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3 PSYCH > memory probs > Flashcards

memory probs Flashcards

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1
Q

what is anterograde amnesia

A

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

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2
Q

what is retrograde amnesia

A

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

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3
Q

what is dementia

A

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

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4
Q

diagnostic criteria of dementia

A

2 or more of the following;
forgetfulness, memory loss, confusion, poor reasoning and logic, personality changes, poor judgement, ability to focus, visual perception

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5
Q

features of dementia in terms of onset, duration, course, alertness, orientation and memory

A

onset: insidious
duration: months/years
course: stable, progressive, step-wise
alertness: normal
orientation: normal or impaired to time/place
memory: recent and remote impaired

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6
Q

features of delirium in terms of onset, duration, course, alertness, orientation and memory

A

onset: acute
duration: hours/days/weeks/months
course: fluctuating
alertness: impaired
orientation: impaired
memory: recent impaired

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7
Q

features of depression in terms of onset, duration, course, alertness, orientation and memory

A

onset: gradual
duration: weeks/months
course: diurnal
alertness: normal
orientation: normal
memory: remote intact, concentration is poor

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8
Q

features of dementia in terms of thinking, perception, emotions and sleep

A

thinking: slowed, reduced interest
perception: hallucinations (30-40%)
emotions: shallow, labile, irritable
sleep: nocturnal wandering and confusion

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9
Q

features of delirium in terms of thinking, perception, emotions and sleep

A

thinking: can be paranoid and bizarre
perception: visual and auditory hallucinations common
emotions: irritable, aggressive and fearful
sleep: nocturnal confusion

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10
Q

features of depression in terms of thinking, perception, emotions and sleep

A

thinking: slow and preoccupied
perception: mood congruent auditory hallucinations
emotions: flat, unresponsive and sad
sleep: early morning wakening

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11
Q

what aspects of background history are important to touch on when assessing cognitive function

A 
presenting problems 
medical history 
psychiatric history 
substance use/misuse 
family history 
corroborative history
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12
Q

features of PMH that may be relevant to memory problems

A 
strokes 
diabetes 
heart problems 
parkinson's 
vascular disease
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13
Q

useful questions to assess daily functioning

A 
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
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14
Q

which aspects need to be assessed in cognitive screening

A 
memory
attention and concentration 
executive functioning 
visuospatial functioning 
language
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15
Q

what are the 4 parts of the 4AT

A

alertness (normal, mild sleepiness, clearly abnormal)
AMT-4 (age, DOB, place, current year)
attention (months backwards)
acute or fluctuating course

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16
Q

advantages of MMSE

A

quick
different languages
only requires pen and blank paper
memorisable

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17
Q

disadvantages of MMSE

A

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

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18
Q

what cognitive function tests are available

A

ACE-III
MoCA
FAB

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19
Q

causes of cognitive impairment

A 
alcohol
depression
medication 
thyroid and other endocrine/metabolic disorders 
brain lesions 
neuro infections/inflammation
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20
Q

signs of Alzheimer’s disease

A

memory loss, particularly short term
dysphasia
dyspraxia
agnosia

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21
Q

CT/RI findings in AD

A

normal
medial temporal lobe atrophy
temporoparietal atrophy

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22
Q

signs of vascular dementia

A 
dysphasia, dyscalculia
forntal lobe symptoms and affective symptoms more common than in AD
focal neurological signs 
vascular risk factors 
step wise decline
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23
Q

CT/MRI findings in vascular dementia

A

moderate-severe small vessel disease or multiple lacunar infarcts

24
Q

SPECT findings in vascular dementia

A

patchy reduction in tracer uptake throughout the brain

25
Q

what are the 3 syndrome of frontotemproal dementia

A

behavioural variant
primary progressive aphasia
semantic dementia

26
Q

signs of behavioural variant FTD

A 
behavioural changes 
executive dysfunction
disinhibition
impulsivity 
loss of social skills 
apathy 
obsessions 
change in diet
27
Q

signs of primary progressive aphasia

A

effortful non-fluent speech
speech sound/articulatory errors
lack of grammar
lack of words

28
Q

signs of semantic dementia

A

impaired understanding of meaning of words
fluent but empty speech
difficulty retrieving names

29
Q

imaging results in FTD

A

CT/MRI frontotemproal atrophy

SPECT frontotemproal reduction in tracer uptake

30
Q

diagnosis of dementia with Lewy bodies

A 
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
31
Q

diagnosis of dementia in Parkinson’s disease

A

signs of dementia
must have Parkinsonism for at least 1 year prior to onset of dementia
positive DAT scan

32
Q

‘red flags’ in cognitive impairment

A 
fast progression 
young patient
neurological signs 
FH of rare or young dementia 
clues in PMH eg HIV
33
Q

who gets a CT scan

A

everyone

34
Q

who gets an MRI scan

A

young
fast progression
other atypical features

35
Q

who gets a SPECT scan

A

signs of FTD

36
Q

who gets a DAT scan

A

Parkinsonism

37
Q

use of cholinesterase inhibitors

A

slow cognitive decline

38
Q

drugs for AD

A

donepezil
rivastigmine
galantamine

39
Q

drugs for DLB and DPD

A 
rivastigmine
donepezil (unlicensed)
40
Q

side effects of cholinesterase inhibitors

A 
nausea/diarrhoea 
headache 
muscle cramps 
bradycardia 
worsen COPD/asthma
41
Q

what are the guideline in place for driving with dementia

A

DVLA must be notified

DVLA requests report from doctor, who decides if patient can continue driving

42
Q

behavioural and psychological symptoms of dementia (BPSD)

A 
hallucinations
delusions
insomnia 
depression 
aggression 
agitation 
disinhibition 
anxiety
43
Q

what is the most common cause of dementia

A

Alzheimers disease

44
Q

describe the role of amyloid precursor protein in the pathophysiology of Alzheimer’s

A

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

45
Q

describe the role of tau protein in the pathophysiology of Alzheimer’s

A

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

46
Q

signs of atrophy in AD

A

narrowed gyri
widened sulci
enlarged ventricles

47
Q

features of sporadic AD

A

late onset

most common

48
Q

risk factors for sporadic AD

A

age

genetic factors

49
Q

features of familial AD

A

dominant genetic inheritance

less common

50
Q

mutations associated with early onset AD

A

PSEN-1/2

trisomy 21

51
Q

what are Lewy bodies

A

alpha-synuclein protein deposits inside neurons

52
Q

where do Lewy bodies most commonly aggregate

A

cortex

substancia nigra

53
Q

symptoms of hyperactive delirium

A 
agitation
aggression 
incoherent speech
disorganised thoughts 
hallucinations 
delusions 
disorientation
54
Q

symptoms of hypoactive delirium

A

sluggish
drowsy
less reactive
looks withdrawn

55
Q

risk factors for delirium

A 
recent surgery 
pain medications 
dementia 
constipation 
UTIs
chronic fatigue
56
Q

how to prevent delirium

A 
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
57
Q

what are the risks of delirium

A

higher rates of falls
longer hospital stay
higher mortality rates

3 PSYCH (4 decks)

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