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BCB > S2W10Demen > Flashcards

S2W10Demen Flashcards

1
Q

Dementia

A

A cognitive disorder and not a mental health disorder.

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2
Q

DSM-V

A

At least one of:
• Aphasia
• Apraxia
• Agnosia

Memory problems:

Early – difficulty learning and STM problems

Severe – forget previously learned material e.g. names

Difficulty with spatial tasks

Poor judgement and insight:

Little awareness of memory loss

Unrealistic expectations of own abilities

May lead to conflict

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3
Q

Aphasia

A

Difficulty producing and understanding speech

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4
Q

Apraxia

A

difficulty carrying out purposeful movements

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5
Q

Agnosia

A

deficit in visual perception and inability to recognise objects

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6
Q

Statistics

A

850k in UK

225k per year (1 every 3 minutes)

1 in 6 people over 80

40k under 65

25k ethnic minorities

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7
Q

Types of dementia

A

Alzheimer’s – 2/3 of people

Vascular – 2nd common

Lewy bodies – 3rd common 15% of dementia sufferers

Frontotemporal dementia (Pick’s disease) – rare and happens in younger people

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8
Q

Alzheimer’s plaques

A

Clumps of protein develop around brain cells

Neuritic plaques – extracellular at axon terminals

Interfere with connections between neurons and impair functioning

Protein is called amyloid – present in healthy brains

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9
Q

Alzheimer’s Neurofibrillary tangles

A

Develop in plaques causes nerve cells to die

Develop within areas of the cerebral cortex, particularly within temporal lobe

Found within nerve cells (intracellular) and consist of protein called tau

Normally, tau transports nutrients to other parts of the cell

Here tau functions abnormally causing microtubules to collapse

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10
Q

Hippocampus alzheimer’s

A

Remember things early on better than things that happened yesterday.

Older memories don’t rely as much on hippocampus, which is damaged early on.

Amygdala one of last to be affected.

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11
Q

Symptoms

A

Memory loss

Language impairment

Disorientation

Loss of understanding of written material/writing

Loss of ability to perform calculation and arithmetic

Difficulty managing finances

Recognition of objects and faces lost

Visual and motor abilities decline, as well as planning

Problems with simple routines e.g. hygiene

Delusion or abnormal belief
May accuse relative of stealing valuables

20% display aggression

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12
Q

Vascular dementia

A

Vascular diseases block blood flow to areas of the brain (stroke) resulting in the death of tissue.

In contrast to gradual Alzheimer’s it comes suddenly and proceeds in step-wise deterioration.

Co-existence of Vascular and Alzheimer’s common over age of 70.

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13
Q

Types of vascular dementia

A

Multi-infarct dementia

Small vessel disease

Cerebral vasculitis

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14
Q

Multi infarct dementia

A

Secondary to 2+ strokes.

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15
Q

Small vessel disease

A

Narrowing of blood vessels

Gradual syndrome where patient slows down mentally and develops physical problems.

Most common.

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16
Q

Cerebral vasculitis

A

Inflammation of blood vessels to brain

Rapidly progressive.

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17
Q

Causes of vascular dementia

A

High blood pressure and coronary artery disease increase risk.

Controlling blood pressure, lowering cholesterol, and stop smoking associated with improved cognitive functioning.

Which functions deteriorate initially depend on which part of the brain is affected

Patients with advanced vascular dementia present similar to Alzheimer’s.

Display highs and drops in cognitive abilities.

Drops after stroke but then some improvement when brain is less swollen.

18
Q

Dementia with Lewy bodies (DLB)

A

Small intracellular bodies develop inside the brain.

Prevent communication between cells.

Found in brainstem and cerebral cortex.

Two groups:

Parkinson’s disease but earlier cognitive problems = DLB.

Parkinson’s for over a year before = Parkinson’s with dementia.

19
Q

Features of dementia with Lewy bodies

A

Difficulty in planning task – which might manifest as apathy

Slowness in thought and responses, and in motor movement

Visual hallucinations of figures or animals (either the patient recognises or faceless)

20
Q

Frontotemporal dementia (FTD)

A

Frontal and temporal lobes begin to shrink.

Usually develops in people under 65.

Rarer than other types.

Most common changes are apathy and disinhibition

21
Q

Apathy

A

lose interest in family and hobbies.

22
Q

Disinhibition

A

might start talking to strangers, picking up other people’s things.

23
Q

FTD other changes to behaviour

A

Over spending

Lack of hygiene

Criminal behaviour

Sexual behaviour

Change of food preferences

Repetitive behaviour

24
Q

Objective measures of dementia

A

Mental Test Score (MTS) and Abbreviated Mental Test Score (AMTS)

Mini Mental State Examination (MMSE)

Addenbrokes Cognitive Examination (ACE) and (ACE-R)

25
Q

Test of awareness of Dementia (untrained people – non cognitive)

A

The patient may:

Ask same questions

Repeats the same story

Forgets routine activities

Get lost in familiar places

Forgets personal hygiene

Becomes dependent when making decisions

26
Q

Mental Test Score (MTS)

A 
Name and age
Time of day
Address
Sate
Place 
Recognition of two people
School attended
Former occupation
Name of wife
Date of World Wars
Monarch/Prime Minister
Months of year backwards
Counting
27
Q

Abbreviated Mental Test Score (AMTS

A 
Age
Time
Address (repeated at end)
Year
Location
Identify two people
Date of birth
First World War 
Name of Monarch
Count 20 to 1
28
Q

Mini Mental State Examination (MMSE)

A

Most commonly used

Not suitable for diagnosis

10 minute duration

Won’t detect subtle memory losses.

People from different cultures/low education may score poorly

Well-educated may score well despite impairment

Not appropriate if patient has learning, communication or sensory disabilities

Measures of orientation, immediate memory, STM and language function

Well validated.

25-30: normal
21-24: mild
10-20: moderate
<10: severe

29
Q

Addenbrooke’s Cognitive Examination (ACE)

A

Some aspects of MMSE but more detailed assessment:

More rigorous memory test

Test of frontal lobe function

Easy to perform in daily clinical practice.

Revised version created to deal with weaknesses.

30
Q

Classical memory errors

A

Confabulations
Intrusional errors
Delusion:

31
Q

Confabulations

A

Filling in gaps in memory

32
Q

Intrusional errors

A

Mixing up two different events

33
Q

Delusion

A

Related to misplacing objects

34
Q

Episodic memory (STM)

A

Personally experienced events.

Up to 30 seconds.

Limited capacity 7 +/- 2

Memory span is reduced for individuals with dementia, especially with delay or interference

Problems with encoding

35
Q

Episodic memory (LTM)

A

LTM:
Longer than 30 seconds

Problems recalling:
o List of words
o Stories
o Faces or pictures

Failure of semantic processing, reducing strength of LTMs

Retrieval might also be impaired

36
Q

Remote memory

A

Tend to remember events from the past more clearly than recent events.

37
Q

Semantic memory

A

Knowledge about the world, rules, facts, categories.

Detereoriation less striking than episodic memory.

Not linked to personal experiences.

Experimental studies show patients are good with category names but confuse objects in a category.

Problem due to degradation of memory (not retrieval).

38
Q

Reminiscence Therapy

A

Provides context in which patients can use LTM to recall past life events.

Since LTM remains more intact reminiscence therapy reduces the experience of failure.

Ebersole (1978) benefits:

Socialisation when applied groups

Self-actualisation

Applied to early dementia with fairly good communication abilities.

39
Q

Dementia and Language

A

Main characteristics:

Impoverish speech

Difficulty in finding the right words or in naming objects

In advanced dementia, speech might be entirely lost

40
Q

Naming Task

A

More difficult in dementia.

Naming low frequency objects the hardest.

Patients have:

Misperception of the object

Semantic errors - produce the word of an object that is semantically related

41
Q

Word Fluency

A

Related to semantic memory.

Task to assess word fluency (name obects):

Starting with the letter “F”,
That are flowers
Found in the supermarket

Patients with dementia do very poorly.

Severity affects performance

42
Q

Spontaneous Oral Speech

A

Patients with early stage dementia have same vocabulary than controls but word fluency is slower.

In conversation:

Produce less sentences

Initiate irrelevant topics of conversation due to poor memory and losing track

Include more requests

Advanced dementia: speech entirely lost.

BCB (19 decks)

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