memory probs Flashcards
what is anterograde amnesia
difficulty in acquiring new material and remembering events since the onset of the illness or injury
what is retrograde amnesia
difficulty in remembering information prior to the onset of the illness or injury
what is dementia
a syndrome due to disease of the brain, usually chronic or progressive in nature, in which there s disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement
diagnostic criteria of dementia
2 or more of the following;
forgetfulness, memory loss, confusion, poor reasoning and logic, personality changes, poor judgement, ability to focus, visual perception
features of dementia in terms of onset, duration, course, alertness, orientation and memory
onset: insidious
duration: months/years
course: stable, progressive, step-wise
alertness: normal
orientation: normal or impaired to time/place
memory: recent and remote impaired
features of delirium in terms of onset, duration, course, alertness, orientation and memory
onset: acute
duration: hours/days/weeks/months
course: fluctuating
alertness: impaired
orientation: impaired
memory: recent impaired
features of depression in terms of onset, duration, course, alertness, orientation and memory
onset: gradual
duration: weeks/months
course: diurnal
alertness: normal
orientation: normal
memory: remote intact, concentration is poor
features of dementia in terms of thinking, perception, emotions and sleep
thinking: slowed, reduced interest
perception: hallucinations (30-40%)
emotions: shallow, labile, irritable
sleep: nocturnal wandering and confusion
features of delirium in terms of thinking, perception, emotions and sleep
thinking: can be paranoid and bizarre
perception: visual and auditory hallucinations common
emotions: irritable, aggressive and fearful
sleep: nocturnal confusion
features of depression in terms of thinking, perception, emotions and sleep
thinking: slow and preoccupied
perception: mood congruent auditory hallucinations
emotions: flat, unresponsive and sad
sleep: early morning wakening
what aspects of background history are important to touch on when assessing cognitive function
presenting problems medical history psychiatric history substance use/misuse family history corroborative history
features of PMH that may be relevant to memory problems
strokes diabetes heart problems parkinson's vascular disease
useful questions to assess daily functioning
any problems in the kitchen can you still use remote control/washing machine etc do you follow the news do you ever get lost or disorientated can you still enjoy golf/bridge etc
which aspects need to be assessed in cognitive screening
memory attention and concentration executive functioning visuospatial functioning language
what are the 4 parts of the 4AT
alertness (normal, mild sleepiness, clearly abnormal)
AMT-4 (age, DOB, place, current year)
attention (months backwards)
acute or fluctuating course
advantages of MMSE
quick
different languages
only requires pen and blank paper
memorisable
disadvantages of MMSE
not adjusted for age
poor examination of executive functioning
poor in severe impairment
poor in high morbidity functioning
may not indicate problems in early stages
significant focus on verbal functioning
what cognitive function tests are available
ACE-III
MoCA
FAB
causes of cognitive impairment
alcohol depression medication thyroid and other endocrine/metabolic disorders brain lesions neuro infections/inflammation
signs of Alzheimer’s disease
memory loss, particularly short term
dysphasia
dyspraxia
agnosia
CT/RI findings in AD
normal
medial temporal lobe atrophy
temporoparietal atrophy
signs of vascular dementia
dysphasia, dyscalculia forntal lobe symptoms and affective symptoms more common than in AD focal neurological signs vascular risk factors step wise decline
CT/MRI findings in vascular dementia
moderate-severe small vessel disease or multiple lacunar infarcts
SPECT findings in vascular dementia
patchy reduction in tracer uptake throughout the brain
what are the 3 syndrome of frontotemproal dementia
behavioural variant
primary progressive aphasia
semantic dementia
signs of behavioural variant FTD
behavioural changes executive dysfunction disinhibition impulsivity loss of social skills apathy obsessions change in diet
signs of primary progressive aphasia
effortful non-fluent speech
speech sound/articulatory errors
lack of grammar
lack of words
signs of semantic dementia
impaired understanding of meaning of words
fluent but empty speech
difficulty retrieving names
imaging results in FTD
CT/MRI frontotemproal atrophy
SPECT frontotemproal reduction in tracer uptake
diagnosis of dementia with Lewy bodies
signs of dementia plus two of; visual hallucinations fluctuating cognition REM sleep behaviour disorder Parkinsonism (not more than 1 year prior to onset of dementia) positive DAT scan
diagnosis of dementia in Parkinson’s disease
signs of dementia
must have Parkinsonism for at least 1 year prior to onset of dementia
positive DAT scan
‘red flags’ in cognitive impairment
fast progression young patient neurological signs FH of rare or young dementia clues in PMH eg HIV
who gets a CT scan
everyone
who gets an MRI scan
young
fast progression
other atypical features
who gets a SPECT scan
signs of FTD
who gets a DAT scan
Parkinsonism
use of cholinesterase inhibitors
slow cognitive decline
drugs for AD
donepezil
rivastigmine
galantamine
drugs for DLB and DPD
rivastigmine donepezil (unlicensed)
side effects of cholinesterase inhibitors
nausea/diarrhoea headache muscle cramps bradycardia worsen COPD/asthma
what are the guideline in place for driving with dementia
DVLA must be notified
DVLA requests report from doctor, who decides if patient can continue driving
behavioural and psychological symptoms of dementia (BPSD)
hallucinations delusions insomnia depression aggression agitation disinhibition anxiety
what is the most common cause of dementia
Alzheimers disease
describe the role of amyloid precursor protein in the pathophysiology of Alzheimer’s
beta-secretase replaces alpha-secretase to breakdown amyloid precursor protein
the resulting amyloid-beta protein is insoluble, and form beta-amyloid plaques around the neurone
the plaques get in the way of neurone and prevent communication between the neurons
describe the role of tau protein in the pathophysiology of Alzheimer’s
tau protein is present in the microtubules within the neurone, preventing them from breaking up
phosphorylation of the tau protein causes them to release from the microtubule and form neurofibrillary tangles
this can lead to apoptosis
signs of atrophy in AD
narrowed gyri
widened sulci
enlarged ventricles
features of sporadic AD
late onset
most common
risk factors for sporadic AD
age
genetic factors
features of familial AD
dominant genetic inheritance
less common
mutations associated with early onset AD
PSEN-1/2
trisomy 21
what are Lewy bodies
alpha-synuclein protein deposits inside neurons
where do Lewy bodies most commonly aggregate
cortex
substancia nigra
symptoms of hyperactive delirium
agitation aggression incoherent speech disorganised thoughts hallucinations delusions disorientation
symptoms of hypoactive delirium
sluggish
drowsy
less reactive
looks withdrawn
risk factors for delirium
recent surgery pain medications dementia constipation UTIs chronic fatigue
how to prevent delirium
identify people at risk help them feel oriented and comfortable glasses, hearing aids healthy eating/fluids stay active good sleep pattern non-opiate pain medication
what are the risks of delirium
higher rates of falls
longer hospital stay
higher mortality rates
