used for anxiety in dementia
antidepressants, benzodiazepines, pregabalin
what is used for visual hallucinations in dementia
cholinesterase inhibitors, antipsychotics
what is used for insomnia in dementia
melatonin, Z drugs, benzodiazepines, sedating antidepressants
what is used for agitation and aggression in dementia
benzodiazepines, antipsychotics, sedating antidepressants, cholinesterase inhibitors, memantine, pregabalin
