OPS2: Dementia Flashcards
what simple tasks can elderly people struggle with
· Mobility →Stairs, Getting to the shops
· Dexterity → making a cup of tea , Brushing teeth
· Communication → sight and hearing → isolation
what age does WHO define as old
65 years old
what do older people value
Company and relationships
Time
A desire to contribute to society
Someone listening
what is dementia
Dementia is a syndrome – usually of a chronic or progressive nature
Deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing
Dementia is an acquired progressive loss of cognitive functions, intellectual and social abilities
what does dementia affect
○ Memory ○ Thinking ○ Orientation ○ Comprehension ○ Calculation ○ Learning capacity ○ Language ○ Judgement
what is dementia characterised by
○ Amnesia (especially for recent events)
§ Memory loss
§ More recent events tend to be more common
○ Inability to concentrate,
○ Disorientation in time, place or person
§ Ie not recognising someone they should
○ Intellectual impairment
what is alzheimer’s
· Most common (60%) type of dementia
· Reduction size of the Cortex, severe in hippocampus
○ Cortex is linked to your personality or motor function, the ability to process sensory information, language processing
○ If there is damage of the hippocampus (first area of the brain to be damaged in this condition) it will cause short term memory loss and disorientation
· We believe that Alzheimer’s is caused by abnormal amounts of protein, protein aggregates, then called amyloids which results in plaque
○ Plaquesare deposits of a protein fragment called beta-amyloid that build up in the spaces between nerve cells.
§ These plaques then disrupts the normal brain function of nerves and this results in a loss of brain function
• We don’t know why these proteins start to cause problems but there is a theory about TAU proteins (protein abnormalities) which initiate the disease cascades and the theory is that these proteins pair up together to cause a tangle with the nerve cell bodies
§ Tanglesare twisted fibers of tau protein build up inside cells.
what are distinctive features of alzheimer’s
○ STML = short term memory loss ○ Aphasia = difficult comprehending or forming language ○ Communication Difficulties ○ Muddled over everyday activities ○ mood swings ○ Withdrawn ○ loss of confidence
what are associated factors with alzheimer’s
○ Age
○ Gender – Women >Men
○ Head Injury
○ Lifestyle:
§ Increased risk = Smoking, hypertension, low folate and high blood cholesterol
§ Reducing risk = physical, mental and social activities
○ Genetic– Abnormalities on chromosome 1, 14 or 21
what is vascular dementia
Vascular dementia is caused by reduced blood flow to the brain, which damages and eventually kills the brain cells.
what can vascular dementia develop as a result of
This candevelop as a result of:
· narrowing and blockage ofthe small blood vessels deep inside the brain(known as small vessel disease)
○ Ie lots of small blood vessels in the brain become either narrowed or blocked
· a single largestroke
○ (where the blood supply to part of the brain is suddenly cut off)
· lots of mini-strokes that cause tiny, but widespread, damage to the brain
○ Ie be quite small but cause widespread damage
· In many cases, these problems are linked to underlying health conditions– such ashigh blood pressureanddiabetes– as well as lifestyle factors, such as smoking and being overweight.
what are distinctive features of vascular dementia
○ Memory problem of sudden onset
○ visuospatial difficulties
§ Difficulty getting up stairs with depth and distance perceptions
○ Anxiety
○ Delusions
○ Seizures
○ Can be stroke symptoms
what is dementia with lewy bodies
· Deposits of anabnormal protein called Lewy bodies inside brain cells
○ These abnormal proteins are deposited on the brain cells and areas that are responsible for memory and muscle movements
· These deposits, which are also found in people withParkinson’s disease, build up in areas of the brain responsible for things such as memory and muscle movement
○ Link between Parkinson’s disease and dementia with Lewy Bodies
what are distinctive features of dementia with lewy bodies
○ STML
○ Cognitive ability fluctuates
§ Ie days which are really good then days which are much more severe
○ visuospatial difficulties
○ attentional difficulties
○ overlapping motor disorders
○ speech and swallowing problems
○ sleep disorders
○ Delusions
what is frontotemporal dementia
- Lot less common but still important to know about it
- Frontal lobes at the front of the brain and temporal lobes just a little further on around the brain
- The frontal lobes of the brain, found behind the forehead, deal with behaviour, problem-solving, planning and the control of emotions
· Younger age of onset
· Ubiqitin associated clumps of protein
•TDP-43
what are distinctive features of frontotemporal dementia
○ STML not always present
○ uncontrollable repetition of words
○ Mutism
○ repetition of words of other people
○ personality change
○ decline in personal and social conduct
§ Act out of character
what are rarer forms of dementia
· HIV – related genitive impairment
· Parkinson’s disease
· Corticobasal degeneration
· Multiple Sclerosis
· Niemann-Pick disease
· Creutzfeldt-Jakob disease
what are dementia risk factors
• Age
○ Older age
- Gender
- Genetic background
- Medical history
• Lifestyle
○ Diet high in carbohydrates, high calories, low proteins
what needs to be considered when planning for the future for patients with dementia
- living arrangements
- legal eg power of attorney
- banking, driving
what needs to be considered about the patient benefit for patients with dementia
- functional benefit
> independence?
> perform daily tasks> - quality of life
- delay progression
- opportunity to complete life goals or desires
what needs to be considered about the cost of patients with dementia
- delay placement in care home
- fewer medications
- caregiver has more time in work place
- less home health aid
what are early stage symptoms of dementia usually misattributed to
Early stage symptoms are often misattributed to stress, bereavement or normal ageing.
what do the early stage symptoms include
○ Loss of short-term memory
○ Confusion, poor judgement, unwilling to make decisions
○ Anxiety, agitation or distress over perceived changes
○ Inability to manage everyday tasks.
○ Communication problems – a decline in ability or interest in talking, reading and writing
what are middle stage symptoms
· More support required, including reminders to eat, wash, dress and use the lavatory;
· Increasingly forgetful and may fail to recognise people;
· Distress, aggression, anger, mood changes – frustration;
· Risk of wandering and getting lost, leaving taps running, gas unlit, cooking unattended or forgetting to light the gas;
· May behave inappropriately e.g. Going out in nightclothes;
· May experience hallucinations, throw-back memories.
what are late stage symptoms
· Inability to recognise familiar objects, surroundings or people – but there may be some flashes of recognition.
○ Increasing physical frailty, may start to shuffle or walk unsteadily, eventually becoming bed/wheelchair confined.
· Difficulty eating and sometimes swallowing, weight loss.
○ Incontinence and gradual loss of speech
○ Can be changes to their diet
§ These patients are often encouraged to have soft, high calorie diets just to gain some sort of nutrition
· Symptoms are progressive and irreversible
what is a MMSE
Mini mental state exam = MMSE
how is dementia diagnosed
· Dementia screen to eliminate treatable causes - FBC, U&E’s, kidney, liver and thyroid function tests
○ Ie the doctor will do blood tests to make sure there is no other condition causing these symptoms
· Glucose, serum B12, Folate and Calcium, C-Reactive Protein and Urinalysis
· If indicated - Syphilis serology, autoantibody screen, serum cholesterol and CT
· Neurological examination and detailed cognitive testing (MMSE)
what are the different methods of cognitive testing
· Mini-mental State Examination ( Folstein)
○ More common test
○ Includes things like repeating name prompts to get someone’s attention or recall their language ability and their ability to follow simple commands and orientation
· Blessed Dementia Scale
○ This scale registers changes in managing daily activities
○ Eg if they are misplacing or forgetting things, loss of bodily functions etc
· The Montreal Cognitive Assessment (MoCA)
○ Assesses the short term memory
· Single Neuropsychological Tests: ○ Clock draw § Drawing tends to be more disrupted the more severe the disease is ○ Delayed word recall ○ Category Fluency
· Combined single tests ○ 7 minute screen ○ IQCODE § Informative questionnaire for the cognitive decline of the elderly ○ AD8 Dementia Screening
what are the pros of mini-mental state examination
> well known
easy to administer
samples range of cognitive functions
test re-test and inter-rater availability
what are the cons of the MMSE
- only 3 words to be remembered on recall - not sensitive to mild impairment
- old ~ new knowledge
- non-standardised time between registration and recall
- not sensitive in testing frontal lobe
what is single test category flucency
• You have 1 minute:
Name as many animals as you can……….
Name as many football teams as you can…
Name as many countries as you can…..
what is delayed word recall
given 10 words and tested to see if they have been remembered
what is the treatment for dementia
• There is no pharmacological, surgical or behavioural cure
○ There can be symptom relief and slowing of the progression
• Counselling may delay residential care by up to 1 year
○ Great for the independence and quality of life for the patient
- Aspirin and reducing cardiac risks (control of BP, weight, exercise etc..) may halt deterioration of vascular type dementias.
- Non Steroidal Anti Inflammatory Drugs (NSAIDs) may slow progression.
- Vitamin E and Ginko Biloba may slow progression.
how is dementia treated with drugs
• Anticholinesterases for mild/moderate Alzheimer’s
○ Donepezil (Aricept®)
○ Galantamine
○ rivastigmine (Exelon®)
• May delay admission to residential care, assist in behavioural difficulty, defer deterioration in cognition
• Specialist instigation and review
○ 1 in 3 on these drugs?
Treatment should continue until the patient, carer, and/or specialist decide it is the right time to stop, if it is not working, or if the person’s MMSE score falls below 10.
what is the drug treatment for vascular dementia
• In a review of six RCTs involving 597 people, Cerebrolysin significantly improved cognitive function compared to standard care alone or placebos.
○ It had a small positive effect on patients’ overall clinical state.
• Some evidence that long-term treatment may give greater benefits, although only two trials looked at long-term effects
Possibility for use in the future
how can care homes be made dementia friendly
• Walls, floor coverings, skirting boards and doors are all different colours
○ provides good visual contrast to aid wayfinding
• Fix labels and images to drawers to help let people find what they need without assistance
○ Encourages the patient to be more independent as they are able to find what they want without needing help
• A bedroom WC should be visible from the bed on sitting and when lying down
○ As a reminder
- Position personal pictures and items with personal relevance
- Radiators should be low temperature heating
• Furniture traditional and domestic
○ Nothing fancy or too modern
○ Different colours
○ Everything well laid out
○ No obstacles or dangers anywhere
what is included in a dementia friendly healthcare environment
- Reception desk visible from the entrance door
- Ceilings, floors and floor coverings should be acoustically absorbent to support audible communication
- Colour and tone of walls should be distinctive from the flooring
- Colour and tone of furniture should be distinctive from the flooring
- Avoid non-essential signs
- Any signage should be at eye level with simple clear use of text and colour. Use pictorial elements
- Ensure good levels of natural light to minimise artificial light
- Any staff only or locked rooms should be coloured the same as the walls to avoid attention
