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CPCP > Year 2 - Week 1 - Dementia > Flashcards

Year 2 - Week 1 - Dementia Flashcards

1
Q

What is dementia?

A

Long-term, progressive condition - affecting sufferer’s cognitive skills & ability to perform everyday tasks.

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2
Q

Why do some GPs not diagnose dementia?

A

Not confident in their diagnosis
Reluctance to cause distress to P = lots of stigma attached to dementia

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3
Q

What can slow the progression of Alzheimer’s

A

Cholinesterase inhibitors

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4
Q

Name a test for dementia that GPs can perform

A

General Practitioner Assessment of Cognition (GPCOG)

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5
Q

Who is interviewed as part of the GPCOG test?

A

Patient & relative/friend

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6
Q

What indicates cognitive impairment on GPCOG test?

A

4 or > / 9 in P and
3/6 of less in relative

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6
Q

What is the mini-COG?

A

Ask P to remember 3 words - then draw clockface and add time - then recall the 3 words.

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7
Q

What is the longer & better test of cognitive function called?

A

Mini-Mental State Examination (MMSE) (or the MoCA or ACE-III).

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8
Q

What is the disadvantage of MMSE?

A

Takes much longer to complete - as tests different subsections of cognition

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9
Q

What can you ask a P who you suspect has memory problems?

A

Have friends/family commented
Is her memory causing any problems?
How are things at home - still able to do everything, shopping, finances, social life?
Mood - any depression
Sleeping pattern
Appetite

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10
Q

What blood tests can you do for reversible causes of dementia?

A

Thyroid Function Tests (check for hypothyoidism)
B12 (check for deficiency)
U&Es (check for hyponatremia)
FBC
LFTs (looking for alcohol misuse)
HIV (if high risk)
FBC + B12 + Folate (pernicious anemia)
Bilirubin (if jaundice)
Calcium (if suspected hypercalcaemia)
Plasma glucose (diabetes)

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11
Q

What can dementia be confused/mistaken with?

A

Depression
Delirium

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12
Q

What is delirium?

A

An acute confusional state

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13
Q

How can you differentiate between delirium and dementia?

A

Delirium - comes on rapidly (hours),

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14
Q

What things can cause delirium?

A

Infection
Pain
Hypoxia
Electrolyte imbalance
Drugs
Withdrawal
Liver failure
Brain injury
Urinary retention

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15
Q

How can you test for UTI?

A

Midstream urine microscopy

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16
Q

How can you test for pneumonia?

A

Chest X-Ray

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17
Q

How can you test for PE?

A

D-Dimer
CT Pulmonary Angiogram

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18
Q

How do you test for hyponatremia?

A

Serum U&Es

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19
Q

How do you test for liver failure?

A

LFTs

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20
Q

What are the most common types of dementia?

A

AD or mixed aetiology (AD + vascular)
Lewy-body dementia
Vascular dementia

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21
Q

Which dementia accounts for 5% of cases?

A

Frontotemporal dementia

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22
Q

Name 2 rare causes of dementia

A

HIV
CJD

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23
Q

Why is it important to try and determine which dementia a P has?

A

Each has different natural history & each is treated differently

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24
Q

How does AD present?

A

Initial symptom of memory loss, followed by loss of insight and gradual functioning deterioriates.

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25
Q

What does AD look like on CT?

A

Atrophy & shrinkage of hippocampus + medial temporal structures

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26
Q

How does Vascular dementia present?

A

Often Ps have some CVD
Is stepwise deterioration (not gradual)
Loss of executive function predominates - can recall facts & personality preserved

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27
Q

How does vascular dementia appear on CT?

A

Lacunar infarcts, white matter ischaemia, leukoencephalopathy & cerebral small vessel disease

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28
Q

How does Lewy-Body dementia present?

A

Marked variability in mental state & alertness day by day
May have hallucinations
Have Parkinsons like symptoms - stiffness, slowness of mvement

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29
Q

Does CT show any changes in LBD?

A

No characteristic signs on CT

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30
Q

Which scan can be used in LBD?

A

SPECT scan

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31
Q

How does Frontotemporal dementia present?

A

Behavioural / personality changes are dominant dementia - dramatic changes
Earlier onset

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32
Q

What can CT show in Frontotemporal dementia?

A

Frontal & temporal atrophy

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33
Q

How can you differentiate frontotemporal dementia from AD?

A

SPECT scan

34
Q

What is another name for frontotemporal dementia?

A

Pick’s disease

35
Q

Which dementias can be diagnosed by GP?

A

Cognitive tests + CT - GP can diagnose AD or VD
CANNOT diagnose without CT

36
Q

Which dementia Ps should be referred to the memory clinic?

A

If GP is uncertain
If rarer dementia (LBD or FT is suspected)
Anyone <65
Ps who demonstrate rapid decline

36
Q

What does an advance directive do?

A

Allows P to specify how they want to be treated if their health deteriorates to such an extent that they can no longer make / communicate decisions

37
Q

What are the two power of attorneys in England?

A

POA about health & welfare
POA about property and financial affairs

38
Q

What are the 4 things to weight up under the Mental Capacity Act when determining capacity?

A
  • Can P understand the information to make the decision?
  • Can P retain the information long enough to make the decision?
  • Can P weight up the information to make the decision?
  • Can P communicate their decision?
39
Q

What can carers carry with them in case they are admitted to hospital in an emergency?

A

A Carer’s Emergency Card in their wallet

40
Q

Which 3 cholinesterase inhibitors are used in AD in the UK?

A

Donepezil
Galantamine
Rivastigmine (patch)

41
Q

What are the contraindications for cholinesterase inhibitors?

A

Cause bradycardia - therefore heart, asthma, COPD or peptic ulcers
Ps on Amitriptyline, Risperidone, Ipratroprium bromide

42
Q

Which drugs are anticholinergic?

A

Amitriptyline
Ipratroprium bromide
Risperidone

43
Q

What is capacity?

A

Ability to use and understand information to make a decision and communicate any decision made.

44
Q

When should capacity be assessed?

A

At the time that consent is required (it can fluctuate over time)

45
Q

What happens if you do not have capacity and you have not made an advance directive or formally appointed anyone to make decisions for you?

A

Healthcare professionals have to act in your best interests

46
Q

Is irrationality the same as lacking capacity?

A

No - provided a P has capacity to make the decision, it doesnt matter whether it is a rational decision or not

47
Q

How are best interest decisions made?

A
  • Can you wait for P to regain capacity?
  • Involve P as much as possible
  • Identify issues the P would take into account themselves (e.g. religious / moral beliefs)
48
Q

Who can be appointed if there is noone suitable to make medical treatment decisions?

A

Independent Mental Capacity Advocate

49
Q

Where do disputes regarding best interests go?

A

Court of Protection

50
Q

Which situations must always be referred to the Court of Protection?

A
  • Sterilisation (for contraceptive purposes)
  • Donation or organs/tissue
  • Withdrawal of nutrition and hydration from P in PVS or min conscious
51
Q

What factors can affect a P’s capacity?

A

Shock
Panic
Extreme tiredness
Medications
Alcohol

52
Q

What age are Ps presumed to have sufficient capacity?

A

16+

53
Q

What happens if P is under 16?

A

Capacity is assessed to determine whether they have enough intelligence, competence & understanding to fully appreciate their treatment = Gillick competence

54
Q

Who has parental responsibility?

A

Child’s mother
Child’s father (if married to mother or on the birth certificate)
Person with residence order for the child
Local authority designated to care for the child
Local authority or person with emergency protection order for the child

55
Q

When can a parent’s refusal of treatment be overruled?

A

If court deems it in the best interests of the child

56
Q

When can treatment proceed without consent?

A

When it is vital and where awaiting parental consent / court ruling would place the child at risk.

57
Q

When can refusal of treatment by a child P be overruled by Court of Protection?

A

When it may lead to their death or severe permanent injury

58
Q

Which is the most common dementia?

A

Alzheimer’s

59
Q

What are the RF for Alzheimer’s?

A

Age
Caucasian ethnicity
Family history

60
Q

What aspects of cognition to Alzheimer’s Ps have?

A

Memory issues = normally first symtom
Orientation problems
Visuospatial (judging distances and navigation)
Speech
Problem solving & decision making

61
Q

What are the risk factors for vascular dementia?

A

CVD - inc obesity, hyperlipidaemia, diabetes, HT, smoking, coronary artery disease, AF, stroke or TIA.

62
Q

What are Lewy bodies?

A

Abnormal protein deposits in the neurons.

63
Q

What features of dementia suggest LBD?

A

Visual hallucinations
Spontaneous fluctuations in cognition
Parkinsonism (tremor, slow movement, rigidity)

64
Q

What is a decline in cognitive function greater than expected for a healthy person of that age, but that does not meet the definition of dementia, known as?

A

Mild cognitive impairment (MCI)

65
Q

How does MCI differ from dementia in terms of progression?

A

Dementia is a progressive disease - MCI is not necessarily progressive.

66
Q

What % of Ps progress from MCI to dementia?

A

10% each year

67
Q

Is MCI treatable?

A

If it is caused by a treatable underlying condition - may be possible to reduce or reverse the symptoms of MCI

68
Q

How does MCI differ from dementia in terms of symptoms?

A

Share many symptoms - however MCI is typically less severe and may affect fewer cognitive domains

69
Q

How does MCI differ from dementia in terms of daily living?

A

MCI - can typically still manage day-to-day tasks independently (may need help with complex or unfamiliar tasks)

Dementia - Ps have trouble with everyday tasks

70
Q

Name three types of delirium.

A

Hyperactive
Hypoactive
Mixed state (hypo & hyper periods)

71
Q

What are the risk factors for delirium?

A

Recent surgery
Narcotic medications
Underlying disease inc dementia, constipation, pneumonia, UTI
Chronic fatugue

72
Q

How can you prevent delirium?

A

Orientation
Comfortable Ps
Reduce extra noise and stimulation
Glasses, hearing aids on
Good daily routine - food, water, toilet
Keep mobile
Maintain healthy sleep
Try to avoid opiate meds

73
Q

Which medications increase the chances of delirium?

A

Opiods
Hypnotivs
Those which increase anticholinergic burden

74
Q

How is delirium linked to falls?

A

Ps with delirium are x6 likely to fall

75
Q

What is the name of specialist dementia nurses?

A

Admiral nurses

76
Q

Which is the NMDA antagonist licensed for used in AD?

A

Memantine

77
Q

What is the triangle of care?

A

Involving the carer in the patient’s treatment as much as possible

78
Q

What is a general term for a patient making healthcare decisions and planning for the future?

A

Advanced Care Planning

79
Q

What is the name of the legal tool where P appoints one or more people to make decisions for them, if they no longer have capacity?

A

Lasting Power of Attorney

80
Q

What is the legal document where a P can record decisions about future healthcare when they lack capacity?

A

Advanced Decision

81
Q

What is the document where a P sets out preferences and priorities about their health care for the future - but is NOT legally binding?

A

Advanced Statement

82
Q

Which document contains guidance for healthcare staff on previous clinical discussions and decisions, should a P lack capacity or be unable to communictae?

A

Treatment Escalation Plans

CPCP (6 decks)

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